Madam, Ken Andersen (Opinion, March 26th) advocates patient empowerment and professional accountability in the delivery of a responsive health service.
The former commercial director general in the British department of health concludes that the French system of healthcare succeeds because France has embraced “an agnostic system where providers are chosen and survive based on ability and quality of outcome, and not idealism”. While this may be so, he omits the fact that funding for healthcare in France is based on a model of social insurance, and that this comes at a significant cost to the French exchequer. (In 2005, the French spent 11 per cent of GDP on healthcare. The corresponding figures for Ireland are 5.8 per cent on public healthcare and 1.7 per cent on private care. (Source OECD www.ecosante.org)
And France, like other successful and equitable health systems, includes a number of fundamental features that differ from the Irish system. Like other European countries, they recognise that it is ultimately more efficient to have healthy populations than sick populations, and on this basis, they invest heavily in preventative medicine and primary care. Family doctors are networked within the community and common illnesses are treated locally without delay. Access to family doctors is free or affordable to all, and not based on ability to pay. There is no complicated means testing. Waiting lists for diagnostic facilities such as X-rays, endoscopy, ultrasounds etc are short and easy to access.
Specialist services are provided in regional centres of excellence, and these are properly integrated with local community-based care.
A massive system failure in Ireland has led to an over-reliance on hospital care, with ensuing bed shortages and overcrowding. The recent launch of the HSE HealthStat programme shows this in graphic detail.
The conclusion drawn by the HSE appears to be that many hospitals are “underperforming” and should be accordingly penalised. But in reality, the underperformance is not because these hospitals are lazy or careless, but because many external factors conspire to render it impossible to deliver care in a timely and efficient manner.
To achieve an Irish health system such is available in France requires not only patient empowerment and professional accountability, but also a big shift towards investment in developing an accessible and responsive community- based service. The recent HSE Transformation document provides a good description of how this might work. But as is often the case, there is an enormous gap between HSE rhetoric and what is happening on the ground.
And the current process by which the HSE penalises services that are over-stretched and at breaking point, because they are over-stretched and at breaking point is utterly counterproductive and borders on the scandalous.
It is certainly not patient-centred.
What we need is an honest, transparent and sensible approach towards the transformation from a “sick” to a “health-promoting” system of care. I agree with Mr Anderson. The health service should serve the patient, not the other way around. Lots of other European countries do this. Why can’t we? – Yours, etc,