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Dead birds are raining on our ailing health system

Recent reports that thousands of apparently healthy birds were falling dead from the sky were predictably interpreted by apocalypse junkies as signs of impending end times.

While these baffling events will likely have rational explanations and probably do not indicate the end of the world as we know it, three other ominous portents also occurred somewhat closer to home; portents of a real and credible future disaster -- a disaster facing our health services.

These signs were the record number of Irish hospital patients on trolleys in emergency departments around the country; the VHI seeking unprecedented rises in its premiums from its members, and the percentage of Irish patients with independent health insurance falling below 50 per cent. Any one of these events would be cause for concern. The juxtaposition of all three is terribly worrying.

As the economic bubble was beginning to deflate two-and-a-half years ago, I wrote a column in the Sunday Independent in which I rued the fact that the minister who had presided over the health service during unprecedented years of financial bounty had not used the opportunity provided by those good times to address the fundamental problems of the system. These problems were -- and are -- inequality, inefficiency and mediocrity.

I wrote then that the time to save for a rainy day was when the sun was shining. I also stated that the only way that our public health system knew how to respond to financial stringency was to curtail activity, closing wards and operating theatres. Why? The hospitals are paid predetermined annual budgets out of general tax revenue, a sum that does not vary with the number of patients seen and treated. If the money gets tight, the budget goes down.

When the budget goes down, the wards close (sometimes disguised as maintenance or painting), the waiting lists lengthen and the trolleys multiply. Even in the good times, public beds were closed from time to time. This is what was predicted would happen, and voila, it has now emerged that while 500 patients were being cared for on trolleys, up to 10 per cent of the beds in our public hospitals were simultaneously closed because of cutbacks.

I wrote that article in July 2008. When I wrote about saving for a rainy day, it seemed that the darkest cloud facing our economy was a €5bn shortfall in stamp duty revenue. Now, as the true horror of the bank guarantee scheme emerges, and it is apparent that the level of public debt that we face may be 20 times higher (according to some, 40 times!) the possible impact on the health service is impossible to gauge.

Instead of a mere rainy day, the public health service now faces a perfect storm of decreased funding and simultaneously increased demand.

To compound the problems caused by curtailed budgets, the demand on the public service will likely increase dramatically. Why?

Unemployment and rising premiums are driving patients from the private insurance/private hospital safety net into the arms of an already creaking public system, just at the time when the funding of that system is going to be reduced further, and the long-predicted and utterly avoidable hospital doctor shortage is realised.

While I am reluctant to jinx the alternative FG/Labour government by either endorsing it or by predicting its being elected, these parties do have well-thought-out health policies based on mutually compatible models of health insurance.

The tragedy, of course, is that no matter how well-thought-out their plans appear to be, these parties will be forced to attempt to implement them at a time of unparalleled fiscal stringency, owing to the decision of their predecessors in government to implement a reverse Robin Hood policy of wealth redistribution from relatively poor Irish taxpayers to mostly rich investors who stupidly speculated on the Irish real estate and banking sectors.

So while we still don't know why the birds are falling, the possible fall of our health system has all-too-readily explicable causes.

Prof John Crown is a consultant oncologist

Sunday Independent