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Dublin: 14 °C Tuesday 23 September, 2014

Column: How many people will austerity kill?

The debate on the health service is a morass of figures. But cuts are life-or-death moral choices, writes Aaron McKenna.

Aaron McKenna

LET ME POSE you a question: How many people do you reckon won’t survive the recession because of austerity?

As we scramble to develop this latest austerity budget, one thing that has disturbed me has been the lack of moral questioning of some of the cuts to come. We’re going to cut hundreds of millions more from our health budget. Very seldom has it been said that when you do that, when you take that much money from hospitals, you will inevitably harm and kill people.

The beauty of huge austerity over many years in a complex system is that you can easily lose people in the numbers. File away cases on a spreadsheet and rebuff any questions with reasonable doubt, medical chance, who’s to know what might have been.

Twenty bed closures and an increase of 30 patients on trolleys in your local hospital might raise your ire. But we never seem to have a debate that focuses in on the individuals who reside in those beds and what happens to them.

A long established PR trick is to personalise good news and make abstract the bad. The cuts in our upcoming budget as with prior and subsequent ones will focus on millions and billions of euros. The PR spinsters prefer to talk about saving €150 million from child benefit than focus on the personalised nature of a €10 cut per child per month.

Whereas it is particularly easy to beat the PR machine on social welfare cuts, which are easily translated into a hit in the pocket, health is a different matter: Its functions are spread over a wide variety of services from Accident & Emergency departments to care of the elderly and on to its own administration. It’s easy to obfuscate what each cut can mean.

‘We’re cutting bone, and it will cause permanent damage’

The Four Year Plan calls for a total €1,445,000,000 cut to the health budget by 2014 on top of the cuts in previous budgets. The healthcare system needs reform for sure. But it doesn’t use €1.445bn in paperclips. We’re cutting bone and it can’t be done without causing permanent damage.

How do you break down €1.445 billion into bite sized chunks people can understand?

There are certain dipsticks, like the 20.27% increase in patients on trolleys in A&E in the first half of 2011 compared to 2010. That’s 7,766 additional people on trolleys who are waiting to be admitted to a hospital bed, a total of 46,065. Compared to the first half of 2008, prior to austerity kicking in, the trolleys are 52.53% more in demand, up 15,865 in the comparable period.

Meanwhile the number of bed closures throughout our health system is fast approaching 2,500. The fewer beds you have, the less capacity for admitting patients from A&E, the more people you get on trolleys.

Anecdotal stories from staff paint another snapshot. At a recent public meeting on the future of Connolly Hospital in Dublin consultants reported appendicitis cases being far worse when eventually treated thanks to a lack of resources to catch the condition early. Another tale was of a surgeon and his team, fully ready to work, having nothing to do at 2pm on a Wednesday afternoon. His list for the day had been cancelled to save money.

‘The hospital is treating too many sick people’

“Cost containment” is the bureaucratic term used alongside “service targets” when discussing money saving efforts in hospitals. The first is easy enough to understand, but in the second expression lies the dirty little PR secret of the health budget debate: When a hospital is demonised for not living within its budget, it is because it has gone over its pre-agreed service targets.

The hospital is treating too many sick people.

Budgets are made up based on the idea that a hospital will treat X number of Y cases, costing €Z. If you’re only scheduled to have 1,000 heart attacks in your hospital then Case 1,010 puts you 1% over your service target. Naughty hospital.

To contain these spiralling costs hospitals are forced to close more acute beds and to entirely close off certain departments: To go back to Connolly, the surgical day ward will be closed four weeks by the end of the year and when it reopens it will be allowed (‘able’ is the wrong word) to treat 10-13 patients per day rather than the 30-40 it handled previously.

These are patients coming in for angiograms, with hernias and ingrown toenails, patients seeking preventative care to keep them out of A&E and patients looking to be cured of minor but life altering ills.

Staff will be reduced a further 10 per cent in 2012 while strict controls are placed on the amount of agency staff to replace them. Thus, wards will be further crimped in capacity as they do not have the clinical staff to safely admit patients.

‘We have choices, even now’

This is being repeated across the country. We are seeing outpatient clinics to help individuals manage illness closing; we are having labs shut for weeks while the last remaining of four original staff takes a holiday with no cover provided; we are existing in a healthcare system described by patients and staff as like a warzone.

To come back to my original question: How many people who might have been seen to by a surgeon at an early stage of an illness; how many people who might have seen a nurse once a month in a clinic now to go to their GP after feeling unwell for a while; how many people admitted to an overcrowded A&E and left in a chair, let alone a trolley, won’t see the far side of this recession because of austerity?

That is a core moral question for our nation and its leaders. We make choices, even now, as to where we make the cuts. Taxes this, Croke Park Agreement that, means testing the other: We have a target that is set by outsiders, but we meet it in our own way. The way we choose says something about us, about our national priorities and the moral compass and fibre of those making the choices.

We look back on history and scoff at some of the short sighted and even inhumane things that were done in this country as regards the ‘welfare of the people’. I wonder what our descendants will think of of the choices being made today. Will they consider them misguided? Uncaring? Or simply reprehensible?

Aaron McKenna is coordinator of the Defend Blanchardstown Hospital Campaign. He is also Managing Director of the e-commerce company Komplett.ie.

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