The list of challenges facing our health services is growing. There are chronic difficulties in the recruitment of personnel, particularly for consultants and nursing positions.
There is a lack of specialists in several therapies. Our GP service teeters on the verge of collapse, particularly in rural and disadvantaged areas. Increased demand fuelled by demographic trends and improved life expectancy, combined with bad management and medical inflation, has given rise to annual budget overruns on a scale which threaten to undermine all our public expenditure planning.
Our health services are dramatically improved in most areas but are still inadequate. By their very nature health services are always inadequate, especially at a time when the population is ageing and when expectations for quality of medical care continue to rise.
Political debate about the health service is always wrapped up in emotion. The improvements in healthcare are too complex to fit easily into news packages or soundbites in the way that individual stories of inadequate care do. The shortfalls in the health services by comparison are highly visible, not least in accident and emergency wards.
The extent to which public, media and political discourse around health policy is now dysfunctional in this country was illustrated in two important respects this week.
The first was in the reaction to the interview which Tony O’Brien gave to the Sunday Business Post’s health editor Susan Mitchell last weekend. It was a lengthy, complex and considered contribution to the health debate.
Varadkar’s approach
For those interested in politics, parliament and public administration, O’Brien’s interview is research gold. We seldom get to read a detailed account, on the record, from someone who has worked at the very top of our public service and who feels free in retirement to speak openly about interacting with ministers and parliament. The true value of the O’Brien interview in that regard will be more apparent in time.
What he said about the Minister for Health Simon Harris was most colourful and therefore got most attention, but what he said about the Taoiseach Leo Varadkar’s approach as Minister for Health was even more telling. It was an interesting insight into how, despite assumptions to the contrary, Varadkar is prepared to offer the public a more nuanced and therefore less palatable take on the reasons for difficulties in the health service. Varadkar’s approach, as described by O’Brien, was straightforward rather than spun and as someone who “calls it as he sees it, he sometimes gets it wrong, and sometimes he’s big enough to say he got it wrong”.
The need for substantial media engagement on political decisions about our health services is greater now than ever
For those interested in health policy, the O’Brien interview raised many substantial issues worthy of immediate and detailed follow-up. The tone of the interview was in parts shaped, inevitably, by his anger at having being forced to step down at the height of the cervical cancer controversy earlier this year. It is in the main, however, a considered piece informed by his experience of the health service at the highest level. He was direct and honest in his view. There was substance in his criticisms.
There was also some insight into the failings in the system, which he proved unable to address. O’Brien set out real concerns about the recruitment and retention of hospital consultations, about the need for a new relationship with general practitioners and about the possibility of paying more to personnel in certain specialities. He also sounded a warning bell about lack of integration in the emergency response services in Dublin.
Overreaction
The follow-up coverage of O’Brien’s interview, however, has focused primarily on one line of his description of Harris. Harris’s opponents lapped it up. Harris’s supporters reached out to defend him in glowing terms. Much of the import in the rest of O’Brien’s interview got lost.
This week also saw an emotive overreaction to Varadkar’s suggestion that curtailing the amount of leave taken by doctors and nurses over the Christmas and new year period should be considered as a means to help tackle the winter time crisis in accident and emergency.
Varadkar, it was claimed, was “throwing frontline health workers under a bus” and ignoring other causes of the crisis. There were even infantile suggestions that instead of worrying about whether doctors and nurses worked over Christmas, Varadkar should make sure the Dáil sat more often. We know from experience that TDs debating the trolley crisis, even with widespread attendant media coverage, does nothing to resolve the problem. Having more people working in hospitals over Christmas week won’t solve the problem but it might contribute to easing pressures in the short term. The notion is at least worthy of more considered examination.
The need for real and substantial public and media engagement on political decisions about our health services is greater now than ever. There was limited sign of it this week.