EDITORIAL: HSE must deliver on agreement

IT is difficult to blame the Irish Nurses and Midwives’ Organisation (INMO) for playing hardball with the Health Service Executive (HSE) during the talks held at the Workplace Relations Commission that successfully averted this Thursday’s threatened two-hour work stoppage at emergency departments, given the justified concerns they had about the ability of management to implement agreed improvements in a timely fashion. Trust is still in short supply in this regard, but at least there is a progress review mechanism to monitor progress and the HSE simply has to deliver on its promises to the union or else face the unwanted consequences of failing to do so.

The number of people who have to spend long periods on trolleys awaiting admission to hospital beds has not been reduced to any significant extent in the past year, despite hundreds of extra millions being pumped into the health budget. Minister for Health Leo Varadkar saw first hand for himself last week, when he visited a number of hospital emergency departments, just how bad the problem still is with 550 people on trolleys on one of those days waiting to be admitted for treatment. 

That was not far off the record number of 601 that caused so much of an outcry this month last year. The Emergency Department Taskforce has been working on freeing up beds in acute hospitals being occupied by elderly people who could be cared for in nursing homes or in their own community with appropriate home care packages, but their progress was so slow that HSE boss Tony O’Brien had to step in in recent months to try to boost their efforts ahead of another winter of discontent.

And, indeed, the much-feared scenario of far too many people having to wait for long periods on hospital trolleys for medical care has come to pass again and is proving a major embarrassment for the government ahead of the upcoming general election. Minister Varadkar tells us that it will take five years and a lot of money to address the problem that may or may not be his to solve after the election, but just throwing money at it is certainly not going to provide a sustainable long-term solution.

Over the past two decades, Minister Varadkar’s four predecessors in the role – Brian Cowen, Micheál Martin, Mary Harney and James Reilly – have not been able to come up with a proper solution, commissioning reports and drafting plans which just seem to gather dust somewhere in the Department of Health. The officials there have to take a lot of the blame for the problems in the health service, along with the HSE, as there seems to be little if any thinking outside the box about how to address these ongoing crises and just doing the same thing over and over again is clearly not getting the desired results.

People are, understandably, angry when they read of all the millions being pumped into the health sector yielding so little progress. They are entitled to question how the money is being spent and why it is not achieving the desired results; it is something that they should be asking politicians, especially members of the government parties, Fine Gael and Labour, when they encounter them on the election campaign trail in the coming weeks.

Obviously, the opposition parties will try to make political capital out of the government’s problems with health matters – the trolley crisis being only one of several serious shortcomings in the sector – but they also need to be asked what constructive plans they have for dealing with the problems and how they are going to fund the solutions they propose. 

While radical solutions are required, they need to be tempered by financial realities and cost-benefit analyses are key to addressing the problems of the health service in a holistic manner. If current structures or practices are found not fit for purpose in the 21st century, which sees an increasing population and people living longer, then they should be scrapped and replaced by whatever is necessary for a modern health system to function efficiently.

The necessary solutions will inevitably cost more and may require extra taxation revenue to implement, but most people would probably be prepared to pay a bit more if it led to an efficient public health service that provided good value for taxpayers’ money and prioritised medical needs over ability to pay. 

The only way efficiency can be assessed is through proper accountability and all the stakeholders involved need to be able to show the public that the money they cost is worth paying as there are too many powerful vested interests earning huge amounts of money by exploiting the existing system to their advantage. The public interest must come first and be foremost.