Saturday 14 December 2019

Simon Harris: 'I am more than sorry, I am also angry, frustrated and determined'

Apologies and excuses won't cut it when our health service suffers gridlock, but there are reasons to remain hopeful

Hospital delays: We need to break the vicious cycle
Hospital delays: We need to break the vicious cycle

Simon Harris

New figures to be published tomorrow are expected to show waiting list numbers going down and a particular fall in the number of patients waiting longest. Should this give us reason to cheer? No. But it should give us reason to hope.

Last week saw our health service experience an all-too-familiar gridlock. The same adjectives crop up. 'Unacceptable' is one of them. We might be tired of hearing it but it's hard to disagree with it.

What caring society can countenance sick people being treated in the kind of conditions that make them less safe and more vulnerable when they most need comfort and compassion? Who can accept the vista of older people being stripped of their dignity and privacy when they deserve the gentle and special attention we all need in later life?

I said I was sorry and I truly am. I'll be honest. I was more than sorry. I was angry and frustrated but also more determined than ever to break the vicious cycle that sees our patients trapped and waiting. Waiting to even get on to a trolley. Waiting to get from a trolley to a bed. Waiting to get out of a hospital bed to care that's better for them. Waiting in pain for a procedure or anxiously for a test.

In a situation like this, people quite rightly won't be satisfied with apologies or excuses - they want action. I know and acknowledge that many people in the HSE work extraordinarily hard on a daily basis but it is absolutely vital that everybody responsible for the management of each of our hospitals and community health services redoubles their efforts. We have many good managers across the health service but others need to do better and there are structures in place for this which must be followed. Last week, I wrote to the Director General of the HSE to make clear health service managers must be held to account for how they deliver each of the measures to address overcrowding in our hospitals.

Additional immediate measures are now under way but that in itself is not enough. We are back in an era of re-investment in our health services and we have an opportunity to put in place the building blocks to tackle this perennial problem. I believe there are three fundamental issues which need to be addressed if we are to break the vicious cycle and they are: bed capacity; recruitment; and making that decisive shift to primary care a reality.

We know that one of the successes of the Winter Initiative was reducing the number of delayed discharges by 200. This means that 200 people who were in acute beds but needed to move home or on to a care setting better suited to their needs have been supported to do so. It is also equivalent to increased bed capacity of 200 in the hospital system but we know it wasn't enough to make on impact on trolleys. I accept the need for additional bed capacity but it is vital that we move forward in an informed way, armed with a proper analysis of the number and type of beds we need.

This issue goes hand-in-hand with recruitment and retention as there is obviously no point having additional beds if we don't have the staff to open them. At the moment 160 beds are closed in our health service either due to infection control, which is a difficult but temporary problem, or staffing shortages, which is a longer term and thornier challenge. I was heartened to see the response to the HSE's recruitment days over Christmas when 115 nurses were offered contracts with the Irish health service but it is only the start. We aim to increase permanent nursing numbers by 1,000 by the end of the year and this is going to require a sustained focus and a series of similar recruitment events.

More than anything, we have to shift away from treating people in acute hospitals when they can get better care close to home through primary care services in the community for a range of conditions, including the chronic conditions that will be an increasing feature of our ageing population. A new GP contract is an absolutely essential element and I am looking forward to formal engagement with stakeholders on these issues immediately.

I have commenced work on these issues already but I have instructed my department and the HSE to intensify this work. These issues offer a chance to try and break the cycle. They are not necessarily "immediate fixes" but the point is we have to keep a concentrated focus on them and not only during a period of overcrowding.

I don't deny they are big issues and I can't deny there is a sense of fatigue and despair because past promises have been broken or forgotten. But I am personally convinced of the possibility of progress. And it comes back to hope.

There was a fairly cynical hearing for a waiting list plan I announced last August. Perhaps this was understandable in the face of the overwhelming number of patients on waiting lists and in a year with limited additional funding for new initiatives compared to the increased investment I plan in 2017 and 2018.

However, I was determined we could do something for the patients waiting longest. We set targets and, though it wasn't easy, we have achieved them.

The progress achieved and the modest downward trajectory of the waiting lists at last may well be dismissed by some as a drop in the ocean. But that should not deter us from recognising the possibility of progress and allowing it to drive us on to further delivery.

I refuse to believe that as a country, we cannot address the challenges our health service faces. It will require people working together and working tirelessly to get there but let's get on and do it.

Simon Harris is Minister for Health

Sunday Independent

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