Madam, – As it celebrates its fourth birthday this week, the HSE faces a dilemma clearly described in Sara Burke’s article (Analysis, December 29th). No sooner had it worked out and published a detailed, costed plan for the year ahead than the Government torpedoed it with a €400 million cut that is nearly twice as much as the entire budget for new service developments (€233 million).
Prof Brendan Drumm and his team will need to perform a miracle if they are to balance the books for 2009 without raiding the extra €12 million for mental health, €7.2 million for disability services, €15 million for cancer and €55 million for the Fair Deal, not to mention community supports and the creaking front-line services that see more people on AE trolleys now than there were when Minister Harney declared it a national crisis.
The glimmer of hope that all the fine rhetoric of the past four years might actually turn into a real improvement in services has been blotted out. We are in for more pain in 2009. Unless, of course, we change the mish-mash of a system and the ideology that is driving it.
Ireland has the most complicated mixture of public and private medicine, with all sorts of perverse incentives in the way money is spent. We have 700 people in acute beds, each costing €4,500 per week, who don’t need to be there. While hundreds of other hospital beds are closed so that books can be balanced at the end of the year, the trolley count grows. We are way behind in service-provision in so many areas of care from asthma to cystic fibrosis, from brain injury to suicide prevention, from child and adolescent psychiatry to palliative care.
There are good systems in other countries and the best and most efficient ones are based on universal provision where the money follows the patient. This approach has developed widespread support, notably in features and letters in your own paper. It is at the core of the Labour Party’s plans for health.
We will have a new Minister for Health in 2009, though exactly when is not yet clear. Minister Harney’s party is now defunct and she has acknowledged that it is up to the Taoiseach to leave her in the job for as long or as short a time as he decides. Isn’t now the time for a change? We have never been more in need of new leadership and a new direction for our health services. – Yours, etc,