LONG BEFORE our current economic woes appeared on the horizon, our health system was showing signs of distress. With up to €1 billion now shaved from the health budget and with an inexorable rise in those entitled to free medical care as unemployment rises, what lies ahead for public healthcare in the Republic?
Despite the efforts of the Health Service Executive (HSE) it is inevitable that patients who depend on the public system will experience some reduction in service. The cancellation of the planned cervical cancer vaccine programme and the uncertainty over dedicated cystic fibrosis facilities at St Vincent’s hospital, Dublin, are just the tip of the rationalisation iceberg.
However, there are those who maintain that improvement is possible without the expenditure of additional capital. In an interview with this newspaper, new chief medical officer of the Department of Health Dr Tony Holohan was adamant that both the quality and safety of patient care could be improved using existing resources. He sees health system efficiency and patient safety as one and the same, with the economic downturn representing an opportunity rather than a threat.
His comments, just days before the publication last week by the Health Information and Quality Authority (Hiqa) of a report into the quality and safety of services at the Mid Western Regional Hospital in Ennis, are timely. That investigation was triggered by serious concerns about the risk to patients at the hospital. The management of breast cancer patients Ann Moriarty and Edel Kelly, both now deceased, was clearly deficient. And while the report is likely to be used to reconfigure services elsewhere in the State, it is vital that one recommendation in particular receives national attention by the HSE. In a section on diagnostic services, the report calls for a safe and robust system for the reporting of all X-ray and laboratory tests: “This system should involve the prioritisation of test reporting and protocols for the follow-up of the reports by the identified clinician”.
Had such a system been in place, the patient journey experienced by both Ann Moriarty and Edel Kelly would undoubtedly have been less traumatic. Both cases demonstrated how easy it is for test results to disappear into the vacuum of a poorly performing hospital. People are entitled to ask if systems are in place in larger and more prestigious hospitals to ensure test results are unfailingly fed back to patients and their family doctors.
Unfortunately, administrative reform at the top of the HSE is currently stalled. The appointment of a new national director of operations to oversee the effective regionalisation of the health service has been the subject of a stand-off between chief executive Brendan Drumm and the HSE board. As a result, it was decided not to fill three vacant national director positions, including the key post of director of operations. Prof Drumm has described the three positions as “essential drivers in an integrated service programme”. The board of the HSE must not allow the absence of administrative clarity further endanger patient safety. Hiqa has provided a road map – it is up to the HSE to follow it without delay.