With the influenza season taking off, the peak annual surge in demand for hospital services is underway. Patients requiring acute admission to a public hospital face considerably longer waits on an emergency department trolley as the system chokes up. The Irish Nurses and Midwives Organisation counted a record 612 patients on trolleys yesterday. At the same time, those waiting months and even years for a surgical procedure are likely to see their admission date postponed until the spring.
We have been here before. Yet the Department of Health and the Health Service Executive (HSE) do not appear able to move beyond doing the same thing over and over again and expecting a different result. The current €40 million winter initiative, for example, has had no impact on rising trolley numbers.
The allocation of a budget in excess of €14 billion for 2017 means that, on paper at least, the cutback years have come to an end. But there is no accompanying optimism from the HSE which has warned that its increased budget may not be sufficient. The cause of such endemic inertia is to be found in the breakdown of the annual budget allocation. Primary care receives €808 million while acute hospital sector funds amount to €4.4 billion. In terms of an annual increase, the primary care sector receives an extra €30.8 million while acute hospitals are allocated an additional €118.4 million. Despite specific commitments from politicians over many years, and an acknowledgement by senior HSE leaders that a “shift to primary care” is the only logical way forward, funding decisions have not followed this logic.
It represents a continued failure to grasp a political nettle: the need to progressively transfer funding from secondary to primary healthcare. This would require facing down angry local constituents as well as a powerful medical consultant lobby. There is no indication yet that Minister for Health Simon Harris will be the one to provide the leadership despite his recent comments that if we are serious about the shift to primary care we have to "put our money where our mouth is".
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In spite of its considerable challenges, however, the health system has managed to make some progress. The end of year report card “Health in Ireland: key trends 2016” shows that people in the Republic are living longer and are less likely to die of cancer and heart disease compared with 10 years ago. Life expectancy has increased by almost two and a half years since 2005 and has been consistently higher than the EU average throughout the last decade.
An early negotiation of a new GP contract, centred on comprehensive chronic disease care in the community, would offer some hope of this year being a turning point for our public health system. However such optimism must be accompanied by a significant dose of caveat emptor.