Leo doing ambulance

This week the health service and especially its emergency aspect, was in the news again. The Government has promised another 300 extra beds, but the delays in emergency waiting lists for July/August are apparently worse than last year. Meanwhile, 230 permanent consultant posts remain unfilled, but the Minister quite rightly wants the existing well-paid consultants to do more work, and especially at the weekend.  And 15,000 nursing positions remain unfilled.

In fairness, Leo Varadkar (pictured above, getting hands on) has a very tough job. The problems in the health service are long standing and have defeated many Ministers. Varadkar, a doctor and a can-do politician, has been honest about the issues, unlike others, and has urged senior management in the health service that it requires a huge collective effort of everyone’s part to sort it out.

Varadar has said bluntly that he as the Minister, as well as department officials, HSE executives, group managers, clinical directors and union and patient representatives will all face either a collective solution or a collective failure if this crisis is not sorted.

There is no doubt there is a crisis, especially on the emergency front, and last week I got a taste of it, when I did two long stints in the Accident and Emergency ward of the Mater hospital in Dublin. I had experienced upper body pains and have since got the all clear, but when you have a cardiac history, you can’t take a chance.

Sitting in an A&E for many hours is an eye opener – the long waits, the lack of clarity or explanation from any visible staff, the lack of filtering out of junkies and drunks who are taking up time and resources and disrupting things and, most of all, the heroic work done by the doctors and nurses.

But these front-line staff are still under huge pressure and apparently starved of resources. Still – still! – the money gets sucked into management, bureaucracy and the salaries of senior people – always a key feature of the Irish public service, in any sphere.

I spoke to a young doctor in the A&E about it – most of his fellow graduates are off in Canberra and Ottawa working in better conditions – and he said ‘I will give me one image: stand outside an Irish hospital on a Friday at 3.30pm and watch all the senior people leaving in their big cars and high salaries – that’s where the resources go. Meanwhile, we have people working the floor here on 30k a year’. And he just shrugged sadly and went back to his busy job.

This is disgraceful and Minister Varadkar looking for another one and half billion will not solve the problem. The health system needs a root and branch overhaul, not having more cash thrown at it.

seamusCoffeyUCClecturer_large

Money is only part of the problem. This week, Seamus Coffey (above), of the Economics Department in UCC made this case forcefully and described how Ireland is actually proportionally in the top four EU countries for spending on health, education and welfare. This fact needs to be drummed home.

According to Coffey, the average expenditure in 2013 on these areas across the 28 EU countries was about 19.7% of GDP, while in Ireland, it was 22.8%. Ireland thus had the seventh highest spending in the EU on health, as well as on education and social protection.

And that is as a percentage of GDP, which is a problematic metric for Ireland given the oversized presence of multinational companies here. If we use a hybrid measure of GDP and GNP, Ireland would rank an impressive fourth, with only Denmark, Finland and Belgium spending more. ‘So if our health service is deemed inadequate’ argues Coffey, ‘it cannot be because we are not putting enough money on it.’

And yet still many politicians and experts call for just more money. Let’s be fair: there are a lot of great things to be said about our health service. It is subject to too easy criticism. Yes, the HSE is an unwieldy bureaucracy but the service itself is generally excellent, and is something of which I have had much experience, with personal and family medical matters: all of it was done smoothly with great support, and at little cost.

The problem is getting seen to and hence people languish on long waiting lists or, in the case of A&Es, try to get up the queue through emergency. But the reality is that A&Es have become the repository for all sorts of social issues, dysfunction, misbehaviour and unnecessary waste.

For a start, imagine the pressure that could be taken off our emergency staff if we could remove the drunks and drug addicts. And not just young drunks being carried in after binging at the weekends, but long time adult drinkers and drug abusers, often disrupting the waiting rooms and berating the staff.  One is sympathetic to these waifs and strays, many of whom clearly have addiction problems or mental health issues.

But the place for them to be is not in A&E, looking for attention and medicine and adding to the torment of ordinary people who are already ill. Twice, I saw the gardai called to deal with disruption in the waiting room but on both occasions, it seemed unnecessary and looked like incidents that the already present security staff could have dealt with, but didn’t. Another waste of public resources.

But the hospital policy seems to be that everyone has to be seen, and in the same fashion. Thus, patients who self-harm through drink and drugs are seen in the same way as those with domestic accidents. Surely this can be filtered out, or given a different level of priority.

And even then one has to wonder about the complaints that ordinary people go to A&E about, all of which seems to get the same attention, like getting into line for a taxi.

One very nice and elderly woman told me she was referred because of a swollen thumb, and was wondering should she not go home. The long waits do deter people eventually, but then patients with genuinely threatening ailments could also be leaving early. Another woman, also elderly, was in because of panic attacks, and was sitting with her daughter. I said they sounded like the sort of panic attacks that many elderly people might get and they both agreed and admitted that perhaps she shouldn’t be there at all.

Given our aging population, there will be further demands like this on our service, so perhaps it’s time to ask who really needs to be in our emergency waiting rooms and who shouldn’t. Ambulance crews also confide, in conversation, that some of their blue-light call-outs are simply not serious enough emergencies, and take the use of an ambulance when it could be more validly used.

But even to a casual observer, there are other areas, beyond emergency, which suggest considerable waste and inefficiency.

For example, millions are lost each year because of missed appointments so why doesn’t the HSE charge patients for not showing up, unless they have a good reason – as they do in the UK. Or are our politicians too timid to introduce such a measure?

Also why do we need so many repeat prescriptions, which are pointless and bureaucratic? I am on heart medication for the rest of life, with three tablets a day. And yet every three months I have to go to the doctor to have the prescription renewed. I don’t see the doctor: I just collect the re-issued docket: why? Is this not a waste of time and another charge for the doctor, which the HSE has to pay for?

Meanwhile, why has our health service been so slow to move to generic drugs, which are much less costly than branded prescription drugs? Why not outsource this service, as happens elsewhere, so the savings can be accelerated?

What we really need to do is filter out what really needs to be seen in our emergency departments, and what doesn’t. Our health service doesn’t just need more money, as Minister Varadkar knows, but it needs more efficiency, and prioritising – and a better use of resources. If the young Minister can get on top of that, he will have done a truly heroic job.

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