Sir, – We are informed by Martin Wall and Fiach Kelly (July 23rd) that the Cabinet has been briefed by some unnamed source, presumably from within the Department of Health, that the HSE is simultaneously "too big to fail" and "too big to succeed" ("Universal free GP care scheme delayed", News, July 23rd).
The Minister, we are told, thinks that there is a need to substantially increase the number of staff at the Department of Health. We are not informed of the reasoning behind this view, which, to say the least, would not be widely held outside his own department.
Considering its limited role and its current size, surely any inadequacies in the Department of Health are more likely to be qualitative rather than quantitative? We are informed of a proposed Sláintecare advisory group, and a separate Sláintecare “delivery board”. Sláintecare, it appears, is going to have some sort of a separate existence.
The new board of the HSE is to be a board of directees, under the direction of the Minister, rather than a board of directors. It is not made clear whether the director general will report to the board or to the Minister.
What seems all too clear is there will be ongoing blurry lines separating power and responsibility, with continued ministerial hand-wringing and expressions of displeasure as major problems continue in spite of massive expenditure. – Yours, etc,
TOM HOGAN,
Catleknock, Co Dublin.
A chara, –There is clear and consistent evidence internationally that continuity of care with a general practitioner results in lower mortality rates, higher patient satisfaction and reduced rates of morbidity and hospitalisation, especially amongst the frail elderly.
Figures from the Commonwealth Fund and Rhode Island Primary care show a rate of return of six to seven times on investment in primary care, figures that could likely be replicated in Ireland.
On the contrary, general practice in Ireland suffered cuts of 38 per cent in Fempi (Financial Emergency Measures in the Public Interest) legislation, which has led to Irish general practice residing on a precipice, with many rural communities now without permanent GP services, GP services unable to take on new patients and an exodus of highly capable Irish-trained GPs to North America, the Antipodes and the Middle East.
It seems somewhat incongruous that instead of investing in and supporting services that provide an excellent return on investment, Minister for Health Harris is calling for a “substantial increase” in the number of civil servants in the Department of Health.
Given that the HSE was hiring new managers at a rate of three new managers per week in 2017 and waiting lists and trolley counts are at historically high levels, it would seem to the untrained eye that perhaps investing in frontline staff, especially general practitioners, rather than further bloating the managerial ranks in Hawkins House, might be a more appropriate way forward. – Is mise,
Dr DÁIBHÉAD O’DORÁIN,
Clontarf, Dublin 3.
Sir, – Fairness and equity of access to services are the underlying principles of Sláintecare, underpinned by legislation which would put on a statutory footing accountability and good governance within the HSE and Department of Health. Health service transformation must be delivered urgently, yet Government has not responded to Sláintecare over 400 days after its publication.
Every missed day condemns patients to trolley queues and lengthening waiting lists for treatment, as demand for services grows due to our ageing population, inefficient work practices and chronic mismanagement.
Delaying reform is not an option. This Government promises implementation of Sláintecare while also saying it is not affordable. This contradictory message indicates the Government is not really serious about undertaking co-ordinated reform. Sláintecare shows how integrated, reorganised services can deliver timely and effective care that is affordable and sustainable into the future.
Continuing to take a short-term view while repeating the mistakes of the past is unacceptable, unsafe for patients and very poor value for money. – Yours, etc,
Dr MICHAEL HARTY TD,
Chairman of the Joint
Oireachtas Health
Committee,
Leinster House,
Dublin 2.