Incompetent HSE rewards failure
Underpaid clinicians are routinely undermined by bungling bureaucrats with their 'jobs for life', writes Dr Ruairi Hanley
IN 2014, the Department of Health will have a budget of at least €13.3bn. With this massive expenditure Ireland should be delivering a world-class medical service for its citizens. In my opinion, the fact that we fail miserably to do so has a very simple explanation.
The HSE is in charge.
For almost a decade, the fate of the most vulnerable people in our society has rested in the hands of an organisation that is grossly overstaffed and institutionally incompetent.
At the end of 2012, there were approximately 15,700 administrators and managers in the HSE. Thanks to longstanding labour agreements, all of these people enjoy 'jobs for life', regardless of ability or performance. A culture of failure has thus been created, protected and ultimately rewarded with a Rolls Royce public sector pension.
At times, it can be hard to comprehend just how badly run our health system is. Simple concepts such as cleaning hospitals and feeding patients are seemingly regarded as major challenges by the HSE. We therefore now take it for granted that damning hygiene reports will emerge annually, featuring filthy corridors and blood-stained curtains.
Similarly, despite the HSE apparently providing food at an average cost per meal equivalent to that of a Michelin-starred restaurant, many in-patients are served up disgusting dishes that do little to improve their recovery.
Matters are little better for doctors in our hospitals. Many colleagues have described an atmosphere of constant aggravation as HSE pen pushers routinely squander resources and undermine clinicians.
In the world of the health service bureaucrat, "meetings" are seen as the ultimate demonstration of productive activity. Thus skilled senior consultants, eager to treat patients on growing waiting lists, find themselves trapped in a nightmare world of epic circular debates featuring phrases such as "stakeholders", "service users" and "synergies". Naturally, whenever anything goes wrong, the only person ever held to account is the medical professional.
Meanwhile, junior doctors continue to work dangerously long hours while claiming the lowest level of sick pay in the entire public sector. They are now emigrating en masse. The loss to the nation will be felt for decades to come.
Regrettably, the one thing that might have kept these talented young people in Ireland was the generous salary on offer for newly appointed consultants. Now that this has been slashed to appease the baying, begrudging mob who believe no brain surgeon should earn much more than twice the average industrial wage, there is simply no incentive for any doctor to remain on and endure 30 years of guff from bungling HSE desk jockeys.
The destination of choice for many of my old classmates is now Australia where senior clinicians can easily earn $250,000 a year, approximately €173,000. They also get extra for private work and various nice things like housing and cars for those working in remote areas. There are a lot of extras, and some will make more than the $250,000. The starting salary for an Irish consultant is now €116,000, following recent cutbacks.
My friends "down under" have discovered a new life of well-equipped, competently administered hospitals in a nation where their profession is respected and not routinely blackguarded by politicians. Most of them will probably never return.
Back here, primary care is also slowly degenerating into chaos. Ironically, in spite of chronic under-funding, this was one area of the health system that functioned reasonably well. Most sick patients can see a GP within 48 hours. In the UK, routine appointments are often only available a week in advance. The reason for this modest success is again very simple – the GP is not yet controlled by the HSE.
Needless to say, the Government is hell-bent on changing this via the 'Primary Care Strategy', which envisages doctors spending hours every week attending 'team meetings' with bureaucrats, where patients are talked about rather than treated.
As part of this idiocy, new and unwanted 'primary care centres' are being constructed across Ireland at a cost of millions of euro. These will do little more than provide a boost for the construction industry and a photo opportunity for local politicians.
The sheer overall imbecility of government policy on Primary Care was recently demonstrated by the decision to grant medical cards to under-fives from wealthy families, while simultaneously denying them to seriously ill people with cancer and motor neurone disease. There can be no rational, medical basis for such an appalling misuse of limited resources.
What I would do if I were Minister for Health?
I would sack 3,000 administrators and cut the pay of the remaining senior management by 20 per cent. All future pay would be linked to positive patient outcomes. Incompetence would no longer be tolerated and P45s would be liberally used to ensure high standards.
I would then use the savings to provide medical cards for most of the population and subsidised GP care for the rest.
Finally, I would end our chronic trolley crisis overnight by opening 1,000 new hospital beds. And then I would be fired within a week.
Dr Ruairi Hanley is a GP and medical columnist. He is writing in a private capacity.