Stephen Collins: Health service a political football yet again
State healthcare decisions must be on basis of facts not political advantage or emotion
The political frenzy surrounding the CervicalCheck scandal is a demonstration of all that is worst in our political system with human tragedies being used as an excuse by politicians to attack another.
The political point-scoring has done nothing for the effort to get the full truth of what went wrong, and amid the demands for sacrificial heads it is doubtful if the right lessons will have been learned.
That is why it was refreshing in the Dáil on Tuesday to hear Clare Daly berate the political parties, and the media too, for missing the point in their desire to apportion blame to others and seek advantage for themselves.
“I am sick of it,” she told Leo Varadkar during Leader’s Questions. “I could not care less if the Taoiseach was the health minister or if Deputy Micheál Martin was the health minister because it goes on. Governments are too busy staying in power to actually govern, the Opposition is too busy scoring cheap political points to actually hold the Government to account, and the media are too bloody lazy to analyse what goes on in here so the Civil Service rules, unelected and unaccountable.”
As a short summary of the problem it could hardly be bettered although it is unfair to lay all the blame on civil servants if the governments of the day won’t come forward with the kind of decisive action required.
Culture of secrecy
As Daly pointed out, the culture of secrecy stems directly from the fear of litigation, with clinical claims against the State rising from almost €1 billion to €2 billion over the past five years. When legal costs are included, this figure could probably be doubled.
That is why there is an urgent need to rethink the entire system so that patients can be given the truth as early as possible without implications for legal action one way or another.
There is an urgent need to rethink the entire system so that patients can be given the truth as early as possible without implications for legal action one way or another
Daly suggested the introduction of a no-fault system for medical negligence claims. This would certainly be an improvement on the current situation. It would enable proper compensation to be paid to families who need it without having to undergo lengthy delays as well as the stress and strain of years of litigation. It would also cut the legal bills to the State and, in the process, free up more resources to improve the health service.
Minister for Health Simon Harris has kept a cool head since the eruption of the controversy, despite a constantly shifting narrative of events. The ultimate test will be whether the episode leads to fundamental changes in how the health service operates.
One of his big initiatives has been to get Government approval for the establishment of an independent board to run the Health Service Executive.
HSE board abolished
While this is a welcome move, it illustrates the way the health system has been used as a political football down the years. Remember it was a Fine Gael minister for health, James Reilly, who abolished the HSE board in 2011 shortly after taking office.
That board contained a number of formidable experts who had an understanding of how the health service worked and how it should be held accountable for its operations.
This left the HSE with the worst of both worlds. A huge organisation employing about 130,000 people without a competent board to oversee its operation and hold executives accountable for the way it was run.
Now, seven years later, there is an urgent need to restore public confidence in the HSE through a series of actions to strengthen the management, governance and accountability of the organisation. The key component is the establishment of a board for the HSE.
There is an urgent need to restore public confidence in the HSE and strengthen the management, governance and accountability of the organisation. The key component is the establishment of a board for the HSE
Harris has made the right decision but the worrying aspect of his announcement was that, in tandem with a core strategic “national centre”, he is proposing new regional bodies with the responsibility for delivering integrated health and social care services.
Political and medical interests
This smacks of a return to the old health board system which was one of the fundamental reasons why country’s health system was paralysed for so long by local political and medical interests who resisted modernisation at every turn.
Ireland is a small country and it should be feasible for a qualified chief executive and senior staff, supervised by an expert board, to run the health service in a competent manner.
Of course, there will always be problems with the health service. Ireland is far from being unique among advanced countries in having constant complaints and controversy about the quality of the health service.
This is inevitable because a service dealing with sick and dying people can never be good enough and a whole range of vested interests in the health service are engaged in a permanent campaign to promote their own interests.
Brian Lenihan snr was once reported as saying that he would only agree to becoming minister for health if he was given the power of conferring eternal life on the entire population.
That said, the lesson of the latest controversy is that decisions about the operation of the health service should be made on the basis of evidence and facts rather than political advantage or emotion.