Saturday 25 October 2014

Forget the grandiose aspirations of UHI, Leo needs to get back to the health basics

Published 14/08/2014 | 02:30

Minister for Health Leo Varadkar's mandate is to 'ensure government parties stop haemorrhaging votes on healh'. Patrick Bolger/Getty Images
Minister for Health Leo Varadkar's mandate is to 'ensure government parties stop haemorrhaging votes on healh'. Patrick Bolger/Getty Images

Remember what should have taken place on April Fools' Day? On April 2, the Taoiseach, Tanaiste, and Dr Reilly unveiled their flagship health reform of Universal Health Insurance.

Our great leaders prefer podium politics to real interview engagement. It transpired to be a total sham. Despite three years trying, they still couldn't answer basic questions: How much will it cost? How will it be funded? Who will pay for it? They attempted the false fiction of a utopian panacea.

Dr Leo rightly binned it within weeks in the new job. His mandate is, bluntly, to ensure government parties stop haemorrhaging votes on health. They've no vision or plan B.

Leo is currently up the Camino - contemplative reflection is an essential prerequisite to restoring sanity to Hawkins House.

He inherited the worst possible ministerial legacy: professional manpower crises; exponentially increasing hospital waiting lists; broken promises; the most expensive drugs in Europe; runaway budgets; endemic absenteeism and shattered morale. Varadkar's in-tray overflows: unfilled consultancy posts; medical card fiascos; the commitment to abolish the HSE by year end. Reilly's tenure had become so chaotic that a cabinet sub-committee was required to oversee his department. Yet Kenny and Gilmore blithely ignored these realities until the electorate roared.

The flip-side of Universal Healthcare, UHI or free GP care to age-specific cohorts, is taxpayers being asked to pay for health costs of the most wealthy in society. Two-tier health means scarce resources can't be targeted for those in greatest need. Universality as a principle, whether it's child benefit or free third-level college fees, represents net transfers of wealth from the working poor to the well-off.

Instead of grandiose aspirations, our new health minister needs to get back to basics. The first critical issue is patient safety. He should adopt a simple Patients' Charter, setting out minimal service standards, fundamentally ensuring adequate numbers of doctors and nurses to run primary care, outpatient clinics and hospital theatres/wards. Although we train more medical students per head of population than anywhere else in the world, our graduates flee to work in the UK, Canada or Australia.

This exodus is caused by 'yellow pack' career-entry terms. Similarly, rural shortages of 2,600 GPs will increase as ageing doctors aren't replaced. The hiring of 50 locum consultants at €300k is crazy, counter-productive economics.

Meanwhile, we're ripped off with excessive drug costs. It's inexplicable that the same packet of Olanzapine (Zyprexa) costs £5 in Belfast, but a whopping €85.40 in Dublin in identical outlets. Private patients and the HSE are paying many multiples of European average drug prices through exorbitant reimbursement schemes to pharmacies for generic medicines and excessive margins. Proper competitive tendering and new negotiation of pharma prices must be an urgent priority for Leo.

Instead of abolishing the HSE, Varadkar needs to reform its culture. Layers of bureaucrats still persist ever since the botched merger of 11 health boards a decade ago. Bertie vetoed logical administrative redundancies. Integrating hospital groups, based on sensible geographical catchment areas, is stymied by parish pump politicians and localised vested interests. Investment is required to train clinicians in new management roles to act as cost gatekeepers. Health service absenteeism is unacceptable, and is the highest throughout the public sector. No-shows on Mondays and Fridays remain unexplained. Uncertified sick leave burdens fall on diligent workers. The failure to implement electronic clinical records results in costly duplication when patients appear in different hospitals, due to multiple diagnostic tests.

The HSE has enormous untapped potential to drive efficiency reforms by using its singular economies of scale. The UK's NHS attained objectives through using its monopoly position.

Meanwhile, the Haddington Road reforms and the breaking down of professional demarcations cannot be ditched.

Pitiful, pinball politics has been evident in relation to medical cards after the recent poll reversals.

Shallow cynicism underlined this Government's approach to free healthcare. In the 2014 Budget, its "probity" review of medical cards was to save €113m. The average annual cost is €1,200 per card, which meant axing 100,000 cards. The Government feigned amnesia as 40,000 discretionary card holders were deemed ineligible, exceeding income limits. Then it promised an expert panel to procure cards for the disabled and long-term ill. Hundreds of thousands suffering from asthma, Alzheimer's, Down syndrome, diabetes and countless other conditions had false hopes raised that they'll be eligible.

Expect angry disappointment as another promise evaporates.

Leo must confront Kenny, Burton, Noonan and Howlin: his problems are theirs. An enhanced supplementary budget and adequate resources for 2015 would defuse phantom budgeting and urgent patient safety pressure points.

This breathing space can facilitate orderly adjustments of cheaper drugs, adequate clinicians, leaner bureaucracy and centralised hospitals. Expect the announcement of cheap discount premiums for private health insurance for those under 40.

Irish Independent

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