Tuesday 29 April 2008

The Health Nightmare

Every time you turn on the TV or open a paper you are greeted with another HSE Nightmare: cancer misdiagnosis, wrong kidney transplanted, needless deaths from stroke, died on waiting list. It's no surprise then that when you look into the HSE archives, that too is like getting trapped in some sort of horrible recurring nightmare. Take the issue of waiting lists from 1998 onwards, through the period when first Cowen, then Martin, then Harney, held the top job in Health. It is like a broken record of broken promises. "Cowen promises more funding for waiting list initiative"(1999) "Minister [Martin] launches new strategy to tackle waiting lists"(2000) "Minister [Martin] announces further £8.9 million allocation of 2001 Waiting List Initiative"(2000)

In fact, Minister Martin promised to end the problem for once and for all. In Feb 2000 he said of waiting lists: "there is no reason to accept them as inevitable. In the current economic climate it is simply not tolerable to people that they should settle for a reduced quality of life as a result of problems of accessibility to fundamental public services".

In the government Health Strategy 2001, signed by both Bertie Ahern and Michael Martin, there is a specific promise on waiting lists. They promise to end the repeating nightmare : "specific targets are set so 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". Wow. We were to wake up from the horrible, sick dreamscape by 2004. Aaaah. But when it came, 2004, Mary Harney was still grappling with waiting lists. In November of that year she was promising more money for the National Treatment Purchase fund in order to tackle waiting lists.

Four years later, in 2008, there were still waiting lists. Harney did make some progress. She said on 5 Feb of this year that "waiting times had come down from years to months". But how many months? The target of three months promised in 2001? Mmmmm. No.

So now, in 2008, 11 years after the first government with Cowen-Harney-Ahern-Martin took office, a stunning 58% of Children and 57% percent of Adults are waiting more than 6 months. That's right, about two thirds of all patients are still waiting for a period twice as long as the target promised seven years ago.

So a despairing population remain locked in the Health Nightmare with no escape. Some people wonder if it's just that the Health Service is chaotic, and suffers from chronic mismanagement? Others wonder if we simply aren't spending enough?

Well the sad news is that it's both of these. The Irish health budget has tripled from 1996 but since it started from a shockingly low base and because the population expanded as well, our per capita investment is still below the Eu average. Clearly in order to make up for decades of underinvestment we needed to overshoot the EU average for a significant and sustained period in order to rebuild the service. That hasn't happened. The recent OECD report tells us that well are still lacking acute beds (by about half) compared to other EU nations.

What about the management and the allocation of resources within the service. Let's begin with the Secretary of the Dept of Health, Michael Scanlon. He recently said about the Irish Health Service that "it is a nightmare trying to find your way through our health system, even when you know your way around it". That's interesting. How about another source : when the commission on public pay tried to assess if the pay scales in HSE management were adequate they were confounded by the impossibility of determining what exactly some of the jobs were supposed to be about. It was unclear what people should be doing or where the chain of accountability lay. No shock there. This shows that nothing has changed since the Brennan Report on the Health Service in 2003 found that:
  • Management and control of services and resources is too fragmented; there is no one person or agency with managerial accountability for how the overall system performs on a day-to-day basis.
  • Those who make decisions (mainly Consultants and other medical practitioners) which commit resources are not accountable for that expenditure and the outputs to be delivered.
  • Systems of governance, financial control, risk management and performance management need to be developed further.
  • The capacity of existing systems to provide relevant, timely and reliable information for linking resources to outputs/outcomes is severely limited.
In short then, we don't invest enough in our health system. Oh, and anyway, the system is hideously inefficient and badly run.

Sadly, nothing will change under Brian Cowen. Any Taoiseach who was serious about the Health crisis would get more involved and would declare it a specific ambition to fix the system. He would team up with the Minister for Health and have regular meetings to help keep the issue at the top of the agenda. But the man who called the Health service Angola will want no hand, act or part in the nightmare. If he changes Harney at all and there is now almost universal appetite for her exit, he will likely plug in another horrified (and probably incompetent) minister who will want to return from Angola ASAP. Back to musical chairs. And regarding investment, well, the man renowned for his caution is hardly going to allow the purse strings to open further on Health. The nightmare goes on..........

No comments: