Sir, – Fintan O’Toole correctly identifies the “dysfunctional culture of the health system” but offers no solutions other than to say the culture needs to be confronted, along with structural reform (“Ireland’s dysfunctional health service crushes idealism and rewards cynicism”, Opinion & Analysis, January 10th).
An important context for any discussion about change is that politicians react to those who shout the loudest. Few shout louder in Ireland than the public sector health unions, including those representing various management levels, who resist change as a matter of routine.
Successive governments have thrown money at the HSE instead of confronting the problems identified. It is not a resourcing problem but one of management being able to allocate resources, primarily for the betterment of Ireland’s public, and not for any other reason.
For this management need Government support for change, a vision for what is needed and the necessary competence to deliver it. The unions need to be flexible to facilitate change. Indeed, meaningful change may involve a compulsory redundancy programme in place to right-size the bloated bureaucracy. It will certainly require greater hours of utilisation of the existing physical medical infrastructure, along with better management and much more flexible work practices.
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Sufficient public support is necessary for Government support to be sustainable when the resisters mobilise.
If meaningful change did take place, the frontline staff, along with others, would be beneficiaries as the workplace would be so much better. That won’t prevent the resisters, however.
As long as a blind eye is turned to what is needed to be done and to the resisters of change, we are stuck with the HSE as it exists. – Yours, etc,
JM DODDY,
Dublin 14.
Sir, – Many on the left continue to claim that we need to spend more money on our public health system in order to deliver an adequate service to our citizens. The Irish Fiscal Advisory Council (Ifac) has reported that, “Ireland ranks as a high spender on health internationally” (The Path for Ireland’s Health Budget, November 2021). This benchmark report confirms that Ireland ranks sixth-highest for government spending on healthcare as a share of national income out of 33 OECD economies. Annual health spending has also risen at a faster pace than elsewhere, says Ifac. In the mid-20th century, public healthcare spending was less than 2 per cent of national income, but before the pandemic it had risen to 8 per cent of national income. And with this year’s annual public health spending budget of ¤23.4 billion, the trend of fast health spending growth continues. As Ifac reports, this is despite Ireland having had relatively favourable demographics over this time, with an old-age dependency ratio well below the median OECD country. In assessing our high spending in the context of annual crises in public health delivery, we must firstly have an agreed set of facts. We must have sources that we trust. Ifac has pulled together the relevant data and presented it in a useful way. For spending ratios, Ifac correctly uses modified gross national income (GNI*) instead of gross domestic product for comparisons with other OECD countries. This is due to the unique structural attributes of the Irish economy, especially in terms of our large multinational footprint.
Personally, I trust both the Irish Fiscal Advisory Council and the Department of Finance. I believe that what they tell us is accurate, to the best of their knowledge.
If we can agree this, then we must demand that public sector management and public sector unions come together to embrace the changes in planning, budgeting, work practices and pay that are essential to the provision of an adequate health service for Irish people, which presently it is not.
Throwing more money at the problem, as we have seen over the past 10 years, gets us nowhere. – Yours, etc,
MARK MOHAN,
Castleknock,
Dublin 15.