Varadkar’s ‘priorities’ are bland, unambitious and confused
A column from the Irish Independent on 27 January 2015.
On the same day that news broke of another investigation into deficiencies in care in a maternity unit in an Irish hospital – including the deaths of two newborn babies – health ministers Leo Varadkar and Kathleen Lynch launched their ‘priority areas’.
There was no fanfare, no report even, just a press release issued from the Department of Health with a table of priorities, an opinion column penned by Varadkar in this paper and a long, wide-ranging radio interview.
The press release had a table of “priority areas, actions and deliverables for 2015-2017” which is an odd time-frame in itself, as the Government has no more than 14 months to run. Surely it would have made sense to have had the election or the end of a second term as the end date?
Also, while pitched as five steps or themes, there are in fact seven ‘priority areas’ with 85 specific actions or deliverables. That is as many health and social care priorities as existed in the 2011 Programme for Government, the vast majority of which remain largely ignored, or shelved, or both.
These new priority areas are hard to argue against – “drive the Healthy Ireland agenda . . . deliver improved patient outcomes . . . reform operational systems to drive high performance . . . implement agreed steps towards Universal Healthcare . . .” In fact, each are welcome and important areas for progress in the health system.
But the lack of ambition is profound. Take one area that has plagued governments for decades – that of long waits for patients for hospital care. It commits to reducing the numbers of patients on trolleys for over nine hours and the numbers of delayed discharges by one-third, with no date specified. That can’t be much consolation to the 326 people who were on trolleys in Emergency Departments yesterday, or the 763 people stuck on hospital wards a week ago, due to the absence of facilities in the community, or rehab or nursing home places for them.
Given the political priority associated with both Emergency Department over-crowding and delayed discharges, these are lackadaisical by any standards.
There is slightly more detail on ‘deliverables’ to reduce waiting times for outpatient, day-case and inpatient treatment with a focus on getting rid of the longest waiters by mid-year. But critically, the target is that no one will wait longer than 18 months for an outpatient appointment, then another 18 months for their treatment by June/July 2015.
The 2001 health strategy, Quality and Fairness, set specific targets in this area – “that by the end of 2004, no public patient will have to wait for more than three months to commence treatment, following referral from an out-patient department”.
This was set as it was good practice then and now to wait no longer than three months for treatment. Critically, this 2001 target did not include the outpatient wait time, which is usually the longest portion of Irish wait times.
However, not only was this 14-year-old promise never achieved but targets have been stretching ever since. Varadkar’s predecessor, Dr James Reilly, set a one-year target for outpatients and an eight-month target for inpatient and day-case treatment.
These were nearly attained for a very short period towards the end of 2012, after money and significant political attention was thrown at them. But they have been going up again for the last two years as demand for care far outstrips supply. And they have been made a lot worse in the last month as many hospitals have cancelled all non-urgent elective care.
This new target means that by mid-year, if achieved, it will be acceptable to wait up to 18 months for the initial outpatient appointment and then another 18 months for treatment – a large multiple of the original targets and an enormous retrenchment on previous promises made by this very government.
The minister knows these are unacceptable wait times, so why set them unless he feels only these are achievable. Varadkar rightly points out that this Government’s work will not be done until it makes “visible improvements to our public health services”.
Many of the actions outlined, if delivered, could and should do that. However, some of the promises are so old it is hard to take any renewed promise on face value. The Health Information Bill was promised in 2001 and it has still not been published or enacted.
Given this Government has only been in power for less than four years, if we focus on its long-awaited, undelivered commitments, they too are hard to believe.
Free GP care was meant to start in 2012, and then for sure in 2014, it is still awaited with baited breath by our youngest and oldest citizens.
A much-needed and long overdue maternity services strategy was promised by the end of last year – at the very latest – and there is still no sign of it.
The priority list also includes completing the initial exercise of costing universal health insurance; extraordinarily this was only commissioned last year.
Varadkar promises to revert to government with a roadmap for next steps, although it is totally unclear as to whether this is about universal health care which is the title of the action area in the table or “securing government agreement on a revised roadmap to universal health insurance” as he wrote in this paper.
The priorities table also commits to increasing the number of people with health insurance.
Given that the Government’s original proposal of universal health insurance is considered long dead in the water, these are curious, confused commitments.
It’s extremely hard to see how they are coherent with the health minister’s commitment to “building a system of universal health care, to improve access for everyone to all of our health service”.
Buried half-way through this bland list of 85 priorities, is a promise to “develop a mechanism to ensure the implementation of HIQA recommendations made to the HSE”.
Perhaps this is one of the master keys to unlocking real changes taking place in the health system. If the litany of recommendations in the reports into the deaths of Tania McCabe and Savita Halappanavar, into poor hospital care in Ennis, Galway, Limerick, Mallow and Tallaght were adhered to, then there could be a chance that people might experience a much improved health service.
It may also mean that the health ministers might not have to wake up to more controversies over poor care in our public hospitals on the very day they launch their priority list of actions for the next three years.