A blank cheque won't get HSE out of intensive care
Published 03/09/2015 | 02:30
The chickens are coming home to roost at the Department of Health. As reported in this paper earlier this week, the HSE requires €1.867bn to run the health service in 2016. This completely confirms how we've blown the economic crisis when it comes to reforming and modernising delivery of healthcare. We're back to square one. The slightest prospect of national budgetary flexibility is sufficient for a bloated HSE bureaucracy to revert to their singular clamour "give us more money". Because mandarins in Hawkins House don't know what they want, how to achieve it or where they're going, taxpayers must pour all the fruits of economic recovery into this bottomless pit.
After more than four years, the Taoiseach's singular top line agenda of "jobs", and his superficial, simplistic approach to government, results in a shambolic state of public health administration. Through austerity, we hacked €2.5bn off the health budget and paid dearly to voluntarily early-retire 10,000 personnel. We embarked on an un-costed, poorly researched, half-baked journey toward some notional Dutch system of Universal Health Insurance and populist promises of free primary health care for all. This FG misadventure, fathered by Dr James Reilly and signed off by Mr Kenny, came without a full examination of the consequences for 100,000 health workers' employment status. There was also the knock-on effects for the insurance premium liabilities on families, and the practical consequences for uninsurable services such as long-term residential care, mental health services or ambulance provision.
After Mr Reilly moved on, the UHI concept was disowned by the Department of Finance and prospective timetables abandoned; what exactly are we left with? A leaderless, rudderless and unaccountable health regime that doesn't know its end destination.
Complete confusion is the only way to describe the current state of public health policy.
We don't know which hospitals are the most efficient or how they compare on the cost for identical elective surgical treatments.
The promised independent hospital trusts, along with transparent performance indicators, remain unimplemented proposals. Instead we have an outline of seven hospital groups (a mishmash of voluntary and HSE facilities) whose only connection is their catchment area. This means that national strategies such as maternity and cancer care aren't working, while the resistance from local TDs seems to trump any chance of integration and consolidation.
Hospitals like Portlaoise Midlands and Our Lady of Lourdes, Drogheda have recurring disastrous outcomes through lack of scale.
This results in over-dependence on temporary locum clinicians. This has contributed to a litany of huge HSE High Court cash settlements to victims and Hiqa findings pointing to failures.
So, should we just pay up? The narratives suggest that the only way to deal with hospital waiting lists and the Emergency Department trolley crisis is to simply re-recruit 5,000 staff and restore expenditure to 2008 levels of €15bn. Unfortunately, this doesn't fit into any credible or sustainable public finances framework for 2016.
The Spring Statement, based on optimistic economic growth forecasts, suggested that the entire available amount of cash across all departments is €750m, along with tax relief of €750m.
Public sector pay commitments through the Lansdowne Road agreement of €560m, coupled with EU/troika orders to reduce the current budget deficit below 2pc of GDP, prohibit the HSE demands from being met.
That's before other urgent political necessities such as dealing with Irish Water, reforming the USC and restoring a minimal infrastructure public capital programme are considered. No matter how desirable, the HSE's wishlist for next year might be, it isn't affordable and won't be paid.
The solutions lie in ensuring value for money - a concept that was conveniently forgotten when the Department of Public Expenditure and Reform officials left Hawkins House in despair when they couldn't achieve €666m of budgetary savings in 2014.
The arrival of Leo Varadkar was an attempt to stop the political bleeding on the back of 57pc of voters in May 2014 emerging from exit polls decrying the Government's handling of discretionary medical cards as a reason for rejecting FG and Labour. Beyond self-deprecating candour, his performance on hospital waiting lists amounted to another massaging of statistics by extending target categories from six months waiting times to 15 and 18 months.
With regard to Irish generic drug prices being the highest in Europe, he threatened legislation on pharma companies to replace the IPHA agreement signed in 2012. But his participative Accident & Emergency Forum has delivered damn-all beyond initial photo calls. A review of Fair Deal, taking more than three years to complete, resulted in no extra places, resources or revised contributions - despite a funding crisis and urgent need for 3,000 additional places.
Acute staff shortages amongst radiographers and radiologists mean MRIs and CT scans are delayed, while costly equipment lies idle. Meanwhile, it's 'administration as usual' within the HSE's upper echelons as there has been a 30pc increase in numbers of top bureaucrats since 2012. 240,000 of the nation's best-off kids and 36,000 wealthy pensioners get free GP care, while most vulnerable elderly are reduced to a one-hour home help per week - as populism takes precedence over fairness and need. We've the lowest survival rates for breast, cervical, ovarian and rectum cancers in Europe, according to the National Cancer Registry. Acute mental health staff shortages of 22pc below recommended levels persist.
By all means, invest in a decent, modern health service, incrementally plan for 2pc of GDP resource allocation to meet our ageing demographic of one million pensioners; and increase hospital capacity to reduce 67,000 queuing for hospital admissions. But whatever happened to the €120m salary savings under the Haddington Road agreement through revised rosters? Where are the step-down facilities that cost one third that of an acute bed? Managers are not held to account. Politics and a dysfunctional Department are failing public patients. Simply writing a blank cheque, while retaining gross mismanagement, failing to address vested interests and abysmal absence of health care planning is unacceptable. Every Cabinet has successes and blemishes; this administration's most lamentable flaw is undoubtedly health reform.