The more things change, the more things stay the same. So it is with our chronically ailing health service. Except for one important point: the number of people who are sick enough to require a hospital bed continues to rise.
Unwelcome new records were set this week. By virtue of lying on a corridor or in a heavily overcrowded emergency department, these patients immediately fall into a higher risk category.
More people will die unnecessarily as a direct result of not being managed in the safe environment of a fully functioning hospital ward. With a reasonable health spend by OECD standards, how did the Irish health system come to this?
While the most immediate trigger is influenza, there are many reasons for the gradual meltdown of the Irish healthcare system.
Our public health service is already dangerously understaffed, and doesn’t have enough beds in the system. Our population is ageing. Regular cancellations of elective surgeries and other treatments mean a greater number of people present to emergency departments as their untreated illness worsens.
It’s a zero-sum merry-go-round, with patients and exhausted healthcare staff as unwilling passengers.
But the main culprits are our politicians and senior Health Service Executive managers. Over-populated with over-promoted officials, the HSE has been one big failure. There are daily examples of how it continues to preside over a dysfunctional health system that – rather than safeguard us – potentially threatens the wellbeing of every citizen in this State.
However, the democratic buck stops with politicians.
Monolithic edges
Mary Harney set up the HSE but without tackling its root cultural deficits. Others, including the current Taoiseach, have tinkered around its monolithic edges.
Simon Harris talks the talk – acknowledging for the first time a need for additional hospital beds – but, like so many Ministers before him, fails to square the circle with concrete action.
One politician especially dropped the ball. James Reilly admittedly was faced with the greatest economic challenge of any recent Minister for Health but he presided over a slash-and-burn of the health service. He almost destroyed Irish general practice with a series of brutal Fempi cuts.
Yes, acute budgetary cuts to the health service were necessary as the troika circled, but a better politician would have book-ended the cuts in line with improved economic performance.
Dr Reilly is also responsible for some of the severe recruitment challenges currently faced by our health system. By creating a yellow-pack pay grade for new hospital consultants he has ensured that many posts attract zero applicants, leaving senior decision-making to a cohort of temporary post-holders.
And none of his successors has had the wisdom or political nous to repair that damage.
Election issue
And, however unpalatable it may seem, we the public are also responsible for the health service debacle.
How so? By not making the health service the main issue in any recent general election. Until voters lay it on the line for politicians, can we really be surprised when they fail to deal with the issue effectively?
Over the coming weeks we will see the health service plumb new depths of despair. Until now children have been largely spared the trauma of prolonged waits on trolleys. However, there are signs that that is about to change. The three Dublin paediatric hospitals are, for the first time, having to hold young patients in the emergency department while waiting for a bed to become available – and this is before the flu has left its mark on this age group.
For adults the wait to be initially assessed by a triage nurse will continue to lengthen. The already long wait to see an emergency department doctor will get even longer. This increases the likelihood of the seriousness of your mother’s or my brother’s condition not being recognised in a timely manner, with potentially fatal results.
Key moment
For this observer a key moment will be the cancellation of urgent cancer surgeries as many patients who undergo major surgery cannot be safely operated on without an intensive-care bed to transfer them to post-operatively.
Or it could be when emergency departments completely choke up, and some will be forced to close.
You can only stretch an elastic band so far before it snaps. Because of a lack of acute hospital beds, a failure to develop primary care and a shortage of heroic healthcare staff, that painful snap may be closer than some wish to admit.