The polls have now put it beyond doubt that the crisis in health services is now firmly established as one of the defining issues in the coming election. However there is little sign so far that the political parties are offering a proper solutions-based approach to dealing with the crisis.
Of course that doesn’t mean they aren’t making promises. One example is the proposed extension of free GP care to all under-18s by 2025; a well-meaning but utterly unrealistic commitment which ignores some key realities.
We are facing a severe doctor shortage across all specialities, and the simple fact is that without doctors we have no hope of maintaining our current level of services - never mind extending them.
Our doctor shortage has led to three key issues that are facing the health system right now. They must be addressed in a realistic and prompt manner before it is too late.
Overcrowding
In the last ten years, while our population overall has grown by 8.5 per cent the cohort of the population that is over-65 has grown by almost 40 per cent. Statistics show us that the over - 65s account for over half of all hospital bed days, yet while this part of our population increases rapidly, we have 411 fewer beds compared with a decade ago.
Our rapidly ageing population has the fourth-lowest hospital bed per capita ratio in Europe. Our average bed occupancy rates are the highest in the EU (95 per cent) and often reach 100 per cent, even though 85 per cent is the internationally recommended safe level.
Until we have an adequate amount of beds in the system, the number of patients on trollies will grow year on year and more dire records will be broken.
To deal with this problem, we need an accelerated programme of investment in acute hospital capacity of at least 5,000 beds to meet patient demand and to ensure doctors can treat patients in a timely manner. Of these beds, 2,000 must be made available within the next two years.
Waiting lists and access
The consultant recruitment and retention crisis is causing havoc across the health services. Over 550,000 patients are on consultant outpatient waiting lists while a further 210,000 are waiting for in-patient or day case or follow-on procedure.
As many as 546 consultant posts are either empty or staffed on a temporary basis around the country, and Ireland has the lowest number of medical specialists per head of population in the EU, according to the OECD.
This issue all stems from the misguided decision in 2012 to slash consultant pay by an average of 30 per cent based solely on when they were appointed. Urgent action is needed to reverse this pay discrimination suffered by these younger consultants. We must also sit down and negotiate a new consultant contract. Only then will we see an increase in the number of consultants employed across our hospital system in line with the recommended ratios so that patients can avail of a consultant-delivered service.
GP capacity crisis
We have far too few GPs in Ireland, which is resulting in unbearable pressure on both the regular and out of hours (OOH) service, with many patients now unable to register with a GP. Over the past ten years, there has been an average increase of 146 patients per GP in Ireland while a quarter of our GPs are due to retire in the next five years. Clearly, our GP sector is unsustainable as it stands.
We urgently need accelerated resourcing of GP services and a complete overhaul of OOH GP services. Young doctors must be given grants to establish new practices and existing practices should be helped to recruit more GPs with grants for additional medical staff.
We also need to address the need to establish funding for the actual cost of locums when General Practice is under pressure in periods of high demand. The priority objective should be to support our sickest and most vulnerable patients. If we do not do this fast, we will see even longer waiting lists in GP practices and the collapse of the OOH service.
We cannot wait any longer
The national discussion on our health system needs to be framed around achievable solutions. It is reckless for politicians - regardless of their party - to talk about expanding services without the proper infrastructure in place.
Until our medical workforce see that they have the ability to work in a system that allows them to do their job in a timely and effective manner and where they are treated fairly and listened to, our healthcare crisis will get even worse as our doctors look to other countries to practice in systems that fully value their contribution.
Politicians need to sensibly prioritise what we can realistically achieve for the good of all patients rather than promising everything to every person in the hope of winning votes. That means substantial - and sensible - investment to meet demographic changes, address legacy structural issues, and show doctors that there is a future for them in Ireland.
We cannot wait any longer. Our health system is in chaos, and we cannot continue as we have up to this point. Patients and our medical workforce deserve better from our politicians.
Dr. Padraig McGarry is the President of the Irish Medical Organisation