I was out to lunch recently and as the alcohol count went up, the temperature of the discussion increased and the willingness to defend absolutely untenable positions became crucial. The subject matter whipped around current news, visiting matters Trump on a couple of occasions (Is there an equivalent to Godwins Law that encompasses DT?) and for a short time settled on the Health Service. One of the requirements of this sort of discourse is that none of the participants is expert on the subject which gives a certain amount of latitude to the debate. At one point we were each asked, ‘If you were appointed Minister of Health, what would be your first action?” There were a number of responses to this that have been lost in the haze but it was a question that came back to me as I was listening to Simon Harris introducing Sláintecare. I wonder whether his first action on appointment was to wonder what he had done wrong in a prior existence to deserve the Department of Health posting. On the same day that the discussion took place there was more fall out from the Cervical Cancer debacle: more GP’s leaving the country; over a million waiting for hospital appointments; more people on trolleys and so on. The only thing that was consistent was the call for more and more money from all of the stakeholders in the Health industry.
Earlier this year there was the trolley crisis and I remember a lunchtime radio presenter promising to read out the number of patients on trolleys every day until the problem was solved. Perhaps I misunderstood her because I don’t hear her publicising the numbers any more. Today we have new problems that remind us that in simple economic terms we have insatiable wants and limited resources. When the lunchtime program was on the subject of the crisis in A&E we heard a number of theories as to how to deal with it. What I didn’t hear was any in depth analysis on patient through-put, broken down by type of incident. What I kept hearing was the number of patients on trolleys and even this figure was different from that published by the HSE. What I kept asking the radio was for some basic data giving the type of medical emergencies of those presenting to A&E. I heard two doctors interviewed saying that every patient attending had a legitimate reason for being there but we all know someone who has been told by their GP to attend A&E to avoid long delays for MRI scans, for example. It would be interesting to know how many trolley patients were discharged as soon as a Doctor could get to them or, how many just needed to sleep it off.
This is not my normal rant but a genuine doubt as to whether the Minister or the management of the HSE understand the drivers and demands of healthcare today. I understand that the Health Service cannot be run like a business but when we see a long term plan being published without costings it ceases to be a plan and becomes something aspirational and full of good intentions and we know what the road to Hell is paved with. At this point I should say that I have a great regard for those healthcare professionals working at the coal face but I get an impression of an organisation that is rudderless, lacking in energy, accident prone and moribund. I also get a sense of segmental interests fighting against each other for a slice of an ever increasing budget. I hope that I am wrong and that there are current, relevant and robust figures and costings on which a plan can be based and that there isn’t a form of internecine warfare responsible for a black hole into which more taxpayers funds are sucked.
To get back to the original question of what I would do if appointed Minister, I would look for current, relevant and robust data that gave me a good sense of where the organisation is and what the plans are. I am not talking about yet another report from one of the top accounting firms. I am talking about data properly targeted and obtained by multi discipline teams from within the Health Service. There are a number of benefits to this approach firstly, the poacher turned gamekeeper effect where all the old hiding places are known. Secondly, if the team dynamic is good then cross discipline and cross health centre contacts are made and best practise procedures are implemented. If management trust their own staff, implementation of ‘quick wins’ will continue to build trust between them. Of course this will need extra funds and the other front that has to be addressed is the taxpayers view that increased funds go into a money pit that benefits everyone but patients. The Minister and HSE have to have a dialogue with the taxpayer that not only looks for more funding but takes full responsibility for implementation, supports investments with value for money data and publishes follow up audits to ensure that targeted gains are achieved. In the UK the Minister for Prisons has promised to resign if, in a year, improvements are not made in 10 prisons taking part in a pilot scheme to reduce drug taking and violence. (Irish Times 21/08/18)
What about it Simon, prepared to ‘nail your colours to the mast’ and for a change make a meaningful promise to the Health service and its clients?
Reference: Irish Times, 21/08/18, Denis Staunton. World News