“I think as a nation we did well. It doesn’t mean we got everything right”. So says Minister for Health Stephen Donnelly in advance of the establishment of a long-delayed inquiry into Covid-19 which is due to start this year.
He prefers to call it a “review” of what happened.
The pandemic was a bruising time for Donnelly, but the finding earlier this week in an international study that Ireland recorded no excess deaths during the core Covid-19 pandemic years will be welcome news for him. The research published by the Organisation for Economic Co-operation and Development (OECD) shows Ireland was one of only nine OECD states to avoid excess deaths in the 2020-2022 period. The State registered the fourth-lowest rate, behind New Zealand, Iceland and Norway.
“The core point for me is that regardless of the arguments on positive versus negative excess mortality, we’re fourth-lowest – and two of those lower are Iceland and New Zealand, islands thousands of miles into their respective oceans, which really can’t be compared with others,” he said.
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He nonetheless continues to attract personalised criticism; Sinn Féin recently claimed he was out of his depth and that he had been “thrown under the bus” in the budget negotiations within the Government.
“I think health will always attract criticism,” he responds. “It’s so important and sensitive, and when anything goes wrong, it’s so serious. Whoever is in this role is going to attract a certain amount of criticism. It comes with the job.
You’ve got to be able to articulate what you’re trying to do on a single piece of paper, even with something as complicated as the health service
“Talking to people, the general sense is that things are getting better, but that we have a long way to go.”
For 2024, he says he wants increased productivity from the health service, including moving to seven-day working in hospitals and the community, and “enhanced” pharmacies. This will be underpinned by a new Health Performance Visualisation Platform (HPVP) that allows comparisons to be made between the performance of different hospitals.
“No one could answer my questions about productivity when I came into this job. Is the number of outpatients going up or down, or staying the same? The data didn’t exist. Now with HPVP for the first time we can look at it, hospital by hospital, clinical team by clinical team and say ‘You had this much resource. How much care are you delivering?’”
He plans to publish the data this year, despite “resistance” in the Health Service Executive. “The public have a right to know about levels of activity and productivity. There are centres of excellence, and centres that are not performing where we want them to be.
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“For all of the investment we have made, we have not had a corresponding increase in patient care, in terms of inpatient, outpatient and daycase work, at least not until 2023.”
“If there is a clinical team of 10 and we increase it to 20, we expect to have twice as many patients seen.”
He brings up trolley numbers to further make his point. “Look at the list; the top-seven hospitals account for almost half of the trolleys – Waterford and Tullamore have none.”
Another table shows the proportion of patients discharged at the weekend for last year; the fewer patients discharged on a Saturday and Sunday, the greater the overcrowding during the week. St Vincent’s University Hospital has the lowest proportion of weekend discharges, followed by Limerick, Tallaght and Portiuncula.
The Minister recently visited Letterkenny University Hospital, in response to claims by staff and local GPs that the hospital was in crisis, in part due to underfunding. “Yet the numbers showed there had been a significant increase in funding and workforce, which had not translated into more outpatient clinics.”
The row with Minister for Public Expenditure Paschal Donohoe over future funding of the health service remains unresolved. Donnelly only got one-third of the extra funding he was looking for in Budget 2024, though he managed to extract an additional €92 million at the end of last year. A yawning gap now exists between what he and the HSE says is needed to run the health service, and what Donohoe’s officials say is needed.
Critically, trolleys and waiting lists are down, new services have been rolled out and patient costs have been radically reduced
Hence the new focus on productivity and savings. After years of generous funding, the health service will this year have to make savings to fund many new activities. Donnelly is setting up a taskforce on savings and productivity, and is hoping for quick wins by more switching to generic and biosimilar drugs, reducing dependence on expensive agency staff and developing protocols aimed to reducing the health service’s massive medical negligence bills.
With new regional health bodies coming into existence this year, Donnelly says people running the health service have to be encouraged to take risks, and the rest of us have to become more tolerant of failure. “If we don’t tolerate any failure, then we are creating a risk-averse culture. I think we have to accept a certain amount of failure. We have to encourage people to take risks, not with patient safety, but with new services and buildings and the like.”
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On top of an additional 1,100 hospital beds created since 2016, 350 more are “in train”, and Donnelly says he will open a further 1,500 if he gets the funding.
Asked about the final cost of the new national children’s hospital, visible in the distance from his office in the Department of Health, he says it will be “several hundred million more” than the last estimate of €1.44 billion, with the exact amount depending on the outcome of large additional claims lodged by the building contractor against the development board for the hospital.
“Positive, not perfect,” is how the Minister summarises the health service’s performance this past year as measured against his aims for it.
At the start of 2023, he jotted down his priorities for increasing capacity and modernising the delivery of care. “You’ve got to be able to articulate what you’re trying to do on a single piece of paper, even with something as complicated as the health service,” he says.
Rattling through the headings – access, services, affordability, workforce, infrastructure, reform – he understandably accentuates the positive.
On the back of large increases in funding, many indicators have started moving in the right direction. Trolley numbers are down – by 6 per cent. Waiting lists are also down, again just marginally. The number of very long waiters has been cut significantly. A new urgent care plan is “really beginning to work”. Free contraception “has gone really well”.
“Workforce has worked well. Er, it has worked too well. We meant to hire 6,200 extra staff but went significantly ahead of that – hence the recruitment freeze.” In 2024, the HSE is funded to take on about 2,300 extra staff.
“It’s not all perfect but that was an ambitious plan. Critically, trolleys and waiting lists are down, new services have been rolled out and patient costs have been radically reduced.”
The modest improvements in overcrowding and wait times have been achieved on the back of massive investment. Over €440 million was allocated last year to address waiting lists, for example.
It cost €130 million to convince GPs that the sky would not fall in if free care was extended to lower-income families and six to seven year olds. Donnelly acknowledges the deal with the Irish Medical Organisation was “really expensive” but points out that 98 per cent of doctors have signed up to it.
The new consultant contract has also proved popular, with 1,250 doctors signing up to it in nine months. Far from eliminating private work, it allows this to continue, so long as the private practice is done offsite and the doctors have fulfilled their public duties.
More of the same is promised for this year. Donnelly says he wants to see waiting lists fall for the third year in a row, a continuation in the decline in trolley numbers and more services for patients.
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