Without clear health reform plans, we need sustained improvements on access to quality health and social care

From the Irish Independent on 19 December 2015

This week, there were more health headlines, emanating from a frank interview with HSE chief Tony O’Brien, the deferral of the INMO nurses’ strike action in emergency departments and the publication of the HSE 2016 service plan.Tony O’Brien spoke about how the Government’s plan to abolish the HSE resulted in “the absence of a clear timeline and road map” for the health system that made running it “challenging” and the political failure to produce “a systematic and realistic funding formula”. In other words, this Government under-funded health.
O’Brien is right on both counts. Five years ago, Fine Gael touted the populist pre-election ploy of abolishing the HSE without any explanation as to what would happen the millions of citizens cared for by 100,000 staff in a post-HSE world. The grand plan to eliminate the HSE was maintained until Leo Varadkar became Minister for Health and admitted that abolishing it in the near future was not realistic.
The plan now is that the HSE ‘will cease to exist’ and over time, the newly-formed hospital groups, community health organisation and National Ambulance Service will be the health structures of the future. There is once again little detail on when or how and most critically why. Surely, our political leaders must learn from the shambolic mistakes of the past and not set up new health structures without a coherent plan, good planning and management, as well as strong evidence that this is the right way to go.
This Government’s under-funding of health is blatantly obvious in the supplementary budgets allocated to health since it came to office. Although Government heads, especially Minister Brendan Howlin, claim they did not cut the health budget, they have had to supplement health by a whopping €2.4 billion since 2011. Quite clearly, the money they allocated to health was not enough.
This under-funding is evident again in the 2016 HSE service plan. Although there is a fractional budget increase of €100 million – 0.8pc of the entire €13 billion HSE budget – it is insufficient to meet the needs of our growing, ageing population in the year ahead.
The plan promises to provide the same amount of services next year as it did this year, with some new developments, including investment in maternity, ambulance and cancer services.
There is a strong, welcome focus on patient safety and quality of care, as well as the integrated care programmes for our youngest and oldest citizens and people with chronic diseases. But not enough money is allocated to ensure their development. Similarly with IT, new money is allocated but not nearly enough to allow Ireland to catch up on its largely primeval IT infrastructure.
There is no extra money for new drugs, and there is €100 million less than what is needed for hospital services. The plan acknowledges that the extremely unambitious targets reset by Minister Varadkar, of guaranteeing being seen in less than 15 months for a first outpatient appointment and for hospital treatment, will not be met. It also states it will be a “continuing challenge” to maintain and build on progress made in emergency departments.
The Health Minister insists there will be no cuts to services but given the track record, it is very hard to see how they will, as promised, generate savings from “cost controls, eliminating waste and promoting efficiencies”.
To maintain home help hours at 2015 levels, and to increase nursing home places by just 344 in the year ahead, the service plan acknowledges raiding €20 million from new money held by the Department of Health which will not be spent elsewhere. This means that there will be in excess of two million fewer home help hours in 2016 than there were before the economic crisis – quite simply not enough money to meet the population’s needs. This short-termism will in turn result in more older people presenting in emergency departments and greater demand for nursing home places.
This week’s strike by nurses in emergency departments was deferred but it could raise its head again in the new year depending on their next ballot. It has yet to be seen if the proposals agreed to defer action are sufficient to put off the strike, which time-wise for the Government is a nightmare in the weeks before the election. There is also a risk that the same proposals could scupper the broader system-wide responses required to inch much-needed progress in emergency departments.
Increasing the starting pay of newly-recruited graduate nurses is being dealt with by a Workplace Relations Commission process outside of the nurses’ strike. This measure, if agreed and with its deadline of next Tuesday, would assist the whole health system, resulting in a better chance to recruit and retain some of our youngest and brightest health professionals.
This week, Enda Kenny said his greatest regret during his time as Taoiseach was hearing people’s stories of their poor experiences of the health services. Rather than magicking up more grand plans without substance, the next Taoiseach and government could do worse than follow the HSE service plan’s intent of consistently improving access to quality health and social care services. And allocating enough money to make it happen.