News Analysis

Friday 19 September 2014

Privatise all hospitals and make primary care free

We need a manager with fresh thinking who will step up and take charge, writes Maurice Gueret

Dr Maurice Gueret

Published 27/10/2013 | 01:55

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MY WIFE, the Nurse with a capital N, tells me I know more about health services than anybody else in the country. She's probably right about that. She's right about everything, is my wife.

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I've worked in most of the hospital specialities, the psychiatric sector and general practice. I've served on health boards and a so-called health authority. For the past 20 years, I have painstakingly detailed all that has gone on in our health services in a door-slab of a book called the Irish Medical Directory. I know the health commentator and journalism fields pretty well, too.

There are plenty of folks who make a tidy living pointing fingers at all that is wrong. That's the easy part. Putting things right is hard.

So where do we start? Not from here is the sane person's answer. The Irish health service is a disaster in the making and the making has taken 80 years of dire planning and woeful political oversight. Its relics, the Sweepstakes-funded rundown hospital at every crossroads and the barely funded GP private contractor service, hangover of the dispensary system, are not worth venerating.

Then there is this parallel universe of the Department of Health and its myriad boards and executives. There are tens of thousands of non-clinical employees, many of whom wouldn't know an orthopaedic patient from an Egyptian mummy. There are a thousand health centres with no family doctors in them. And hundreds of phantom health board doctors who are salaried to replicate the jobs of general practice.

GPs are the great untouchables of the Irish health service. Since the foundation of the State, the Department of Health and its boards have refused to salary, house or resource them to do their jobs properly. They are paid like gardeners. So much for the grass. Extra for the hedges. And do you want the stuff taken away, too? It won't surprise you to hear that some have better tools than others.

There is one fundamental problem underlying the many in our health service. Nobody has ever taken charge. Everybody wants to shuffle the deck. But nobody wants to play cards or take a gamble. The ministers hide behind HSE chiefs. The HSE chiefs hide behind hospital trolleys. The medics, the nurses, the pharmacists and all the others hide behind unions whose interests, are member- and not patient-driven.

You want fresh thinking? Blue Sky stuff, I think the buzz word is. Well, here's my deal. You leave these shores and recruit a Trapattoni for our health services, but one that will live here and watch a few players in action. We don't need a dozen HSE chiefs or four waffling ministers in a discredited department. We need a manager. One who doesn't need a translator and has a track record in delivering health systems that work. The manager needs a 10-year contract, and only has to visit Leinster House at the beginning and end of the term.

We give our new manager two jobs. Job One is privatising the entire hospital sector, setting limits to profitability. You make hospital insurance, subsidised as necessary, mandatory for everyone and their employers.

Job Two is making primary care, the GP services and essential medicines, public and free for all. Don't worry about hospitals, they will be well able to fend for themselves in an insurance world that is designed to penalise cherry-picking. With the massive capital savings, and income to be gained by selling public hospitals, we invest well in primary care. We salary everyone in this sector and get rid of these perpetuating contracts that have to be renegotiated every time a new vaccine or fad comes along.

We recruit more GPs and provide an adequately resourced out-of-hours service. You get 24-hour care when you need it, at home or in a properly resourced medical centre. When you do need a hospital, you get the cleanliness and service that private hospitals build their reputations on.

It won't happen. The lefties won't do private hospitals (unless they are sick themselves) and the righties won't do free community care for all. They'll rearrange the deckchairs and swap the oars around. On the leaky dinghy that never quite sinks.

'What the Doctor Saw' by Dr Maurice Gueret will be published in November.

www.drmauricegueret.com

Sunday Independent

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