What is the truth about the Irish health system?

Confession time: I've seen hardly any of RTÉ's recent fly-on-the-wall documentary series about the health service. You would think Keeping Ireland Alive, with its 75 cameras trained on hospital wards and doctors's surgeries on a single day last May, would be required viewing for health journalists like myself.

Well, it should be. I did switch on the programme several times, and stayed long enough to see it was brilliantly edited and profoundly moving. As one of the many reporters who have been thrown out of an emergency department for daring to open a spiral notebook, I could only envy the access the HSE gave to the makers of the series.

Call me squeamish, though. There were just too many surgeons' knives being waved around, too many bits pulled out of human cavities and too much human heartbreak on show for me not to reach for the remote. I knocked it off for the same reason I've never seen ER, or Grey's Anatomy, or that programme on Channel 4 where they performed surgery live.

Skill and dedication

By and large, the series showed a different health service from the one you are likely to read about in the media. The focus was on the skill and dedication of staff, the courage of carers and the fortitude of patients. Bureaucratic hassles, resource issues and internal tensions, where they were hinted at, belonged in the background.

The response to Keeping Ireland Alive has been overwhelmingly positive. The reviews have been good too, and staff are justifiably pleased with the spotlight shone on their work.

All of which begs a few questions: is this the real story of the Irish health service? Are those who write about health in the media being overly critical?

This is the narrative politicians love – when in power. Not only is great work being done every day, they tell us, but things are getting better. Any problems that emerge are dismissed as mere glitches capable of early resolution.

The evidence in relation to the performance of the health service is mixed. Life expectancy is rising, and death rates for conditions such as cancer and heart disease are falling.

The health service can take some credit for this, and for more specific improvements in limited areas such as stroke and hospital-acquired infections.

Yet we still lag behind our European neighbours on most measures of performance and, for some indices, we are in the dunce’s corner – in respiratory disease and primary care for instance.

Daily shortcomings

Many of the stories I write about problems in the service come from staff confronted by the daily shortcomings of the system. They often relate to access to healthcare: trolleys in emergency departments, waiting lists for appointments and procedures, a lack of options in community care.

The problems are long-standing and in many cases they are getting worse, hence the frustration of staff.

Money isn’t the answer. Ireland has one of the highest levels of health spending in Europe. The health budget trebled in size during the boom years and, while it was cut over the past decade, the reductions are lower than those inflicted on other areas of society.

International comparisons tell us we employ more nurses than most other places and, on paper at least, the salaries we pay are generous relative to other European countries. On the flip side, we have too few doctors and hospital beds.

This is an “in-between” phase in the development of the health service. The years of big investment are over, but there is enough money around this year to solve the worst problems. The Government is weak and likely to be short-lived, and there is no political consensus on health. The Oireachtas committee looking at the future of the health service is only beginning its work.

Broader view

It is, therefore, a good time to take a broader, more reflective look. The media too needs to examine whether it gets the balance right on health coverage. Is the glass always half-empty? Does a focus on individual cases where things go wrong give a misleading impression of wider standards? Do we critically examine the arguments made by health commentators?

Many of these commentators have skin in the game; most health managers, for example, were or are doctors or nurses. Decisions about resource allocation can benefit staff in their private work as well as affecting public services. Patients’ groups get funding from drug companies.

I would love not to have to write stories about long waiting lists, botched operations or broken promises. I would love not to have to report that delays in, say, scoliosis operations or stroke rehabilitation are getting worse, not better. I would love to find that the many interest groups in the system are in agreement.

Sadly, this is not the case. About 20 per cent of the health system is misfiring. I will not be running out of things to write any day soon.