CONFIRMATION BY Minister for Health Mary Harney of “considerable” cuts in public health spending for 2010 means the health system faces an extremely challenging year. With a funding shortfall of at least €1.2 billion already signalled for next year, it is now a question of how deeply cuts will affect patients and their families. Such a sudden and substantial reduction in spending threatens to dwarf the cuts of the 1980s when the system was stripped of hospital beds and community services were cut to the bone. Some experts maintain the health service has never fully recovered from the repeat surgery applied during that recessionary period.
At a conference on health service funding, Ms Harney indicated she will be looking closely at the cost of providing services here compared with other countries. “We’re going to have to look at efficiency levels, at output levels, we’re going to have to look at how people work – we need greater flexibility, for example,” she said. The Minister is correct to focus on these issues, but it will be a major challenge to implement such changes in the short timeframe available. However, needs must: health service unions faced with a choice between jobs or pay cuts and greater productivity must be open to the sort of changes she will propose.
There are many examples of waste in our hospitals. Healthstat, the Health Service Executive’s monthly report on the performance of acute hospitals, has consistently shown a 15 to 20 per cent “did not attend” rate at many outpatient clinics. In one Dublin hospital, almost one-third of people booked for assessment at its ear, nose and throat clinics never showed up. This represents a massive waste of staff time and hospital infrastructure; it is unacceptable that the HSE has yet to tackle such gross systemic waste. The rising numbers of people suffering delayed hospital discharge, despite efforts to tackle the problem, means that about 360,000 bed days, that could be used to treat people in acute medical need, will be lost this year. And this problem will not be helped by continuing delays in implementing the “Fair Deal” on nursing home costs.
Many proactive reforms must be considered also. This week’s conference heard a proposal from the Netherlands to encourage greater e-mailing between doctors and patients. A number of studies have shown both the efficiency and acceptability of such clinical interactions. But no matter how innovative, such initiatives will only work if implemented from the bottom up. The most successful money-saving efforts will be those proposed by frontline staff. Exclusively relying on centrally driven, inflexible diktats, such as that adopted by the Department of Finance in recent weeks, merely causes avoidable delays and impacts negatively on patient care.
Unfortunately, even with the best intentions, the lesson from the 1980s is that the old and disadvantaged suffer most when health service cuts are introduced. Politicians, managers and frontline staff must work together to avoid a return to the days of three- to five-year waiting times for hip replacements and cardiac procedures in our public health system.