Monday 18 December 2017

There are solutions to the health crisis

Health Minister Simon Harris
Health Minister Simon Harris


Here we go again. As regular as clockwork, the chaos in hospital emergency departments has returned. Cue the various vested interests within the health service to adopt predictable positions. Eventually the crisis is distilled into a convenient form: "More beds!" becomes the catch cry and, at a political level, a pantomime villain steps forward, head bowed, with an apology at the ready. The villain is the latest Minister for Health who has been judged to have tried and failed to foresee and manage the current crisis. Simon Harris joins a long list of his predecessors who have contended with the apparent shambles that is the country's health service.

Yes, it is true that in the period since 2008 there has been a significant reduction in hospital budgets and staffing, which since then has been only tentatively reversed. That is a consequence of the financial crisis which has wreaked havoc on the country's social services. At the same time there has been a significant increase in the volume and complexity of activity in the country's hospitals. It is notable, however, that throughout the financial crisis there has also been a 10pc reduction in the average length of stay in our hospitals, contributing, in terms of bed days freed up, the equivalent of approximately 1,000 acute beds. This tends to point to a solution to a problem which is more complex than simply a demand for more beds. The truth is that the problems being experienced in emergency departments are the result of many factors, which in several respects can be traced back to an outdated model of care struggling to cope with new types and levels of demand.

While acute hospital care will always be essential, it must be provided within an integrated model to avoid unnecessary hospital stays. Where patients need acute services the transition between primary, acute and community care must be better managed so that it is effective, efficient and safe. Attempting to address these rising needs based on outdated models and assumptions will not achieve an acceptable health service for the Irish people. Today, some three-quarters of health service activity relates to dealing with chronic disease. There is scope to reduce admissions for chronic illnesses to potentially free up significant bed numbers. To build a better health service there is a need to change some of the operating assumptions on which health policy and health services were traditionally based. This change needs to be accelerated and implemented systematically and system-wide.

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