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Building a better health service?

12 Jan 2017

Dr Muiris Houston

While attempting to be positive this will be a Happy New Year, Dr Muiris Houston pokes holes in the HSE National Service Plan 2017, which he warns could easily become a chasm

Are you settled back into a routine as you read this? While it’s great to get some sort of a break over Christmas and the New Year, the return of routine can be helpful at this time of year. That presumes of course the annual flu season hasn’t knocked your schedule for six or your hospital isn’t backed up with trolleys stretching into the car park.

Part of routine is dealing with reality. And the reality of healthcare is reflected in the hard facts of the 2017 National Service Plan ‘Building a Better Health Service’, published by the Minister for Health and the HSE just before Christmas.

Not surprisingly, the plan focuses on some of the key pressure points in our public health services: hospital waiting lists, emergency department crowding and the provision of home care and nursing home packages.

On perennial emergency department crowding, the plan has little to offer. It’s basically the existing €40 million Winter Initiative, which has already failed to stem the tide of rising trolley numbers in emergency departments.

“The €40m made available for the Winter Initiative in 2016 has been rolled into the 2017 funding base and this should (my emphasis) lead to improvements in patient experience times, numbers of patients on trolleys and access to appropriate home care packages,” is what the Department of Health said in a statement.

That must go down as one of the most forlorn and plaintive “shoulds” in the Department’s chequered history.

Completely unrealistic
A projected 1.8 per cent increase in the number of people who will receive home care packages in 2017 is completely unrealistic. Already, some patients and their families who have been approved for a package are being told by local HSE offices that funding is not available to implement the decision. How such a miserly funding increase can meet current demand, let alone satisfy patient need next year, was approved at the highest level is beyond me.

At least HSE Chief Executive Tony O’ Brien was honest when he warned its budget for 2017 may not be sufficient to meet competing demands, including replacing ageing medical equipment and costs of new drugs.

It was a point picked up by Dr Tom Ryan, President of the IHCA, who noted that acute health infrastructure was crumbling, with many hospitals attempting to treat patients with inadequate facilities and equipment that was increasingly obsolete.

He said that it was disappointing that the National Service Plan did not provide funding to address the critical acute hospital and mental health capacity deficits that were preventing consultants and frontline staff from treating patients without delays.

“I am also very concerned that despite promises to address the recruitment and retention of nurses and midwifery staff, no effort is being made to address the hundreds of vacant consultant posts that exist across the country and are having a massive impact on patient care,” Dr Ryan said.

By general consensus, the holding of a walk-in recruitment event for nurses returning home for the festive period — a big part of the service plan announcement — won’t make much of a difference. Indeed, the INMO responded with a 90 per cent in favour ballot for industrial action brought about by ever-growing staffing gaps in the acute hospital system.

Curious development

Does anyone else view the holding back of some of the budget by the Department of Health for allocation during 2017 as a curious development? This was how it was put in the service plan announcement:
“A sum of €36.5 million is being held by the Department of Health for:
• Mental health services — €15m to initiate new developments in 2017.
• Primary care development — €18.5m for service developments including reduced prescription charges for over 70s.
• Social inclusion — €3m to invest in services relating to addiction and marginalised groups.”

Long-term health commentators and cynics (who, moi?) will suspect a Machiavellian motive behind the move to create a potential floating fund of cash beyond the immediate grasp of the HSE. Watch this space.

In truth, there are plenty of minefields ahead. The lack of a clear allocation of funding to meet back pay due to unfulfilled elements of the hospital consultant contract — the subject of a recent legal test case — represents a significant threat to this year’s health budget. Throw in an unexpected global infectious diseases event and existing holes in the service plan will become a chasm.

Did I start this column by suggesting the benefit of routine? Clearly that was written with the remnants of festive cheer clogging up my central nervous system!

Whatever lies ahead I wish all readers a healthy and happy New Year.

The post Building a better health service? appeared first on Irish Medical Times.

Click here to view the full article which appeared in Irish Medical Times: Opinion