If Carlsberg did healthcare, they would be wary, very wary of political initiatives, writes Denis Doherty.
Generations ago, Irish farmers learned that putting a bush in the gap through which livestock made their escape only encouraged them to trample over the bush or seek out another weak spot through which to escape again. Farmers realised that a strong boundary was the best solution and also made for good neighbours.
Political initiatives can sometimes be the political equivalent of the ‘bush in the gap’ solution. For as long as I can remember, supplementary budgets took care of overspending. Every year, the supplementary budget was accompanied by dire warnings that overspending would not be tolerated in future and that this was the last ever-supplementary budget. Supplementary budgets have been discontinued but overspending continues and is accommodated by another species of bush in the gap! Is it any wonder that, by not rewarding prudent financial management while rewarding profligacy, supplementary budgets, not called that anymore, are a regular feature of how our health services are funded?
Putting a bush in the gap through which livestock made their escape only encouraged them to trample over the bush or seek out another weak spot through which to escape again.
The National Treatment Purchase Fund, the Special Delivery Unit, waiting list initiatives and winter initiatives are just some of the political initiatives that promised a lot, succeeded in the short term but turned out to be no more than ‘bush in the gap’ solutions that quickly degraded, leaving wider gaps due to the increased volume of traffic going through them.
The latest initiative being promoted by some politicians seeking the provision of a patients’ hotel on the campus of the hospital in Clonmel makes earlier initiatives appear a lot sounder than they were judged to be at the time. Patients’ hotels have been used in Scandinavia for decades where sparse populations and severe winters justify their use. I once stayed in a hotel attached to a cancer treatment centre in upstate New York. Many of the patients catered for there lived a long distance away and many others were from across the border in Canada.
Lengths of stay in hospitals have reduced so dramatically in recent years that, with the possible exception of National Specialist Treatment Centre locations, investment in patients’ hotels would contribute about as much to healthcare improvements as commercial hotels do in solving our homeless problem.
The challenge then is to devise a system that will bridge the gap between the service public patients receive compared to that received by their privately insured counterparts.
Credit where it’s due, the way the catherisation laboratory controversy in Waterford has been handled should serve as an example of how all political initiatives ought to be handled. If the advice of the expert report is followed, the patients served by the hospital in Waterford will benefit from investment in upgrading the existing laboratory and the recruitment of additional staff to enable the hospital to meet the needs of the population it serves. That is surely preferable to investment in a political trophy that cannot be justified on clinical grounds.
So, what should replace the political ‘bush in the gap’ approach? We need to put in place a new boundary within which we can provide a health service that actually serves the needs of our people and becomes one we can all be proud of.
In the UK, the NHS is finding it difficult to cope with the demands being placed on it. The difference between there and here is that the British people, their political representatives, of all political persuasions, and their media are intensely proud of their NHS. At the memorable opening of the London Olympics in 2012, the NHS was celebrated in a fashion that was both genuine and remarkable. The NHS came into existence soon after the Second World War when Britain was war-torn. It provided universal cover that remains free at the point of use. That may explain why the NHS is cherished in the way it is.
The notion of an Irish NHS has a lot of appeal here, especially to those who favour a single tier, egalitarian system. That seemingly reasonable approach will quickly encounter major difficulties when the feasibility of dealing with the changes, on the scale that would be involved, is seriously addressed. To begin with, the health services in Ireland and Britain have evolved very differently over the past seventy years since the NHS was created. Private health insurance and private health care provision in Britain are very small compared to here.
It seems inconceivable that a solution that would shift current private expenditure on healthcare to the exchequer could be entertained. That is the elephant in the healthcare room in Ireland that needs to be confronted. The private healthcare market in Ireland has contracted and will not necessarily recover as the economy recovers due to the changing demography here which is placing the cost of private health insurance beyond the reach of many who desire to be privately insured.
The challenge then is to devise a system that will bridge the gap between the service public patients receive compared to that received by their privately insured counterparts. Healthcare is a human right that ought to be available when it is needed and not when the system can respond. It will be necessary to achieve a balance between the range, standard and availability of the health and social care services we aspire to and the means by which the services can be paid for.
That will take time to accomplish. It will necessitate broad agreement being obtained from the people and those who represent them. While the new boundaries are being positioned, measures need to be put in place to deal with the greatest public scandal of our time. In one of the wealthiest countries in the world, hundreds of thousands of our people are being denied timely access to necessary out patient and inpatient hospital care. The increasing incidence of poor standards of residential care being experienced by older persons and persons with disabilities should be unacceptable and remedied urgently.
For the time being then, new political initiatives are required urgently. The overriding approach needs to be on meeting priorities based on evidence-based considerations.