Health services have an outsized political impact in most cultures and western democracies in particular. They are a tangible outcome of the social contract that underpins these states, and their performance is one indicator of the extent to which the Government is upholding its end of the bargain.
The national soap opera that is the new National Children’s Hospital should be seen in this context. The ever-increasing cost of the facility – the bill now stands at €2.24 billion – may have lost its power to shock, but the corrosive effect on confidence in the Minster for Health and the Government continues.
The debacle is of a piece with the wider narrative that the Irish health service is uniquely wasteful, inefficient and failing to deliver. Arguments to the contrary – that health services everywhere are inherently expensive, inefficient and hard to reform – cut little ice with an electorate confronted with long waiting lists and queues at A&E.
They are not very interested in comparison with the faltering National Health Service in the UK, once the gold standard for a publicly funded system. Likewise, the complexities of implementing Sláintecare – the current blueprint for a “world class” health service – are of little interest to voters; they just want a better service.
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The task of running, never mind improving, the health service may be Sisyphean in nature, but it cannot be shirked. It remains the job of the HSE management and the Department of Health to contain costs and ensure that the €23.5 billion health budget is spent as effectively as possible.
To this end the HSE is currently undergoing yet another reorganisation under its latest chief executive, Bernard Gloster. Many of the changes seem to be being made with one eye to the signal they send externally. Senior management are being reshuffled and a number of top-level jobs are being cut. Whether this delivers any improvement in service remains to be seen but it addresses criticism that the organisation is top heavy. Likewise, whether improvement will result from the replacement of six regional hospital groups and nine community healthcare organisations with six new health regions remains to be seen.
In the short term, the Government has little choice but to cough up the additional money needed to complete the Children’s Hospital. There will be time to apportion responsibility once the doors open. Or perhaps, at that stage, nobody will be too concerned with the overspend.
Late October is the current deadline, and the fervent hope of the Government is that the hospital is open and delivering the promised improvements in the provision of health services to children before the next general election. Failure to achieve this milestone would only add to public anger about the health service and do the Government’s electoral prospects no favours.