“There are no beds. The sick and the dying are left outside while stressed healthcare professionals work round the clock to help them.
“Elective procedures are cancelled, previously closed beds are reopened. It is a surprise. The ensuing media storm assures us the situation is unacceptable. The doctors’ representative, the nurses’ representative, the union representative, the patients’ representative, the minister and the technocrats who run the system are all over the airwaves because the situation is unacceptable.
“The solution is more money. Much more money. Money and time. Because change will take place, but only over a number of years. And change must happen. Because this is unacceptable.”
That scene of chaos just described was written by UL economist Stephen Kinsella in a paper titled “Why can’t we fix healthcare?” in January 2017 – yes, 2017. Kinsella could have written the very same article at any time over the past several weeks; it would have consisted of the same narrative, with the usual quotes from the various players, each one gravely shaking their head about our ongoing health emergency.
As any public policy analyst knows, the root of the problem is not a lack of investment, but clearly a result of the presence of multiple powerful interest groups, including politicians, policy-makers and a range of health professionals. All claim to have the interests of the patient at heart, yet remain adamant their professional privileges should be protected.
Everybody calls for change, but are themselves unwilling to change and follow proven international best practice in the management and delivery of world-class healthcare. While the Organisation for Economic Co-operation and Development (OECD) and other international comparisons are regularly trotted out, the antiquated internal processes and work practices in Irish healthcare are very often conveniently ignored.
Resistance to change is not new. Speaking after his recent resignation as the HSE’s head of digital transformation, Prof Martin Curley said the HSE is not fit for purpose, with significant resistance to change therein.
Similar sentiments were expressed by former HSE chief executive Paul Reid, who stepped down last year, citing frustrations with feeling “constrained” in the HSE’s ability to deliver change.
Yet during the height of the Covid crisis, change happened and sectional interests became irrelevant, with a sense of collective social solidarity within our health system. Frontline workers at every level distinguished themselves by putting their lives at risk every day, and still continue to do so. Many internal processes deemed hitherto impossible to implement happened overnight.
Having witnessed the degrading and inhumane conditions and chaos within our hospital emergency departments over the past several weeks, has the time not come to reignite again that culture of creativity at all levels within our healthcare system?
Ironically, the most obvious starting point to develop a world-class health system is to finally end our constant focus on hospital care. The obsessively slow Sláintecare implementation plan speaks volumes on how our policy pathways work. The plan itself has already identified the need to develop real primary care and community-based services – not what passes now as primary care.
Properly resourced GP practices would ensure many people sitting in emergency departments could be treated by their GP or practice nurse in their own community. The role and current practices of our pharmacy system also require examination, especially in the management of certain ongoing conditions that are currently being performed in GP practices.
Our world-class centre of excellence cancer care model has proved we do not need under-resourced hospitals at every crossroads. However, what we do need are properly resourced community health and social care services with access to diagnostics in a timely and efficient manner. Such a structure will ensure a range of locally provided services fit together so various professional disciplines are integrated and people can move smoothly through the system.
The need to shift health and social care provision away from acute hospital care to planned care, nearer to people’s homes, especially for an ageing population living with long-term complex care needs, has never been more essential. While home carers are a vital component of the community care model, recruitment problems as a result of poor pay and lack of professional development are an ongoing issue for these workers.
As agreement nears completion on paying “public-only” consultants nearly €300,000 a year as part of their proposed new contracts, an immediate examination of the working conditions of the lowest-paid workers in Irish health and social care must be prioritised.
The presence of egos, empires and silos coupled with weak governance and little or no accountability at all levels within our health ecosystem has ensured that, despite ever-increasing funding, Ireland has some of the worst health outcomes in the developed world.
As a nation, we deserve better, and it behoves the Government, opposition parties and all stakeholders to show a sense of collective leadership in the provision of a health service we can be truly proud of.
Dr Patrick McGarty is senior lecturer in public policy at Munster Technological University