Healthcare and radical change

Sir, – The news that hospital waiting lists have now moved over 900,000 for the first time, while alarming, sadly cannot come as any surprise (News, August 20th). Senior management in both the HSE and Department of Health have for many years now shown an inability to assess the long-term costs of their decisions and policies. Policies appear to be implemented purely on the basis of imagined short-term cost savings with little thought given to the long-term human and financial cost implications of those decisions.

There is now a huge shortage of medical consultants with 728 unfilled posts yet there is little indication that the HSE or Department of Health have any long-term plan to fill these posts. The implications of these shortages are evident not just in the scandalous numbers on waiting lists but in rocketing negligence costs that, according to the National Treasury Management Agency, have now topped €4 billion.

While the Department of Health may be filled with experts on health, one wonders at the level of financial literacy in that department. The myopic commitment to controlling short-term costs appears to mask a complete lack of awareness about the long-term financial implications of their decisions and policies.

The huge cost overrun with the new children’s hospital rang alarm bells and hinted at a worrying hands-off approach from the then minister for health. With Sláintecare coming down the tracks, the Irish people need assurances that the Department of Health has the requisite skillset to manage this financially. All indications to date suggest that this department simply lacks the competence to accurately access long-term costs.


The inability of the Department of Health and HSE senior management to accurately assess the risks of their policies and the true long cost of inadequate medical staffing is potentially ruinous for both the Irish taxpayer financially and patients in terms of services. The current situation where Irish patients are waiting years for services while Irish doctors are emigrating in their droves cannot continue.

If senior officials in the Department of Health and HSE cannot manage costs and provide services, the Department of Finance needs to step in here and start rigorously accessing the long-term implications of Department of Health decision-making. If the Department of Finance is unwilling or unable to do so, we need to give serious consideration to bringing the troika back to initiate the long-overdue radical reform necessary at the most senior level in our health service. – Yours, etc,



Dublin 18.