THERE ARE some things we know about health services. We know that throwing money at hospital problems will not make them go away. Hundreds of millions of additional euro were spent on hospital care during the boom years, but accident and emergency services often remained dysfunctional and waiting lists were unacceptably long. Efforts to control extraordinarily generous pay and conditions of hospital consultants were effectively abandoned and wages rose throughout the system. Rather than attempting to reform the existing two-tier model the Government now plans to replace it with a universal health system and Minister for Health James Reilly is driving the project.
The difficulties facing him and the Government became apparent when it emerged that in the first four months of this year, the Health Service Executive ran up a deficit of €183 million, of which €99 million was accounted for by hospitals. Now that the financial horse has bolted, there is talk of drawing up cost containment plans that may involve closing wards and theatres and cancelling planned surgery. Surely that should have been done last December when the health budget was allocated? Or did hospitals unilaterally over-spend their budgets? One way or another, there is a need to find out precisely what happened, if only to ensure opposition to Government policy was not an underlying factor.
Local health issues generate raw emotion and the resulting political pressure has ended more than one Dáil career. Taoiseach Enda Kenny encountered one of the longest-running hospital campaigns when he visited Roscommon last Monday. Retention of a 24-hour AE service was the demand. He offered protesters “the truth” but he made no promises. Elsewhere, Dr Reilly was insisting there was no point in hospitals looking for extra money from Government because it simply wasn’t there. The EU-IMF were not just at the door, he said, but were in the parlour. So health services had to keep within budget. As for drastically overcrowded emergency departments, he suggested hospital wards could be opened to relieve the pressure. Anticipating opposition to such action, he said this was not about money but was about organisation and planning.
Hospital structures have tended to reflect the needs of service providers rather than patients. Expensive equipment and operating theatres remain idle for long hours; demarcation issues cause internal friction and cost money; basic hygiene is a problem and procedures for patient evaluation at AE departments practically guarantee delays and overcrowding. Some or all of these issues may be addressed under the Croke Park agreement, but it will not be easy. Demand for services in winter months will pile more pressure on the system.
Just as a ban on bonus payments was opposed within the commercial semi-State sector, a restructuring of health services is likely to bring resistance. Industrial unrest, hospital overcrowding and public discontent are likely reactions. The Government’s objective of controlling expenditure while planning the introduction of a universal health system is hugely ambitious in that mix.