THE health service, as orchestrated by the HSE, is infuriatingly difficult to evaluate. Claims about the degree and pace of improvement are confusing, and often seem contradictory.
Asked about a leaked draft HSE plan to reduce the number of hospital beds by 1,100 this year, while cutting the number of inpatient hospital admissions by 54,000, chief executive Brendan Drumm said that this was the right thing to do. More treatments should be performed on an out-patient basis or in assessment units.
Four years ago, he said, the HSE was anticipating spending €2.5bn on 3,000 beds but, today, we are managing without those extra beds and, indeed, with 1,000 fewer beds.
Touche to Professor Drumm. What had been perceived as a problem is, in fact, progress.
And who could argue with the vision of a hospital system free of people who need nothing more than a scan or some procedure which could be carried out in an hour in some outside facility?
Yet the vision of a constantly improving health service, so articulately expressed for the past five years by the soon-to-depart chief executive, does not always reflect the reality on the ground.
Four years after Mary Harney pronounced as a crisis the hundreds of people languishing on trolleys for want of a hospital bed, the numbers are much the same.
Even allowing for periodic fluctuations in supply and demand, it is hard to see where the progress has been achieved.
Likewise, the establishment of the National Treatment Purchase Fund in 2001 was designed to ensure that, by the end of that year, no adult would wait more than a year for treatment and no child longer than six months.
Yet, at the beginning of 2010, 18,000 people are on waiting lists for inpatient and day-case procedures and more than 6,000 have been delayed for at least six months.
The HSE perception of improvement in the health service tends to clash with the experience at trolley level.
We might expect that the executive's huge and expensive resources (€6m may be spent on outside consultancy this year) could be brought to bear on the anomalies and, if not solve them, at least explain them a little more clearly.