Our rapacious gluttony for healthcare resources

Like many of the lycra-covered lovelies pounding public roads all across Ireland at this time of the year, health service managers are working out their flabby-bottomed balance sheets in an attempt to slim down, writes Laurence Nightingale.

With the excesses of the festive period still lingering about the nation’s waistline, health services everywhere are braced for a period of belt-tightening unrivalled in modern memory.  Overspending in Health has drawn sharp criticism from our international paymasters. Ireland of course is no stranger to overindulgence with particular aspects of this cultural foible celebrated by our friends the world over.  However it is the nation’s rapacious gluttony for healthcare resources that threatens the cordiality of our relationship with erstwhile pals in the Troika. Gobbling up pills like a turkey at a Rave, the Irish citizenry loves nothing better than health consumption. Whether it’s bed days, antibiotics or home help hours, we just can’t get enough.

Laurence NightingaleSo like many of the lycra-covered lovelies pounding public roads all across Ireland at this time of the year, health service managers are working out their flabby-bottomed balance sheets in an attempt to slim down. January, a month brimming with optimism and renewal, is a critical time for health planners as they attempt to turn the National Service Plan into something resembling reality on the ground. They do this safe in the knowledge that there will be zero tolerance for budget overruns in 2013 irrespective of the adequacy of the envelope.

So what of its prospects? Can the health service stay on the disciplined path and become the lean, mean, indifferent machine so desired by technocrats?  In 12 months time will service managers pose ironically in outsized scrubs claiming proudly to having been ‘this big’ a year ago?  Would its chances of success be improved if the nation got behind this transformation?

Well the Irish health service certainly meets all the criteria to feature in a TV makeover show. In the first instance, it’s got the heart-rending back-story necessary to engender the love and sympathy of Irish Mammies; its potential greatness thwarted by layers of fat; numerous failed attempts at reforming its ways and a persistent sense of low self-worth.  Yes the health service has it all – only the heartless could resist the urge to help dry its big, wet, salty tears?

January, a month brimming with optimism and renewal, is a critical time for health planners as they attempt to turn the National Service Plan into something resembling reality on the ground.

Secondly it has form on weight loss. With thousands of staff exiting the services since 2009 and administrative headcount levels back where they were in 2002, it is leaner and more flexible than ever. It responds well to exercise too. With health service managers stretched to their limits and pulled in several directions at the same time, the system has the kind of extraordinary physical capacity rarely seen outside of Cirque de Soleil.

Finally it has stamina. Unyielding, grinding pressure exerted on it by a growing and ageing population; a seemingly endless list of targets applied to its every move and a level of scrutiny unparalleled within the Irish public service has failed to weaken its management cadre.

However even with all the resilience and will-power it can muster, the health service faces saboteurs on a number of fronts. With its ranks perilously thinned out in recent years, it continues to be reviled as bloated by band-wagon commentators and self-serving management consultants.  Repeatedly told it is not good enough, not slim enough and not quick enough in reaching its goals, the environment it operates in is not the most positive or life-affirming for an organisation undergoing change. Indeed, there is a danger that the health service will suffer collectively from some form of body-dysmorphia, as its perception of itself becomes coloured by the views of those that dismiss its complexity as a symptom of poor management without ever really understanding it.

The real danger of course is that the health service becomes overly focussed on achieving its target reductions – effectively crash dieting to achieve a short term goal or quick win. It may well be ‘bikini-ready’ by the summer but will have done the kind of damage that will take years to recover.

A structured, supported and well managed downsizing is what the health service really needs. It must change the habits of a lifetime and the comfortable familiar reflexes on which it has traditionally relied must be phased out gradually. For this it needs time, understanding and some unabashed cheerleading from people in leadership positions.