For the health service 2015 was a case of 'plus ca change, plus c'est la meme chose'. Hospital trolley numbers continued to increase throughout most of the year. Waiting times for hospital treatment proved equally stubborn. A small chink of light emerged in recent weeks as the number of people waiting on trolleys in hospital emergency departments (EDs) began to stabilise.There were some positives for the much criticised Health Service Executive (HSE). A notable improvement in 2015 was the reduction of the waiting time for nursing home Fair Deal approval to four weeks on average. And "length of stay" figures improved as a result of a better flow of patients through EDs and medical assessment units.
These modest gains notwithstanding, the tone for 2016 has been set by comments made in recent weeks by HSE director general Tony O'Brien. There is "no plan, no money and no vision for health in Ireland", he said. Somewhat bizarrely, Minister for Health Leo Varadkar agreed with him. Although in keeping with a strategy of serially commenting from above on health service issues, no doubt driven by a desire on the part of the Minister to get to the general election without any fallout from health denting his political reputation, the combined contribution by the two leading figures in health provision was surreal.
While healthcare remains a perennial challenge and a political poisoned chalice, the general election is an opportunity for the electorate to express its disquiet about health matters. Political promises must be taken with a grain of salt; the main health policy change promised during the last election, James Reilly’s universal health insurance, has been quietly buried by his successor.
Universal healthcare based on medical need and provided free at the point of delivery remains a noble goal. However it is probably unachievable by the HSE, whose dysfunctional culture remains overly focused on the priorities of staff rather than on the needs of patients. This is best illustrated by its failure, not for the first time, to fully spend its mental health budget. Although acknowledged by all as the underfunded Cinderella of the health system, the HSE’s inability to put scarce resources to work for the betterment of a vulnerable group in society is inexcusable.
Primary care, while bruised by a series of unreversed public expenditure cuts, may well be the key to making meaningful progress in healthcare for 2016. The successful negotiation of a new GP contract, centred on the comprehensive provision of chronic disease care in the community, must be prioritised. So too must the reallocation of a percentage of the hospital budget to build up the infrastructure necessary for many more people to be looked after in primary care. And we must hope that the ‘known unknowns’ of health that will emerge in 2016 are relatively benign.