Health crisis – problems and solutions

A chara, – The complex, costly and dynamic nature of healthcare provision continues to challenge healthcare systems globally. In Ireland the delivery of safe, high-quality, optimal care for patients was challenging before the pandemic, and is more so now as we grapple with retaining staff working in unprecedented conditions.

Significant investment by this Government in developing community-based interventions to deliver care and to prevent chronic disease developing is very welcome and will in time reduce the pressure on acute hospitals and healthcare services in general.

The Taoiseach last year cited our better health outcomes than those of Britain for people affected by cancer, heart attacks and strokes, while also acknowledging hospital infrastructure has not kept pace with demographic changes.

In Ireland we have a funding model wherein the money follows the patient. Acute hospital revenue is linked directly to resulting activities, ie episodes of care are funded. This move to incentivise care can impact on the quality, safety and risk for patients in these acute settings, particularly during times of great service demand.

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We know there is a direct relationship between nurse-patient ratios in acute hospitals and patient outcomes. In Australia studies have shown having minimum nurse-patient ratios is more cost-effective. It results in shorter hospital stays for patients and reduces hospital readmissions, freeing up beds and reducing burnout among staff. Subsequent legislation in Queensland for a nurse-patient ratio system has saved 145 patient lives in the first year and helped avoid 255 readmissions and 29,200 hospital days, with estimated savings of between AU$55.2 million (€35.6 million) to AU$83.4 million (€53.9 million).

Concentration on workforce planning in the acute hospitals, with legislation to ensure safe nurse patient-ratios, with the necessary skill mix, will not only deliver better quality and safer care for patients, it will save money. – Is mise,

RÓISÍN LAWLESS,

Áth Buí,

Co na Mí.

Sir, – In the acres of newsprint devoted to the annual mess in our public hospitals, one phrase jumped out from your lead story on Friday. The HSE believes that an increased on-site presence by senior clinical decision-makers will help clear the backlog. But its interim chief executive does not see this approach as being sustainable in the longer term “given the structures in place in the health service” (“Hospitals told to implement seven-day working with ‘immediate effect’ to ease overcrowding”, News, January 6th).

Could we start there, please? – Yours, etc,

PAT O’BRIEN,

Dublin 6.

Sir, – Where is all the ever-increasing health spending going? Irish Fiscal Advisory Council and OECD reports show that Ireland is a top public health spender compared to all other countries in the world. Every year the Government dramatically increases spending on the public health system but no visible improvement appears to arise; instead the calls of “crisis, crisis” ring ever more loudly. The highly successful and highly tax-generative Irish economic model is funding this huge spending and it is clear that successive Irish governments are doing everything possible to provide the resources to the health system to enable a high-quality service to our citizens. This year the State plans to spend circa €23.4 billion on the public health system, which is over 25 per cent of all Government spending planned for 2023. The State is also in the process of adding many thousands of additional full-time staff, while waiting lists grow longer despite the favourable demographics of a relatively young population. Year after year we listen to unions, consultants, GPs, etc, complain and berate the Government, despite the massive resources provided. Isn’t it time for public sector management and public sector unions to work together to deliver the changes necessary to provide at least an adequate service to Irish people? I believe that no politician or political party can truly do much more than has been done – it is up to unions and management to fix the health system. – Yours, etc,

MARK MOHAN,

Castleknock,

Dublin 15.

Sir, – The Minister for Health likes to champion the unprecedented investment in the health system, but never mentions the unprecedented mismanagement of that same system. – Yours, etc,

EAMON FARRELL,

Dublin 4.

Sir, – The long lead times in trying to resolve many of the factors leading to overcrowding in hospitals are well known. There are also shorter-term measures that could be addressed to reduce the relatively longer time patients have to stay in hospital.

For example, there is a need for more step-down or nursing homes where patients who need more recovery time, but do not need hospital care, can be transferred to. Such facilities could, compared to new hospital beds, be provided relatively quickly and cheaply. Instead, we are seeing nursing home closures. Why are MRI, CT scanners not operating routinely 24 hours a day, seven days a week? These are expensive investments which should be functioning around the clock. Patients should not have to wait unnecessarily in a hospital bed, or a trolley waiting for such procedures. There is no point in asking consultants to work more at weekends if these and other support facilities are not operational. There is enough expertise around the Cabinet table to address the challenges in the health system. What is lacking is leadership, urgency as well as joined-up thinking and action. – Yours, etc,

MARTIN POWER,

Blackrock,

Co Dublin.