AFTER FIVE years in the post, the first chief executive of the Health Service Executive (HSE) steps down this month. What stamp does he leave on our public health system and what shape is it in facing lean economic times? Prof Brendan Drumm has been keen to mark out his legacy in a series of recent media interviews.
He told The Irish Timeshe believes his greatest achievement has been to lay the foundations for an integrated health system in which people can access more care in the community. In addition he was involved in the introduction of a new consultant contract and the setting up of primary care teams and centres. Under his watch, a health service performance management system with monthly reports commenced.
But it is hard to escape the fact that progress has been painfully slow, something that he acknowledges in respect of a unified information technology system across the health service; progress on outpatient waiting lists has also been slow in some areas and for some specialities. Despite the introduction of waiting list initiatives, the office of the Comptroller and Auditor General estimates some 175,000 people are waiting for hospital outpatient appointments in the Republic. And of course patients remain on trolleys for unacceptable periods in some of the State’s flagship hospitals.
It would be unfair to lay the blame for the series of cancer misdiagnoses and gaps in child protection services at Drumm’s door. It will be appropriate to judge his performance in the context of the 15 year change programme he outlined when he first took the job. It must also be acknowledged that the experience of patients is almost uniformly positive once they enter the health system, a point made by a number of contributors to our letters pages recently.
Progress largely occurred during the boom years, albeit against a backdrop of money being used to plaster over dysfunctional elements of the health system. With leaner economic times come different challenges. This year’s health budget has been cut by €1 billion, leading to a reduction of 1,000 in hospital beds. With a running deficit of €84 million by May, a difficult second half has already begun for the HSE with reports of cutbacks in home helps and with preventive medical services and respite services sharply pruned.
As signalled by the publication of Government capital spending plans, next year represents a formidable challenge. Expenditure on healthcare projects will fall by €100 million for 2011 with an inevitable effect on the quality of patient care. Poor infrastructure can threaten patient safety, as demonstrated by the misdiagnosis of miscarriage, attributed in part to outdated scanning equipment at Our Lady of Lourdes Hospital.
A likely cut in the health budget of €700 million next year will inevitably add to pressure on front-line services. The Minister for Health must insist that the board of the HSE refuses to sanction any “salami-slicing” proposals put forward by management. As far as possible, cuts must be rational, nuanced and stress-tested if patients are to be protected.