If the biggest thing that happened in the health service this year was the appointment of a new Minister, the main focus in 2015 will be on how Leo Varadkar performs in the job.
Varadkar has enjoyed a long honeymoon since his appointment last July, thanks to a combination of factors. The brightest, youngest and most politically savvy member of the Cabinet couldn’t help looking good against his predecessor, James Reilly. He has earned continuing goodwill by being frank and energetic, and by downplaying his ambitions relative to Reilly’s often grandiose plans.
He parlayed his political capital in an improving economic environment into extra money for the health service for next year, though the financial situation is looking nowhere near as rosy as the initial post-Budget spin suggested.
Trolley numbers
The Minister’s grace period will most probably end within weeks, when trolley numbers and waiting lists hit their deep-winter highs. Already this month, up to 400 people a night are being treated on trolleys in hospital emergency departments on many nights, not far short of the levels that drew howls of admonition from Reilly when he was a Fine Gael opposition spokesman.
An outbreak of homegrown Ebola cases is looking unlikely now, but any surge in flu or respiratory-type illnesses will put immense pressure on hospitals to cope. In such a scenario, the Minister will only be as good as his emergency planning.
Health in Ireland is intensely political, so the imminence of the next general election – likely in early 2016 – will dominate policymaking in the area over the next year.
The Minister’s job is to manage a difficult sector and prevent or minimise any major mishaps – as far away from “the vision thing” as you can get.
The central task for any health minister is to get waiting lists down, but it’s hard to see Varadkar making much progress given the money available and the staffing situation.
The most obvious way to tackle the problem is to reduce the number of delayed discharges in the system. These are patients, mostly elderly, who are well enough to be discharged from hospital but who can’t be because of the lack of care options at home or a long-term bed in a step-down facility like a nursing home. More than 850 such patients are occupying expensive hospital beds, and exposing themselves to unnecessary risk of infection.
Part of this problem is due in turn to the pressures on the Fair Deal nursing home scheme. Older patients are languishing in hospital while waiting for a nursing home place under the scheme, for which the waiting list continues to grow.
The Minister is proceeding with a number of modest initiatives designed to have an impact on these waiting lists, but the sums of money involved won’t make much more than a dent in the problem. Once again, the approach is one of containment rather than cure.
Free GP care
The big policy initiative from the Government next year is free GP care for the under-sixes. Designed as a vote-winner among the “squeezed middle”, the plan has attracted widespread criticism on resource and fairness grounds. Family doctors, in particular, have been vocal on the measure but the betting is the Irish Medical Organisation will relent once the Minister makes the right offer.
One useful and lasting contribution Varadkar could make is to sort out the staffing crisis in medicine and nursing. Making it more attractive to well-educated, highly mobile doctors and nurses to work in the Irish health system will probably require more spending on salaries, even for those consultants who are already well paid as a profession, but there appears to be no other way to solve the problem.
Budgets
This year, the HSE is getting the largest supplementary budget in its history, even as the usual promises are made about breaking even next year and the big stick being waved if this is not achieved. In fact, the Minister has been remarkably relaxed on the issue of spending since he came into office.
No serious effort was made in the second half of the year to rein in costs and, as a result, hospitals massively overspent. The same charade can be expected in 2015, to the frustration of the rest of the Government, and there is of course no possibility of the brakes being applied in the immediate run-up to an election.
Neither, and for the same reasons, will we see much-needed reform and rationalisation of some services which are underperforming or which are verging on unsafe. You can’t run an emergency department safely when it houses an extra 50 patients a night on trolleys. You can’t run surgical units safely when the throughput of patients is so low to enable staff to maintain their skill levels. You only need to read the newspapers to see the huge safety issues raised in recent years around certain maternity units.
None of these challenges will be tackled head-on because of the political fallout that would result from closure, rationalisations or changes in configuration.
It is the eternal tragedy of the health service that political fixes tend to be put in front of clinical considerations and, in this regard, 2015 is unlikely to be any different.
