Can Caring Efficiency Revitalise Ailing Irish Health System?

This Wednesday, the Irish Minister for Health, Dr James Reilly, published the Health Service Executive (Governance) Bill 2012—legislation evolved to pave the way for major changes in the design of Irish health services. “For too long the treatment of patients in our health services has had to conform to the needs of the system,” said Dr Reilly. “This new Directorate structure in the HSE will allow us to redesign the system to put the needs of the patient front and centre.” 

The legislation is seen as part of a drive toward improving healthcare standards in Ireland and improving the efficiency of their delivery, essential steps in the introduction of a Dutch-style ‘health insurance for all’ scheme mooted for 2016 under the Programme for Government.

The announcement of the new HSE structure was greeted, however, with the prompt resignation of the HSE chief executive, Cathal Magee. The new legislation foresaw structural changes within the HSE, including replacing the position of chief executive with that of a director-general, a move widely seen as watering down the top position at the HSE. 

Make no mistake – the crisis in our health system is a very real one

- Colm O’Gorman, Executive Director of Amnesty International Ireland

In further developments, the matter has also led to a spat among the governing coalition parties, with Dr Reilly (Fine Gael) apparently failing to notify Tánaiste Eamon Gilmore (Labour) at a cabinet meeting on Tuesday of Mr Magee’s resignation. Mr Gilmore claimed he subsequently found out about the resignation on the radio.

New Departure for Irish Health Service?
Welcoming the publication of the new HSE Governance Legislation on Wednesday, Fine Gael’s Cork South Central Deputy and Chair of the Oireachtas Committee on Health and Children, Mr Jerry Buttimer, said the new structures being put in place will ensure greater accountability of where and how the health budget is being spent. 

“Since coming to office, Minister Reilly has been attempting to get to grips with the health service, putting structures in place to ensure the delivery of a service that is fit for purpose,” said Mr Buttimer.

“The legislation being announced today will see the appointment of seven Directorates, each with responsibility for overseeing one area of the health service, such as mental health, hospital care, primary care, social care, children and family services, public health and corporate/shared service. This will provide a clear line of accountability, for the first time, of how money is being spent in each area. 

“This Government is serious about delivering services for the people based on their medical need and not the money in their pocket, … [and] is committed to developing a universal, single-tier healthcare service which will bring the cost of achieving the best outcomes for patients down,” he said.

“Minister Reilly, for his part, has succeeded in bringing trolley numbers down through the Special Delivery Unit, which saw the number of patients on trolleys down 17 per cent in the first three months of the year compared to the same time last year,” said Mr Buttimer.

Lack of Trust

A litany of issues has plagued the HSE since the advent of the economic crisis. Problems such as overcrowding remind the public of the 1980s, when lines of patients languished on trolleys in hospital corridors. Recent issues included a lack of accountability over the deaths of children in state care over the past decade. 

In another example of perceived flaws and inefficiencies within the health system, a report this week found that 19-year-old Galway woman Elaine Curley, who was involved in a car accident in a rural area, died after an almost two-hour ambulance trip to Galway Regional Hospital, although the accident occurred approximately 15 minutes from Roscommon County Hospital. Roscommon hospital houses a fully-equipped Accident & Emergency Department, which was closed in an initial round of government cutbacks in 2011. 

Despite such cutbacks, however, the HSE is faced with a staggering 280 million euro budget deficit for 2012, while the Croke Park social partnership agreement (under which public service workers secured jobs and wage levels in exchange for other reforms) means the government may have difficulty implementing the reforms necessary to bring health spending into line with national budgetary targets.

Years of Stagnation

In 2001, the Government announced its National Health Strategy, Quality and Fairness: A Health System for You, to “provide vision and strategic direction for development of the health and personal social services”. The strategy set out key objectives for the health system up to 2010, which included the consolidation of health services under the HSE. The strategy planned to deliver an improved health system, with better planning, maximised use of resources, and strengthened governance and accountability.

Eleven years later, however, reform is still on the agenda, and the failure of successive governments to resolve issues of efficiency and administration during the Celtic Tiger years have meant that they persist today. 

Speaking at a conference in Dublin in January of this year, Colm O’Gorman, Executive Director of Amnesty International Ireland, said that although the government parties put healthcare reform at the heart of their manifestos, there has been very little progress. The same problems remain, he said: reported delays in accessing medical cards, increases in private health insurance costs, inefficiencies in HSE management structures.

“Make no mistake – the crisis in our health system is a very real one that could ultimately ruin more lives in the long-term than the economic crisis if we don’t fix it,” he said. Mr O’Gorman added that our limited resources need to be used to ensure that “no matter who you are, or what you can afford, you will be taken care of when you get sick.”

Speaking in advance of that January conference, Dr Fergus O’Ferrall, and Irish health-policy expert, said: “That the Government is proposing major change in how we pay for healthcare in the middle of a grave national crisis shows just how badly we need reform. 

“There are 27 other countries with successful variations of social insurance funding for their health systems, so there is no reason why Ireland cannot have such a system adapted to Irish conditions. But we have to make sure we learn from their mistakes to ensure our reform is effective – we have no margin for error when the country’s finances are in such dire straits.

“It is time Irish law embeds the principle of universal access to healthcare, for which government must therefore be held to account,” said Mr O’Ferrall.

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