HEARTBEAT:Health's circular circus rolls on and on, in an endless journey to nowhere
' DUAS TANTUM res anxius optat, panem et circenses", roughly translated from Juvenal's Satires, as "only two things the folk want, bread and circuses". Well, the bread may get a bit tight in these straitening times, but as long as we have the current Minister for Trolleys and the comedians in the HSE, we'll continue to have the circuses.
You couldn't make it up. Shakespeare in King Learnoted "the wheel has come full circle", nursery rhymes such as "here we go round the mulberry bush", songs such as L'on y danse tous en rondall embrace the principle of circular movement. None espouse it better than our heroine and her assorted heroes.
Such circularity of course serves a purpose: you don't have to go anywhere or achieve anything. You don't arrive at an ultimate goal. If the wheel is big enough and you're lucky, people may not even notice that you're back where you started.
The HSE is to decentralise into X number of regional entities. They were called health boards, and before they were abolished to make way for the Minister's new dawn, there were 11 of them. The new dawn that was described as a centralised solution to all our health service problems, was widely welcomed at the time. It appeared logical to abolish the 11 and bring all aspects of the service under central supervision, funding and control. At this point please remember that we have a population of just over four million souls.
Reasonable people felt that we would see concentration of management skills and importantly, economies of scale. We were wrong. The same old honchos, who had populated the landscape of the health boards simply donned new hats, reinvented this important wheel and now promised us a glittering future. This was the Minister for Trolleys' "historic piece of legislation". Some brave new world it turned out to be.
Now we're back where we started but you're not supposed to notice. We've another new dawn and we're going to decentralise again. I'm repeating myself. That's the worst of talking about circles. There's another little bit of magic here. Centralisation yielded no economies of scale. Splitting it all up again could lead to maybe 1,000 redundancies; not job losses or cuts; mark you.
We'll just have different managers and different "vertical pillars" and all will enmesh and integrate smoothly. "Stop for God's sake, my head is swimming. Will there be any more beds?" I wonder. "Can your thick head not grasp the fact that beds are passé? We're going to have a cancer strategy and centres of excellence and quangos of every size, shape and expense. Never mind what we said before. Who'll remember any of that?"
Ah yes, you can't be expected to remember everything but " mendacem memorem esse oportet" should be a principle for those seeking to confuse the public as regards their previous statements. The mendacious should indeed have a good memory.
It looks in any case as if there is not going to be any money for anything other than talking. We're not to talk about cut-backs, we're to talk about savings. We've been talking about those for years in the health service. We're told they are not really happening. We are asked to understand that the HSE has to live within its budget and if a byproduct of such frugal living is that patients don't get treated: then so be it.
If we have no money and times are getting worse, what will happen to the roll-out of the primary care strategy? What will become of hospital- building programmes? What will become of the cancer strategy, given that the designated hospitals have not the capacity or the staffing to receive the additional influx of patients?
We are told that central HSE will be responsible for policy and that management of the funds and services will be devolved to the rim of this wondrous wheel. May we then enquire what will become of the previous fount of policy making, the Department of Health? What do the good folk in this department do now, since their previous function appears to have devolved to that repository of all the talents, the HSE? There's a good opportunity to effect savings.
I didn't get back to Cork and the NTPF, and meanwhile Letterkenny and Louth County Hospitals add to the dismal news from this dysfunctional service. I was distracted by my circles and the image of that mythical bird that flies round in ever decreasing concentric circles until it finally disappears up its own rear end. It should be the emblem of the HSE.
• Maurice Neligan is a cardiac surgeon