Wednesday 11 December 2019

It's no good sticking a plaster on the current trolley crisis - it's time for a properly costed long-term plan

Health Minister Simon Harris unveils a plaque for the refurbished Scott Building at Tullamore General Hospital yesterday with Marcella Corcoran Kennedy, and Cllr Eddie Fitzpatrick
Health Minister Simon Harris unveils a plaque for the refurbished Scott Building at Tullamore General Hospital yesterday with Marcella Corcoran Kennedy, and Cllr Eddie Fitzpatrick

Brian Turner

At this time of year, New Year's resolutions are common. Hands must be wrung. More must be done. This cannot happen again. Yes, it's early January, so there must be another A&E trolley crisis.

This time around, the outbreak of a particular strain of flu has been blamed for adding to what was already a high demand for A&E services. While that might have contributed to the problem in recent days, the recurring (or ongoing) A&E crisis is symptomatic of a wider problem in the Irish health system.

Before discussing that further, it is important to point out that it is not all bad news. We have a tendency at times like this to deride the Irish health service as a basket case and imagine that other countries have world-class systems. The truth is that those on the front line are generally providing a very good service, despite in many cases working under severe pressure. Meanwhile, other countries are struggling with issues like A&E overcrowding and waiting lists as well.

In the most recent European Health Consumer Index, Ireland was ranked joint 10th out of 35 countries on outcomes and joint eighth on prevention. However, it was the accessibility score that was the Achilles heel, on which Ireland was ranked joint last. It is this issue that is exemplified by the waiting lists and A&E crisis.

The fact is that Ireland's health system has still not fully recovered from the cutbacks of the late 1980s and early 1990s. To put things into perspective, a recent OECD report showed that Ireland has 2.8 hospital beds per 1,000 of the population, compared with an OECD average of 4.8, while we have 2.7 doctors per 1,000 of the population, compared with an average of 3.3, and we have a particular shortage of specialists.

In order to bring our numbers up to the OECD average, we would need to recruit over 2,800 doctors and open over 9,000 additional hospital beds. Unless Health Minister Simon Harris is hiding a lightning-shaped scar under his hairline, this is not going to happen any time soon.

A mitigating factor is that we have a relatively young population in Ireland, although this does not justify such a difference. Furthermore, our population is growing and ageing and an increasing proportion of the population is living with chronic illnesses.

Moves have also been made to try to reduce our reliance on hospital services and move more care into primary care settings, which are more appropriate and cost effective. However, this has been talked about for over 15 years but progress has been slow.

Furthermore, recent steps to remove the financial barrier to accessing GP services, by giving GP Visit cards to the under-six and over-70 age cohorts (who didn't already have medical cards) have resulted in a higher workload for GPs, with a consequent knock-on effect on waiting times in some cases, although most people can still get a same-day or next-day appointment - something we take for granted but is not always the case in other health systems.

The bottom line is that, while short-term solutions are well and good, and no doubt some will be found again this time, the system needs further reform and far more significant investment if it is to stand a realistic chance of meeting the needs of the population into the future.

Other countries are grappling with this also, and there is some discussion around the long-term sustainability of health spending internationally, given changing demographics and the burden of chronic diseases.

In this context, we need to have a reasoned discussion in Ireland about what kind of health system we want, how we want to fund it, and how much we are willing to pay for it. To this end, the establishment of the Oireachtas Committee on the Future of Healthcare to come up with a 10-year plan for the health system is welcome and the publication of its report later this month is eagerly anticipated.

As part of this discussion, we need to be honest about how much meaningful reform will cost, and this number will be large. While it is true to say that it is not all about money, equally it is unrealistic to suggest it can be achieved without spending more. However, the silver lining is that the short-term costs should yield long-term savings.

In the same way as many people will join a gym in the coming weeks, only to fall back into the old ways by Easter, we need to ensure that the short-term solutions are backed up by the hard slog of longer-term reform of the Irish health system. Otherwise, we will be talking about the same resolutions again this time next year.

Dr Brian Turner is a lecturer in economics at UCC

Irish Independent

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