Sir, – The HSE is heading for an annual deficit of half a billion euro this year, yet in some areas its profligate behaviour is continuing unabated. It plans to tender out the running of Warfarin (essentially stroke prevention) clinics in Sligo Regional Hospital. This may be rolled out nationally to replace all hospital-based Warfarin clinics that are currently costing the HSE about €1,350 per patient per year to run.
As is usual in such exercises, patient-relevant details such as the quality or accessibility for the service user (cost to society) are not part of the tender. No doubt the competition authority will be satisfied that the necessary administrative boxes will be ticked in the proposal and no notice will be taken of the patients having to conform to the needs of the health system.
GPs nationally have already developed more sophisticated electronic dosing systems to support such a service, including audit standards not required by the tender. For over a decade we have been offering to provide such a facility at a fraction of the cost of the hospital delivered service, in a more holistic fashion, in locations and at times that are much more convenient to the patients. But our efforts to formally engage have always been rebuffed by HSE management.
This project is an excellent microcosm of the HSE bureaucracy that non-administrators and users of the health system are regularly exposed to. It exposes the lack of financial, performance or political accountability being applied to some local and national policy makers. If this scheme goes ahead, it will fragment primary care and promote its corporatisation – both issues well proven to increase unnecessary costs in healthcare.
It seems the HSE management’s response to the financial crisis is: crisis, what crisis? Or, as Queen Marie Antoinette is commonly but erronously quoted as saying before she was beheaded, “Let them eat cake”.
Apparently the HSE has a similar appointment with Madame Guillotine. Its title will change, as will a few personnel, but will its successor learn anything from previous mistakes? I am not anticipating too much as I believe that that will take a root and branch cultural revolution of biblical proportions. – Yours, etc,