Political expediency and patient safety


Sir, – Dr Tom O’Rourke (Letters, July 11th) touches on the heart of the problem with our health service when he points out that a reorganisation of hospital services would need to be carried out by a minister of health brave enough to risk his government’s popularity at the ballot box. This is something for which both politicians and the public who elect them should accept some responsibility.

Ministers of health of successive governments over decades have commissioned reports on restructuring of the management system of the health service from health boards, to the HSE and hospital groups. Now Sláintecare takes on an even wider remit of a complete restructuring of the current service provision model, together with further changes to hospital groupings, community services and private healthcare. Much time and money are invested in these projects, which may prove challenging to deliver and there has been little visible benefit to the end-user in the past. Perhaps organisational structure is an easier concept to grasp for ministers and officials of government departments than gaining an understanding of the complex hierarchy of healthcare needs. The current situation leaves hospital and community settings in conflict for limited funding streams, rather than in cooperation across the system, which would better suit user needs.

It is rare for a minister of health to stay in post for a full term of government. Even if they do, the threat to party votes approaching election time makes it unlikely that they will tackle such a politically charged issue as the restructuring of the acute hospital services, the need for which was eloquently described by Patrick Broe in his letter of July 9th. The establishment of a new unit such as Sláintecare within the Department of Health is costly but has provided an excellent smokescreen to divert attention. Challenging questions raised in the Dáil or by journalists can be deflected by referencing the ongoing work of this group and reports awaited. Ultimately for this project to be worthwhile, the Department of Health and the current Minister, supported by the Cabinet, will need to lead and progress with proposals for improved services. Past experience would tell us that many are unlikely to be delivered on.

Perhaps we would do better to divert these resources to support front-line healthcare workers in service development. In consultation with patient support groups, they could identify gaps and deficiencies in their own service and ways in which they could achieve local efficiency and improvements in a meaningful manner and delivering results within a short time frame. Better still, if this were tied to a “money follows the patient” model, where efficiency achieved would bring additional funding back to the same department, this would be doing a service to the public. It would also incentivise demoralised workers at the coalface, who would see the benefit in the additional improved service they could provide.

By listening directly to the concerns they are voicing for their patients, and supporting the improvements that they feel they can achieve, this would give better value for money, in terms of patient experience, than repeated reorganisation of higher levels of the management structure of our health service. – Yours, etc,



Ophthalmic Surgeon,

Dublin 13.