Readers like you keep news free for everyone.
More than 5,000 readers have already pitched in to keep free access to The Journal.
For the price of one cup of coffee each week you can help keep paywalls away.
Mark Stedman
VOICES
Leo
If there was an overnight fix for the health service I would've implemented it
I’ve been in this job for 18 months and I can say with absolute certainty that if there was an overnight fix, I would have implemented it on day one, Leo Varadkar writes.
TOM CLONAN IS right about a lot of things. But when he’s wrong he is totally wrong.
Yes, we have a massive job to do in fixing the health service. No one should pretend otherwise. But we have only just emerged from the deepest recession in Irish history. So only now can we start increasing expenditure and investment in Irish healthcare. It means catching up on the best part of a lost decade
That is exactly what we are doing. Actually, it was the last government that cut health spending by €2 billion, not this one. In fairness to the last government, they did not cut health spending because they thought it was a good idea or a wise policy. They did so because of the financial and economic crisis.
This government protected health spending from 2011 onwards holding it steady in 2012 and 2013. This year we increased health spending for the first time since 2007. Next year the health budget will rise again.
In spite of the crash, health spending per capita for Ireland is at the OECD average (public and private combined) and is set to rise further provided we keep the economy strong and the recovery going.
According to the Medical Council, the annual exit rate of Irish doctors is 5% – not 90 % – and that includes doctors from overseas who come and go regularly. The figure is still too high but nowhere near the extreme levels that Tom suggests. The 90% actually refers to a survey of college students who were ‘contemplating’ going overseas at some point. I imagine you’d get a similar figure if you asked the same question to any college class.
There are 500 more nurses on the payroll than 12 months ago and more doctors employed in the public health service than ever before. 78 consultants have been appointed this year so far, and there are 19,000 doctors on the register, a ten-year high.
Indications are that the vast majority of the graduate nursing class this year are staying, and there has been a 120% increase in the number of nurses looking to register in Ireland in the past year.
Addressing overcrowding
The government allocated more than €117m in additional funding this year to reduce overcrowding in our hospitals. This has reduced the Fair Deal Nursing Home Support Scheme waiting time from 15 weeks to between two and four weeks, thus freeing up over 225 hospital beds every day.
We have also taken a large number of specific measures to address overcrowding including:
- Increased access to homecare packages so patients can get home sooner;
- Opening 173 Community Beds so patients can get out of hospital sooner and get their rehab and convalescence in a more appropriate setting;
- Extending opening hours of day hospitals for elderly patients;
- More Community Intervention Teams who give medicines, drips and IVs in home or nursing homes to reduce admissions to hospital and speed up discharges;
- Making greater use of all the non-ED facilities available, such as medical assessment units, minor injury units and urgent care centres;
- The phased opening and re-opening of more than 400 beds in hospitals for the winter months.
At 8am yesterday, the number of people on trolleys was 245, with 109 waiting over nine hours. These numbers are still too high, but it is 20% lower than it was last year, and the number waiting over nine hours is down 30%. We’ll be working hard to sustain and build on this into December and January.
Tom is also wrong about hospital beds because he’s not comparing like with like. Ireland uses a mix of public and private beds so there are actually more beds available than he takes account of. And I have no idea where his claim that patient load will continue to rise at 3% comes from. Ireland’s population is increasing and getting older which is why we need to take account of it when planning budgets and services.
However the actual number of elective admissions last August was up 1% year-on-year, while emergency admissions were down 1.7%. The number of over 65s is set to increase by 3% next year but is he suggesting that every single one will require hospital treatment? After all, older people are healthier than they used to be.
Where I take issue with Tom is with regard to the elderly patient in Tallaght who came to prominence recently. The incident absolutely should not have happened. No one can have any doubts about that.
But Tom is completely wrong on what happened afterwards. Neither I nor my Department launched any investigation into how the information became public. That is entirely a matter for the hospital itself and I had no role in initiating it at all.
No role in staff matters
I support and encourage a culture of transparency and have always done so. My record on the penalty point saga backs that up. And if Tom wants to look closer at last week’s Patient Safety Package, he would see that we are providing legal backing to a culture of Open Disclosure in the health service and a legal requirement that all serious incidents be reported by staff when they occur.
In this case, the hospital took a decision to set up an investigation because the patient registered a complaint about his personal information being used in the media without permission. Surely Tom does not think that patient complaints should be ignored to protect a staff member, whistleblower or not?
The Minister for Health has no role in staff matters. I am not the employer of anybody in the health service. Staff are employed either by the HSE, their hospital, or by a voluntary or charitable body funded by the HSE. Others are contractors and are not staff at all. Therefore the Minister has no role in staff issues and cannot hire, fire, promote or demote, discipline or investigate anyone.
Nonetheless I do from time to time receive inappropriate requests asking me to get involved in staff matters.
Tom seems to think that there is an overnight solution to the problems facing the health service. I’ve been in this job for 18 months and I can say with absolute certainty that if there was an overnight fix, I would have implemented it on day one.
There’s still a very long way to go, but we are making very good progress in a number of areas. When I became Minister for Health I quickly identified some important reforms and projects.
Since then in primary care we have implemented GP care without fees for the oldest and youngest in society, and relaxed the rules on discretionary medical cards so that almost 100,000 people with high medical costs or needs have them, even though they do not satisfy the means test.
Probably most importantly we have taken the first steps to move chronic disease management into primary care with the asthma and diabetes cycles of care. Nearly 14,000 children have registered for the Asthma Cycle of Care and 37,000 patients for the Diabetes Cycle of Care.
We have pressed ahead with important and overdue projects like the new National Children’s Hospital, the new National Maternity Hospital on the campus of St Vincent’s, the new National Rehabilitation Hospital and the new Forensic Mental Health campus. All will be under construction next year, subject to planning permission.
Of course we have enormous difficulties but we have also made advances in many areas and we should not lose sight of that: improving life expectancy; less expensive medicines for patients and taxpayers; improving cancer survival; reduced deaths and disability from stroke; advanced paramedics at the scene of serious emergencies, providing care long before the patient gets to hospital; an air ambulance to take people from more remote areas to specialist centres in time; and the lowest MRSA infection rates reported in many years.
Everyone, no matter their means, at some point in their life, interacts with the health service and so a well-functioning health service is ultimately a matter of importance for everyone.
It’s my absolute priority to ensure that we achieve that goal.
Leo Varadkar is the Minister for Health and Fine Gael TD for Dublin West.
Tom Clonan: ‘Ireland is on the brink of a perfect storm in our health services’
