Analysis: Overcrowding is defining issue of Varadkar tenure

It is clear now that the ultimate assessment of Leo Varadkar’s tenure as Minister for Health will be based on his performance in eliminating queues and overcrowding in the health system.

The numbers were already trending upwards by the time he took over from James Reilly last year and to the ambitious young politician's chagrin, they continued to rise.

Varadkar is still popular with the public but a failure to get a grip on the health brief will do him no favours at the next election or when history books are written. Ask Fianna Fáil leader Micheál Martin, who is still criticised for an inability to make hard decisions when health minister.

Varadkar must have thought he was on to a winner when he came up with soft targets that seemed eminently achievable: have no one waiting for an appointment or procedure longer than 18 months by last June; and no longer than 15 months by the end of this year. By contrast, Reilly, with less money, tried to have no one waiting for longer than nine months – and failed miserably.

But Varadkar was quick to learn the truth of a former minister Rory O’Hanlon’s comparison of the health service to a “black hole” that soaks up all money without offering up much in return.

More than 2,000 additional front-line staff have been recruited in the past year. More than €130 million has been found to fund special initiatives to tackle emergency department overcrowding and long waiting lists.

Fair Deal scheme

More beds have been opened and extra funding provided for the Fair Deal nursing home scheme, thereby freeing yet more hospital beds.

And yet none of this seems to have made any difference to the deep-seated problems of the health service. If productivity is measured in terms of improved outcomes, it hasn’t happened. The trolley crisis is worse than it has ever been; last January saw a record of 601 patients on trolleys and the problem has persisted right through the summer.

As for waiting lists, they dipped dramatically at the end of June as an all-out effort was made to get long waiting patients treated. Some 20,000 patients were referred to the private sector and the Minster claimed 96 per cent-plus achievement of his target.

But as so often happens in the health service, once the foot was taken off the pedal, and the money taken away, the situation started to worsen again. The lists are swelling again. In just two months the number of outpatients waiting more than 18 months grew from 1,988 to 11,235. The number of people awaiting inpatient or daycase treatment for over 18 months increased from 19 to 1,368.

It is hard to assess the overall trend. The mid-year figures were artificially depressed by taking patients off the waiting list where an appointment had been made, even if they hadn’t seen a doctor at the time. It looked good in terms of fulfilling the target, but it doesn’t impress so much today, now that many of these patients have returned to the lists.

The Minister’s decision to throw another €25 million at the problem in the coming months will probably keep waiting lists in check for the rest of the year, but it’s far from a long-term solution. That will probably have to await another minister in a future government.