Investment in healthcare

Expectations and demands

Letters to the Editor. Illustration: Paul Scott

Sir, – It is, in a sense, good to see that the Minister for Health is frustrated by the fact that increased investment in healthcare is not delivering an equivalent rise in activity (News, April 15th). Often it can seem that public expenditure rises without our representatives following up to consider if value was obtained.

Writing as a hospital doctor, I’d like to offer some suggestions on why activity hasn’t risen concomitantly with resourcing.

Firstly there is a matter of the economic principle of diminishing returns. This tends to arise in many walks of life, and is perhaps not so much an explanation as a way of paraphrasing the observation.

But in general as one spends more on something, the value per unit spent declines.


Why it is so obvious in current healthcare probably comes down to two strong trends, one of which wastes small amounts of time daily on a massive scale, the other larger time periods on a smaller scale.

Paperwork, red tape, bureaucracy and checklists are a much bigger component of hospital life now than in previous decades.

A patient going for surgery will have multiple pauses, time-outs and checks along their “care pathway” to confirm their identity, operative plan, allergies and other concerns. This arguably benefits them, reducing certain risks from very low levels to around zero.

But as tens of thousands of staff do several such checks on each patient they treat daily, the amounts of carers’ time they cumulatively consume is very large.

A second trend is a move toward less invasive procedures. A few decades ago surgery largely involved open incisions with good visualisation of the relevant structures and the perhaps unrefined removal of problem areas. Now, having widely adopted “key-hole” surgery, we are moving toward robotic procedures. There is no way to avoid this given the associated reduction in patient trauma, incision-size and in various complications. But it makes for much slower operations, particularly as staff are learning the techniques. This can easily double the duration of a procedure, although subsequent recovery should be more straightforward. These changes are essentially inevitable for a developed healthcare system.

To the fortunate patient, they offer greater safety and smoother recovery. But they require an expenditure on time, while frequent checks are done, and on infrastructure such as surgical robots, that will significantly prolong the relevant interventions. – Yours etc,



Co Cork.