HEART BEAT:With a deficit in excess of a billion euro, the HSE is currently deciding where the axe will fall
IT HAS ALL been experienced and written about before. We either forget or were not taught, or did not read. Edmund Burke could have been writing about our squandering of the good times; “If we command our wealth, we shall be rich and free; if our wealth commands us, we are poor indeed.”
Well, we’re going to be poor all right and surprise, surprise, the HSE is going to have a major budget deficit, in excess of more than a billion euro.
There may have to be cuts, they tell us. Well there’s nothing new there except that lately they have taken to calling the process “reconfiguration”.
The HSE is considering the position – and where the axe might fall. Why not the usual indiscriminate swipe, without rhyme or reason I asked myself.
Incidentally, I am led to believe that the only doctor on the HSE board has resigned leaving it a medic-free zone. Bit like running a ship with no sailors; no wonder we are on the rocks.
Remember I wrote about the hospitals in Monaghan and Cavan and the ability of Cavan to cope with the closure of the former, since it had only received four beds extra. Well, it seems that this axis is to receive €12 million less in allocation, and the Mid West, where the powers are trying to perpetrate the same confidence trick, is going to get €13m less.
Well there’s not much comfort there for those fighting to retain acute services in Ennis and Nenagh. Limerick’s “centre of excellence” to deal with patients decanted from the running down of the peripheral hospitals doesn’t appear to be on the immediate horizon either. In other words, it’s the same scam as in the northeast. There is no new facility now or in the foreseeable future.
All the major teaching hospitals face cuts as well. Considering that they could not run on their allocations last year, it is hard to see anything but service cutbacks being the outcome of this situation.
Meanwhile, the new salary scales for the consultants comes into force and they are certified as being compliant with the new contract, €250,000, for doing as they did before, because they haven’t got the beds to do anything else. This farce will make no difference to the problems besetting the health service.
Listening to people mouthing about consultants working in teams is meaningless prattle by people who know next to nothing about the practice of medicine. How would they, these people, who have never been in the system they purport to govern?
We hear talk of breasts, colons, prostates – rather than scared, sick patients and their families. We hear talk of cancer strategies which may take up to 20 years to deliver and this in a country that cannot afford to vaccinate little girls against cervical cancer. Just for the record, it is not a matter of vaccinate or screen; both are required.
Dr Samuel Johnson, quoted in Boswell’s Life, said “Sir, the insolence of wealth will creep out.” I thought of this when I heard Mr McEvaddy talk about the heroes of Anglo-Irish and I wondered was he the same Mr McEvaddy whose new private clinic was recently opened by the Minister.
You can have a colonoscopy there for €900. Strangely, there is a big national waiting list for colonoscopy. Maybe the National Treatment Purchase Fund will refer patients there. Wouldn’t that be a solution to that particular problem?
Last week I described cutbacks affecting young doctors and their training. I did not mention that their training grants, allowing them to attend meetings and do courses, some of them compulsory, have been abolished also.
Furthermore, attendance at lectures in hospitals, teaching rounds and grand rounds, where a visiting specialist teaches the medical body, is not to be remunerated in the future.
I know of no other medical system in the world where such an assault on medical teaching and learning has been perpetrated. It is clear that the people responsible for this debacle have not the faintest idea how medical teaching is organised or, indeed, medical practice works.
I do not think that there is any hope of recovery with the present Minister and her thrust toward privatisation.
Equity of access is a concept that she cannot grasp. Every action discriminates against those without private insurance, a growing number, as even she might have noticed.
Meanwhile, where are the cuts in the HSE and its gross over-administration? Maybe some of these functionaries could be employed to spy on the junior doctors and make sure they don’t sneak into the odd lecture or, better still, check on the consultants to make sure they are working in teams?
It is a fact that every day the doctors cancel surgical and procedural lists and that elective admissions, even for cancer investigation and treatment, cannot be admitted because there are no beds. This has not changed, it is about to get worse.
The net effect of recent changes brings consultant salaries close to €250,000 each and the average non-consultant hospital doctor (NCHD) loses €10,000 per head, and also a large part of their education.
The medical system, like the country at large, is rudderless and without leadership.
On all fronts we need a change.
Maurice Neligan is a cardiac surgeon