Parties need to reach consensus on fixing our health service
Analysis from Irish Independent on 7 November 2015
They say insanity is doing the same thing over and over again and expecting different results. Einstein’s cliché applies perfectly to political and management responses to the myriad of crises in our health system.
There is a reason that for two decades tens of thousands of people have had to wait too long on trolleys in our emergency departments. Despite two national task forces and hundreds of millions of euro in public money, no government has solved this perennial issue, which forces citizens into inhumane circumstances.
Similarly, there are reasons that Ireland has spectacularly failed to bring down waiting times for public patients for planned hospital treatment. Highlighted as far back as the 1990s, despite politicians promising to tackle this and lots more public money being spent, consecutive governments have failed to bring waiting times anywhere in line with other high-income countries.
In 2015, Ireland remains the only European country without universal access to primary care. That means that a majority of the population still have to pay on average €52 per GP visit and are often denied access to a range of other essential primary care services, such as public health nurses and therapists. Medical card holders can attend GPs without charge. But they often have to wait months or years to access these other primary-care services.
The most odious of all the fiascos in the Irish health system is that public patients experience delayed diagnosis and treatment for essential healthcare due to our two-tier hospital system.
This manifests itself in long waits for critical tests, which in turn delays access to acute hospital treatment; this can cause long-term disability and early death. No government has even tried to tackle this.
Yet our politicians are surprised that despite their various efforts, these dogged problems persist. They fail to realise that many of these problems continue due to the very decisions they make. Decisions which tinker around the edges rather than bringing about real change in what is a dysfunctional, unfit-for-purpose system. Decisions which prioritise political self-interest over the public interest.
Eamon Gilmore’s new memoir provides some insight into health decisions. Gilmore specifies the €113m in savings that was identified in Budget 2014 – “a review of all medical cards to remove ineligible and redundant cards”. He went on to describe how “the clumsy and inept implementation of this decision would plague the Government through the first half of 2014, would contribute to Labour’s heavy election losses in May and ultimately to my own resignation as Labour Leader”.
Gilmore acknowledges that this measure ended his political career. What he fails to recognise, even though he was in the room when the decision was made, was that it was this inept political decision, not its implementation, that led to his downfall.
The €113m specified was based on an old report which had identified that such money could be saved. Health officials made it clear in heated budget negotiations that they had already made such savings, that further such savings simply did not exist. At the press briefing following that budget, in an unprecedented move, HSE boss Tony O’Brien stated this publicly.
Premising a budget on savings in areas that cannot be achieved means there will be overspend in the health budget year after year. Keeping on doing the same thing over and over again will never get different results.
A fresh approach to critical health decisions is needed.
It is patently clear what needs to be done to address the trolley crisis, to bring down waiting times for hospital treatment in line with international norms, to provide universal access to essential health and social care without the barrier of cost. The problem is delivering these long-term, often costly and hard-to realise solutions is usually mitigated against by our politicians and our political system.
The short-term nature of the political cycle and the clientelism required for re-election in our PR-STV voting system are unlikely to change any time soon.
The only way to start doing things differently, to provide sustained improvement in the health system, is to have cross-party consensus on health.
This would require a vision and agreement between all political parties on the right course of action for health – a commitment to sustained investment in staff and resources, to better access to high-quality public-health services across the continuum of care, to more prevention, primary and social care services, to empowering staff to provide the best care, in a system where there is clear accountability.
Such a pact would stop short-term political decisions, which undermine progress, and enable the sole focus to be on improving the public’s access, experience and outcomes from the health system. It would provide a buffer, so that in heated moments, the same mistakes are not repeated.
Ultimately, the public health system is there for the public good. However, this will never be achieved as long as tinkering around the edges continues and political self-interest gets in the way.
Cross-party consensus on health is the key to politicians, health service managers and staff making courageous choices which result in a very different, much-improved health system.
Perhaps 2016 is the right time for such a momentous move.