Consultant says Irish health system ‘completely broken’

Prof Orla Hardiman calls for new centre for health research and data-driven approach to care

Prof Orla Hardiman said the health system was now completely demoralised. Photograph: Alan Betson/The Irish Times

Prof Orla Hardiman said the health system was now completely demoralised. Photograph: Alan Betson/The Irish Times


The health system is now “utterly demoralised and completely broken”, Ireland’s first professor of neurology has said.

Prof Orla Hardiman told the MacGill summer school in Glenties, Co Donegal that she last spoke at the event 2007 at the peak of the Celtic Tiger.

“Notwithstanding our unprecedented wealth, the public mood about our ailing service was one of anger and frustration,” she said.

“At the time, the profession was under siege by the continuous barrage of criticism . Trust between the HSE and the front-line staff had been badly damaged during this time, and morale in the public sector was very low.

“Here we are in 2015, debating the same issues, but in the context of an utterly demoralised and completely broken service.”

Prof Hardiman said there was “rampant staff burnout” and that we were haemorrhaging our best and brightest young professionals to the UK, Australia and Canada.

“There is an imperative to fix these problems. But in reality they have been have been endemic to our health system ever since I was appointed as a consultant back in 1996, and it seems that we are no closer to solving the horrendous problems that we face at some of the most vulnerable times of our lives."

Prof Hardiman said the health system was now “really badly broken”.

“We are currently operating in a system that evolved piecemeal with no overall design, and is still organised in large part around adjustments made in the mid-20th century,” she said.

Prof Hardiman said health care costs had the potential to rise at “exponential rates” as public expectation increased and as newer and more expensive technologies continued to develop.

“Realistically, health costs could be infinite and a health budget could consume our entire GDP- indeed in USA the health budget it is running at 17 per cent of GDP, despite Obamacare.”

We had never really addressed this problem with any degree of honesty in Ireland, Prof Hardiman added.

We were also one of the only countries in the EU that required payment for primary care services.

The manner in which free medical care was administered to the proportion of the population that was entitled to it was “completely inhumane”.

“Those with serious medical problems are forced to engage with a cumbersome, inefficient, and often humiliating system that demands a level of detail that most of us in the full of our health would struggle to provide,” she said.

“Administration is replete with street level bureaucracy, files are regularly lost, and people with life-threatening illnesses are barraged with repeated demands for trivial details that have minimal relevance to their health status or true income levels.”

The Beaumont Hospital-based neurologist said we could never repurpose the Irish health system without huge structural changes and a major commitment to a reform in clinical governance.

Prof Hardiman said we needed a new data-driven approach that incorporated clinical research into the delivery of our health service.

“This approach must be above political interference and should be evidence based,” she said.

“The creation of an Irish Institute of Health Research would be an excellent place to start planning for the new vision of healthcare we need for the remainder of the 21st century.”

Minister for Health Leo Varadkar told the event on Thursday night that delivering free primary care to all adults to refund medical expenses such as GP visits, prescriptions and dental fees could be done in the term of a new government through a reformed PRSI/Universal Social Charge system.

He said “something as small as a 0.1 per cent increase in PRSI would provide universal access to primary care for all working people”.

Taoiseach Enda Kenny will address the summer school on Friday evening. Speakers at Friday’s sessions include Minister of State for Rural Development Ann Phelan, Archbishop Diarmuid Martin, TD Catherine Murphy, Sister Stanislaus Kennedy and economist Ronan Lyons.