Everyone says the health service is banjaxed, so why don’t we spend more money on it?
Money may not be at the root of the health service’s many problems, if figures emerging this year are to be believed. First, the Central Statistics Office changed the way it calculated health spending, to better align this process with international practice. This showed that the amount we spend on health, through the Government and privately, is the second-highest among western countries in the Organisation for Economic Co-operation and Development (OECD). Even when you consider public spending alone, Ireland is above average on what it devotes to the health service.
Now Eurostat has weighed in with figures that show we spend a greater proportion of government expenditure on health than anywhere else in Europe. Conversely, we spend less on old age than the rest of the continent.
They say comparisons are odious. If it’s broke, shouldn’t we just fix it?
Obviously, these figures raise questions about value for money. Why, if we are spending so much, are we getting such a poor service? And what do the figures tell us about where we should be directing future spending?
I'm asking the questions here. What do the figures tell us about where we should be directing future spending?
Other reports by the OECD show we have a low number of doctors and hospital beds by international standards but an above-average number of nurses. Mind you, these studies also tell us that our hospital consultants and, to a lesser extent, our nurses are exceedingly well paid by international standards, but try telling that to the highly qualified staff who are leaving Ireland in droves.
It is important to remember that not all of the health service is broken. Every week, fabulous, cutting-edge, life-saving work goes on in hospitals across the State. Some hospitals have low waiting lists and trolley numbers, while others are consistently “out the door”. It’s a mixed picture.
So why don’t we fix the broken bits?
If I knew the answer to that I’d be Minister for Health. The actual Minister, Leo Varadkar, says that it’s a mixture of a wide range of factors. Capacity is certainly a problem: we need more beds, and more doctors and nurses to staff them, especially given the ageing of the population.
What the politicians won’t tell you – because they dare not – is that we have too many hospitals, too many emergency departments, too many maternity units, and so on. In some cases, such as that of nursing homes, the units are not in the right place to match population needs. If we rationalised the hospital system we could reallocate resources to where they were needed, providing more and better care in the community.
Hospitals need to become a destination of last resort for patients who look after their own health, and are cared for in the community, rather than the default option. Emergency departments need to be for emergencies only rather than for people with chronic-disease issues or those who can’t get timely X-rays.
The system needs better management – not more managers – and it needs to work better for frontline staff, whose sinking morale constitutes a crisis, not just a recruitment problem.
We can reform, with luck building on the emerging desire for consensus, or a “Tallaght strategy”, for the health service. Or we can continue to bumble along as we are.
