Varadkar won't fix issues in health service by 'making heads roll'
Leo Varadkar tends to be as straight-talking in his emails and texts as he is in person. In an email on September 4 sent to his adviser Brian Murphy, and copied to three senior HSE managers including HSE boss Tony O'Brien, Mr Varadkar made it perfectly clear that he wants a HSE head to roll if there are not tangible improvements in our overcrowded emergency departments.
In that email, the Health Minister wrote down "a few thoughts". Under Trolleys, he said: "The picture is worrying and I am apprehensive about where we are heading into for the winter. I have no reason to believe it won't be worse than last year and that really means a head, or heads, will have to roll."
But are heads rolling really the solution to our overcrowded emergency departments?
Speaking on 'The Late Late Show' last Friday, a much more bashful and charming Varadkar admitted that his work in health was a "work in progress", that they plan to open 300 beds to help relieve the emergency department crisis, and how he was determined to be the Health Minister who turns the health system around.
But if he is really determined to be the Health Minister who makes a difference, that provides a decent health service for Irish citizens, that ensures access to quality care when people need it, then perhaps the minister needs to take a different approach.
Issuing ultimatums that heads must roll; stating he has no confidence in the implementation of the Emergency Department Taskforce that he established; witch-hunting the very doctors who run emergency departments, and being outraged that €100 million has not fixed the trolley crisis, is not the way to go.
Meanwhile, on Monday evening the HSE announced that Tony O'Brien would take over as joint chair of the Emergency Department Taskforce from October 1 for five months.
O'Brien acknowledged that addressing the root of the problems in emergency departments "involves much more than the acute hospital system and lies across many of the health services".
Fixing the overcrowding in emergency departments means changing how the whole health system works and resourcing it to provide better care in a different way. It means making sure people can get access to simple diagnostic tests without having to show up in an emergency department.
It necessitates sustained investment in primary and community services, especially for older people.
During the coalition's first year in government, the numbers of home help hours were cut by 1.2 million. These have increased since, but they are still below the levels they were at in 2006 and are totally insufficient to meet need.
Investment in geriatric services and extending them to the community is a proven and effective way of keeping older people out of emergency departments. It is much better for older people's well-being and quality of life and much more cost effective.
Given the increasing numbers of older people with complex health needs, some of these will need hospital admission, but why can't GPs have direct access to Acute Medical Assessment Units for such patients? Two thirds of people referred to Acute Medical Assessment Units get a bed or are discharged within six hours and there are such units in all hospitals now except Portlaoise.
At the most recent meeting of the Emergency Department Taskforce, Mr Varadkar was incensed that the additional €100 million he had secured for delayed discharges and the taskforce did not seem to be making a difference.
What Varadkar failed to acknowledge is that Irish health spending is now below 2006 levels. There is no black hole in health. In 2008 we were spending €3,400 per person on health. In 2011 it was €3,026. Last year it was €2,775.
This shows that the money spent is going further to meet the needs of our growing, largely youthful, population, which is also living longer.
It is being spent addressing our greater burden of ill-health. There are big drives to improve the quality of care, as well as increasingly costly solutions in both drugs and new technologies, all of which cost more money.
Of course the money is not being spent in the best possible way; there is more unmet need than we realise because many people are denied access to essential care and we simply do not measure it.
In response to a question from this author in May of this year as to what was his biggest achievement as HSE director general Tony O'Brien responded by saying "still being here". When asked what his biggest frustration was, he replied "still being here".
The same might be true for Leo. If Fine Gael are re-elected and Enda Kenny is the next Taoiseach, which looks pretty likely right now, then Leo might still be health minister.
If Mr Varadkar is to be true to his straight-talking word that he "is determined to be the Health Minister who turns it around", then he needs to provide a vision for a better health system.
However, making heads roll will not fix it.
Providing sustained leadership achieved through courageous political leadership, by doing lots of relatively small things very differently, might.
Here's hoping that he does and can.