Some success in tackling public hospital ‘carnage’

It is a mark of how dire a state the Irish health service is in that the end-of-year figures for waiting lists and queues can be considered a qualified success.

More than 386,000 people on outpatient lists and 300+ people on hospital trolleys every morning show how poorly the system is managing demand, but things could have been much worse.

The year kicked off with a record 601 people on trolleys in early January and for most of the months that followed, the numbers continued to get worse compared to the same month in 2014. Inpatient and outpatient waiting lists also soared.

Despite the efforts of an energetic new health minister, the spending of tens of millions of euro in additional monies and the creation of sundry plans and taskforces, the figures kept moving in the wrong direction.

Individual "hard cases" popped up with distressing regularity to drive home to the public what one doctor called the "carnage" taking place in hospitals. In January, 81-year-old Gerry Feeney died three weeks after being discharged from Beaumont Hospital, where his family said he was treated with "no dignity" and sat in a "soiled state, in public view".

In June, Rose O'Halloran, at 101, years older than the State itself, spent more than 24 hours on a trolley in the noisy confines of the emergency department of Tallaght Hospital. In November, it emerged a 91-year-old man spent 29 hours on a trolley in the same hospital while his wife was also in the hospital.

Situation becoming critical

By autumn, the situation was becoming critical for Minister for Health Leo Varadkar and the Government. Mr Varadkar's inability to get a handle on the waiting list problem threatened to deal a fatal blow to his longer-term political ambitions, not to mention the Government's hopes for re-election.

The young minister sought to rally the troops and sent HSE director general Tony O’Brien in to personally head up the taskforce dealing with emergency department overcrowding. Mr Varadkar claimed “heads will roll” should there be no improvements, then withdrew the threat when it was apparent he had no power to remove senior health officials.

There was only one thing to do: continuing in a long tradition of health ministers, the Minister threw money at the problem. Yet more funding was obtained for additional initiatives designed to tackle overcrowding and long waiting times for appointments and treatment. Long-mothballed beds were re-opened and private doctors were enlisted to treat public patients.

The strategy has begun to bear fruit. The outpatient waiting list is down 30,000 from a high of 414,000. Trolley numbers are down about 20 per cent on a year earlier. Mr Varadkar won’t make his soft target of having no patient wait for an appointment or treatment for more than 15 months by the end of the year, but he mightn’t be far off.

We can hold off on the ticker-tape, however. After all, we’ve been through this only two years ago, when the last minister, James Reilly, effected a drastic improvement in the waiting list figures by throwing money at the problem. Once the funding was removed, however, the lists soared again.

It’s hard not to come to the conclusion the Government has given health enough extra funding to ensure overcrowding and queues stay below record levels, without doing anything to banish the problems permanently.

HSE budget

It there was a touch of déjà vu about overcrowding in the health service, the problems with the HSE budget were definitely a familiar refrain. Despite earnest protestations that “this year it will be different”, health-service budgets were overspending from the start of the year and by December they needed an injection of €600 million in a supplementary budget to break even.

The budget deficit was caused by special factors, we were told, but then deficits are always caused by special factors. This year, it was the fault of the initiatives to tackle the trolley crisis and long waiting lists, but also the requirement to fund the Government’s pet project of free GP care for under-sixes and all over-70s.

Having completely failed to implement its central health promise in the Programme for Government – the much-trumpeted introduction of universal health insurance – ministers desperately needed a fallback to show some progress had been made.

Mr Varadkar dropped his predecessor James Reilly’s reference to “universal health insurance” in favour of “universal healthcare” and successfully requisitioned for himself Labour’s policy of extending free care in phases.

Vigorous opposition

Despite vigorous opposition from dubious GPs, the Minister managed to get the under-sixes policy across the line, and will hope to reap the gratitude of the baby boomers in the coming election. There are sound public health reasons for providing universal free healthcare for small children, but there was far less justification for universalising coverage for over-70s. The majority of older people already had a medical card, so the measure benefited only the best-off in this group.

So far, the direst predictions of a calamitous winter in our hospitals have not been realised. Things are improving slightly. Equally, we remain a long way off a properly functioning health service or the vision to make that a reality.