Sir, – The recent resignation of the HSE’s head of digital transformation, Prof Martin Curley, is the latest in a growing series of high-profile resignations of defeated would-be reformers in the HSE (Shauna Bowers, “HSE’s head of digital innovation resigns citing ‘frustrations’”, News, January 17th).
Not only do we need innovation at the top of the HSE but more importantly we need young, dynamic and steadfast leaders, who are capable of driving through radical reform in the face of substantial resistance. There are innumerable problems within the HSE, however setting a targeted focus on four key areas is urgently needed, namely the rollout of a national universal electronic patient records in every hospital; a national universal patient identifier for every patient; a national universal radiology and bloods system for every HSE hospital; and a national universal payroll system for the entirety of the HSE.
These four changes would improve the efficiency and safety of healthcare delivery in this country substantially, reduce waiting times for patients and improve job satisfaction for HSE staff immeasurably.
A laser-like focus on these four reforms and a juggernaut-like-determination to push them through is required. – Is mise,
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Dr DAVID J TANSEY, MD, MBA
Specialist in Endocrinology and Diabetes at St Vincent’s University Hospital,
Dublin 4.
Sir, – Shauna Bowers reports that the HSE’s head of digital innovation has resigned and claims that the HSE is not fit for purpose. Isn’t that why it needs a spot of transformation?
Your Europe Correspondent Naomi O’Leary wrote (Europe Letter, April 8th, 2021) that having a strong digital infrastructure in the health service is the secret weapon in dealing with the pandemic. It must be a secret because nobody told us.
She went on that in Estonia 99 per cent of health data is digitalised in a centralised national database which allowed the course of disease outbreaks to be tracked long before the current pandemic.
And what of the tech capital of Europe? Naomi O’Leary wrote that Ireland is on the other end of the scale with patient records siloed across different services and an archaic reliance on paper throughout the system. This shocks healthcare workers who have worked abroad.
She concluded that plans for a single digital patient health record, the most basic of first steps, remained as plans.
We have no reason to doubt her. The chief operations officer in the HSE told Claire Byrne on RTÉ on January 8th, 2021, that the IT system being used to support the vaccination roll-out was very tedious and labour-intensive – a labour-intensive IT system is a contradiction in terms. On January 13th, 2021, Jennifer O’Connell quoted an estates manager with the HSE who said that she had been working on a digital transformation project when Covid made land here but had to put it on ice as her team “was asked to deliver beds”.
I was about to write that this requires no comment but in fact it does. It is a national scandal that a public health service which we fund to the tune of more than ¤20 billion a year does not have a functioning IT system.
The usual HSE smoke would make vague reference to data sensitivities but that doesn’t play here.
Estonia is a member state of the EU and is burdened with the same data privacy obligations. – Yours, etc,
PAT O’BRIEN,
Rathmines,
Dublin 6.
Sir, – I must take issue with Mark Mohan (January 16th) and the Irish Fiscal Advisory Council when it comes to international comparisons of public health spending.
Mr Mohan gives his view that “Ifac correctly uses modified gross national income (GNI*) instead of gross domestic product (GDP) for comparisons with other OECD countries” and it is this view which I contest.
GNI or GNP (whether * or not) is indeed a better indicator of the living standards of residents than is GDP because GNI excludes the most important income outflow from Ireland – the repatriated profits of multinationals.
But the real constraint on public spending on health is not our living standard but our taxable capacity, which is much better measured by GDP than GNI. After all, we are properly quite happy to tax the items included in GDP but excluded from GNI. Mr Mohan is also ambiguous in implying that the Ifac report uses GNI* for other OECD countries when comparing with Ireland, whereas in fact it uses GDP for every country other than Ireland.
But that makes not much difference since in most countries GDP and GNI don’t differ much and Ireland is probably unique in having GDP exceeding GNI by so much.
In recent years, Irish GDP has exceeded GNI by about 30 percent.
Thus, if Ifac had used GDP as the base, then it would have found that Ireland ranked, not 6th, but 20th of the 33 countries in terms of public health spending. And why shouldn’t it have used GDP since, as I have said, GDP measures taxable capacity much better than GNI and the Government’s constraint is taxable capacity, not the income available to residents?
The same reasoning applies to all public spending. In 2019, the average ratio of tax revenue to GDP in the EU was 41 per cent.
Ireland’s ratio was 23 per cent, with only Romania having a ratio below 30 per cent. If we collected as much of our potential as our EU colleagues do, we could (note, I don’t say would) get much better public services all round. – Yours, etc,
JOHN BRISTOW,
Killiney,
Co Dublin.
A chara,– The ESRI report on the “relatively low” cost of providing free GP care to all is a good example of improving one part of a system rather than focusing on the full system (“Free GP care for all would cost €881 million and could be rolled out by 2026, ESRI says”, News, January 17th).
It reads like replacing a saddle on a bike to make the ride more comfortable without mentioning the slow puncture.
We will not have sufficient GP to provide the free service. – Is mise,
DERMOT O’ROURKE,
Lucan,
Co Dublin.
A chara,– Politicians have accused the HSE of a “lack of leadership” regarding the current crisis. The health service has been blamed, for a long time, of being top-heavy with management.
Perhaps it’s actually a case of too much leadership? – Is mise,
PETER DECLAN O’HALLORAN,
Belturbet,
Co Cavan.