We need to talk about… our hospitals!

What is it about our acute hospitals that cause our politicians to treat them with such deference? Individually, the local hospital is often the elephant in the room when healthcare costs are talked about, writes Denis Doherty.

What is it about our acute hospitals that cause our politicians to treat them with such deference? Individually, the local hospital is often the elephant in the room when healthcare costs are talked about. Collectively, these hospitals appear as menacing as a herd of elephants in the system! It is a large herd relative to the size of our system, it is spread out and lacks cohesion, many members of the herd are elderly, their individual contributions are diminishing and so others have to compensate for their limitations, they are expensive to support, have very long memories and tend to exact retribution on those who offend them.  For over fifty years the approach has been to appease them and to avoid any measures that would cause serious offence. Then there is the ‘herd’ made up of private hospitals. These are popular with the large portion of the population who can afford to use them but are heavily criticized by many opposed to the two-tier system.

Denis Doherty
Denis Doherty

In 1968, the ‘Fitzgerald Report’ set out how our acute hospitals should be re-organised to better meet the needs of that era. It made great sense but the modest attempts to implement some of its recommendations met with such hostility that very little was done. Other reports were commissioned and that bought time but, at a cost.

In 2003, the Report of the National Task Force on Medical Staffing, which has become known as the ‘Hanly Report’ was published. It recognised that optimum medical staffing arrangements needed to be looked at in the context of how acute hospital services are organized and delivered. The recommendations in the ‘Hanly Report’ proved about as popular as those contained in the ‘Fitzgerald Report’. Some improvements have been brought about but medical staffing arrangements are far from ideal and the acute hospitals network remains the most inefficient part of what is an inefficient healthcare system.

It is a large herd relative to the size of our system, it is spread out and lacks cohesion, many members of the herd are elderly, their individual contributions are diminishing and so others have to compensate for their limitations.

In 2008, a government commissioned report on where a new regional hospital in the North East should be sited recommended Navan. Almost immediately, a member of the government that commissioned the report promised it would not be implemented and, so far, it has not been implemented. The need for a regional hospital in the North East is even stronger today than it was when the government commissioned the study that was published in 2008.

In recent years, a number of HIQA reports, published following inspections of acute hospitals, have been highly critical of what they found.  Ad hoc remedies followed but there is little evidence that the lessons for the system as a whole are being acted upon.

There is much talk currently about ‘overruns’ and ‘overspending’ in healthcare here when the reality is that, due to the economic crisis and the need to reduce public expenditure, health services are underfunded at a time when demand is increasing, medical inflation is growing and performance standards are improving. Simplistic solutions that would penalise a beleaguered and committed work force even further are often advanced as remedies in political debate.

The ‘Troika’ is reported to have recommended that health spending ‘needs to be reined in’.  That will likely result in short term remedies being taken and the likelihood is that the financial benefits of these remedies will be much less than the negative effect they will have on services.

Almost immediately, a member of the government that commissioned the report promised it would not be implemented and, so far, it has not been implemented.

Then there is the government plan to introduce universal healthcare entitlement based on the Dutch model. Competitive health insurers are a key feature of the Dutch system. The insurance companies, in effect, determine, for better or worse, the acute hospitals network in Holland.

Change and modernization are overdue and, in my view, major change is also inevitable. The question is, will it result from good planning that will put in place an acute hospitals network capable of competently meeting the acute care needs of our people or will it result from more negative inspection reports from HIQA, from reining in healthcare costs to satisfy the Troika or from the demands of competing health insurers or a combination of a number or all of these?

Shouldn’t we commence the debate straight away?