EDITORIAL: Time now to scrap the HSE?

WITH waiting lists for medical appointments and treatment growing longer and longer, has the time come to scrap the Health Service Executive, which does not seem to be capable of administering its brief and providing us with a public health service that is fit for purpose? The arguments for doing so are very strong, given the further controversy generated by last week’s RTÉ Investigates documentary, ‘Living on the List,’ which revealed another 49,000 people on what were termed ‘shadow waiting lists.’

What was truly shocking was the subsequent revelation that the combined waiting lists amount to a colossal 632,100 – almost 12 percent of the entire population. Many will be waiting for a very long time to be even seen by specialists in the first place, let alone get treatment, and the sad fact is that some of these people will probably die while waiting. 

The wait for appointments could be anything up to four or five years, which begs the question: How did we ever get to this stage?

When the published number of people on waiting lists for appointments and treatment surpassed the half a million mark, just before Minister for Health Simon Harris took office last April, we were all rightly appalled, but took some comfort in the prospect of a new man with a plan taking over the helm. However, those hopes have been dashed as the latest figures are nearly 30 percent worse now and the Minister does not seem to have been able to get to grips with either them or the HSE whose best efforts to tackle the waiting lists are just simply not good enough.

If you keep on doing the same things that led to the situation in the first place over and over again, nothing is going to improve. The HSE itself has even contributed to extending the waiting lists by further deferring planned surgical procedures in many cases in order to free up staff and beds to deal with the other major crisis it is facing in Emergency Departments nationwide with shameful new records being set in January again for the number of people on trolleys in overcrowded EDs awaiting treatment peaking at an all-time high of 612. 

Granted, there is an ongoing human resources crisis in terms of recruiting enough frontline medical staff, although curiously no shortage of managers on the administrative side. Those on the frontline do a magnificent job and one wonders how they cope with the extra pressures the mismanagement of the public health service is putting on them.

At some stage, there comes a breaking point and that has arrived now with the announcement of industrial action by nurses who are members of the Irish Nurses and Midwives Organisation (INMO) due to start on March 7th next, which is going to add to the chaos in the health service if it goes ahead. They are simply going to work to rule by doing the job they are contracted for and, by not providing extra cover or doing overtime, there will be an inevitable knock-on effect on services.

One cannot blame the INMO for bringing matters that they have been complaining about for a long time to a head through this industrial action, as their members have been bearing the brunt of the pressures brought about by the constant shortfall in resources. The Minister and the HSE not only need to address the human resources issues, but also the way money is spent in the health service, which seems to voraciously gobble it up, and identify the areas where value for money is not being achieved.

The appropriate analogy in this case of patching up the various wounds across the whole service with bits of sticking plaster is not working – and never will in the longer term. Like good medical practice, a holistic view of the health service needs to be taken and the bigger picture critically looked at with a view to radically reforming something that is clearly not working properly.

Big decisions need to be made and people need to be made accountable for what they are doing. The HSE was set up on January 1st, 2005 by then Health Minister and now Fianna Fáil leader Micheál Martin to replace the regional Health Boards and get rid of some of the many layers of bureaucracy its was felt were obstructing progress, but over 11 years later the public health service is still a shambles and, with the two-tier public and private model stronger than ever thanks to the disproportionate influence of various vested interests, the usefulness of the HSE needs to be holistically scrutinised.

A good start would be to make public hospitals solely just that and let private hospitals and consultants run their own operations separately. But, what needs to come first is committed cross-party political will to take necessary action to tackle the problem once and for all.