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The noughties and our health - a lost horizon?
[ by Niall Hunter, Editor www.irishhealth.com]
As we contemplate the end of a year and the end of a decade, we must mourn some lost horizons and missed opportunities.
The big loss, of course, is that not only have we woken from a pleasant economic daydream, but we have fallen out of the bed and discovered we are wearing no pyjamas.
While we were living through it, it deemed like all our economic fantasies had come true and would continue to do so in perpetuity, or at least as long as the banks would lend us the money.
As we now face up to our recessionary nightmares, there is, amidst all the righteous indignation and blame obsession, perhaps a hidden feeling that we were getting a bit above ourselves and probably deserved out comeuppance anyway.
Many of us now, according to irishhealth.com’s major pre-budget viewers’ survey, are tearful and sleepless as we walk the tightrope over the fiscal abyss.
As we bounce along the rope, we hope that when some guys in the ESRI or the OECD say the recession might be over soon, they mean for us and not for some select group of investment bankers quaffing pints in Doheny’s.
Our mental health is worsened by the Matt Talbot like self-lacerating school of economic comment.
One occasionally flinches at the relish with which some former cheerleaders for the bankers and the developers now tell us we were all, even the more modestly paid among us, living beyond our means and things will never be as good again.
And of course we told you all of this was going to happen anyway. Well, actually, most of you didn’t.
Then at the other extreme we have the sand-loving ostriches blaming everyone for their woes, especially Cat Stevens and Thierry Henry, and claiming unconvincingly that the economic realities do not really apply to them and if they are suffering, it is all someone else’s fault.
These are the people in 'Livelineland' whose solution to the crisis is to put everyone, except themselves of course, on the minimum wage.
The Budget, and the run up to it, while it provided some very harsh medicine, at least forced many who were still sleepwalking to face up to how bad things are and what needed to be done. If that’s a positive from the current disaster, then many will take it.
In terms of our national health, the real sense of loss from the death of the big stripey cat is that despite all the wealth at the Government’s disposal, there has been little improvement in our health services in terms of efficiency or equity.
Ten years on from the dawn of the most prosperous period in our history, the service still has long waiting lists and hundreds of patients on emergency department trolleys.
Susie Long died for lack of rapid access to necessary cancer testing. How many more people have been in the same doomed boat?
Serious safety and organisational kinks in the system, which are not yet been ironed out, caused many patients to be misdiagnosed or damaged.
We were forced into reforming our cancer service only when safety scandals jump-started a plan that has been set out seven years previously and not acted upon.
The private health sector, itself in obvious trouble as incomes diminish, has had to act as a sticking plaster as our public hospital system has shed all pretension to providing an adequate level of service.
Over the past decade, massive amounts of state funding were pumped into an inefficient hospital system, which despite the mantra of reform from Brendan Drumm and Mary Harney, is still dysfunctional and has yet to be replaced by a workable parallel community treatment model.
A workable model of a better health system was set out in the Health Strategy of 2001, including an extensive primary care system which, unfortunately, was almost immediately long-fingered because of the cost.
The only change we really saw was the replacement of the health boards with an even more unwieldy and inefficient health bureaucracy - the HSE.
It’s a poor health legacy for what was once one of the world’s richest countries.
It is only when we have faced financial catastrophe that the Government has pushed the reform agenda in terms of how our hospitals and other aspects of the health service can work better.
While abolishing antiquated rostering, overtime and allowance systems that existed for the benefit of staff mor ethan patients will not be easy, most people in the service now accept that the days of a largely office-hours -oriented health system are numbered.
Any system, and to be fair it is not just in the health service, that pays compensation to workers when they are not in a position to earn overtime, needs to change and change fast.
It is not just the monetary waste, but the skewed bureaucratic logic of such a practice that must gall those in beleaguered private sector the most.
As we move into 2010, we celebrate, if that is the correct word, a new decade and pretty much the same old health service, and the same old social and economic problems that have bedevilled Ireland since they started painting the postboxes green.
There is always some consolation. Notwithstanding some major controversies and scandals, the quality of care in public hospitals, from doctors, nurses and other workers, in spite of the inefficient system, is generally very good.
Comparing Ireland’s health service to that of the UK’s NHS, many who have experienced both will say that while the structure is better in the UK, the individual quality of care here is superior.
Patients rating services on irishhealth.com’s Rate My Hospital (launched in 2006) have paid testament to this, in spite of the many faultlines in the system.
Over the past decade, our health as a nation too has largely improved, although it will be some time before the deficiencies in cancer outcomes will get up to speed as the reorganised system kicks in.
Recent official statistics show we are getting healthier; well what they actually show is that fewer us are dying prematurely of major diseases.
We are about to inherit the obesity legacy that has lurked thoughout the noughties We have an obesity strategy, which of course, is very far from being fully implemented.
The recently-published Department of Health report “Health in Ireland- Key Trends 2009” shows that in the past decade, Ireland has had unprecedented gains in health status with increases in our life expectancy outpacing that of the EU as a whole.
The report admits that it is difficult to measure what proportion of these improvements can be attributable to better health services, but it is at least indicative that much of the gain has been in mortality from conditions particularly amenable to treatment and care such as heart and circulatory system disease.
The decline in smoking has obviously been a contributory factor in this, but even the workplace smoking ban of 2004 has failed to make a serious dent in the remaining numbers of “hard core” smokers.
So it appears to be a matter of debate as whether our better health is due largely to better treatments being available and better trained health professionals, or due to the massive amounts of money invested in services over the past decade, much of which was compensating for the 1980s cuts in any case, and a lot of which went on paying a huge wage bill.
Most people will probably plump for the former, rather than the latter argument.
irishhealth.com, launched in August 2000, was born and has come of age in this decade of explosion in technology and internet communication.
Thanks to irishhealth and similar resources, and ever-changing ways of transmitting data, we now have more information on health than we ever had before.
Some might say we have too much information, but that is perhaps the price we pay for the democracy of the “world wide web” (does anyone call it that anymore?).
The better informed people become, the more accountable will be the groups that run the services.
As the main consumer health website in the country, we have tried our best keep people as well-informed as possible about health, as well as providing a useful discussion, support and advice forum for our 140,000 registered readers.
And, as a news website, the nature of our health system dictates unfortunately, that we must continue to tell the same old story.
Headlines in 2000, when we were just established, referred to the obesity “timebomb”, bed capacity shortages, A&E crises and taskforces, long waiting lists, ministerial promises; lack of access to GP and hospital care etc.
And in 2000, vCJD (remember that?) was the swine flu of that era.
And speaking of swine flu, how come our health service is so efficient at managing a major public health threat yet finds it so difficult to get a public patient into a bed?
Our health administrators and political leaders give us assurances that every health system in the developed world has problems and complaints from service users.
Few systems, however, other perhaps than that of the USA, have had the same, recurring, structural flaws that have bedevilled the Irish system over many decades.
One little example, that constantly mystifies me is why hospitals still make patients wait for hours to be seen at public outpatients clinics.
Something that never seems go leave our health system is bureaucratic contempt for the ordinary patient.
Of course , those waiting from 9 am or 10 am until lunchtime or beyond are the lucky ones. Some are waiting up to eight years even to be given the honour of attending an outpatients clinic.
And in few other countries has there been so much talk about what needs to be done with so little effective action to follow. If we could substitute rhetoric for reform, we would have the best health system in the world.
We would build many primary care centres and new hospitals out of the press releases that have been issued over the past 10 years telling us how things are getting better.
In the coming decade we need to decide on what sort of health system we want and how we are going to fund it. The Minister for half of the past decade, Mary Harney, has tried to change things, and keeps telling us of her Utopian vision, but there is precious little evidence of it materialising.
She has some achievements to her credit, and has progressed the reform agenda further than most of her recent predecessors.
However, history judges politicians clinically, she will probably be remembered best for her stalled co-location plan, which may wither and die when she leaves Hawkins House; for her unfulfilled promise to sort out the A&E crisis, and for her somewhat liberal use of the Government jet.
No review of the decade, can, unfortunately, be complete without mentioning the national shame of our very own holocaust of institutional and clerical child abuse, which like the need for reforming the health service, we are now only beginning to come to terms with and to deal with.
What is galling for many who have waded through the horrors of the Murphy and Ryan reports is that some of the religious groups whose members were involved in major abuses of power and of people still play a key role in healthcare provision in this country.
It is easy enough to complain about how bad things are. Is there anything we can gain solace from in such dark times? Some comfort can be gained from the fact that there are many people making a difference to people’s lives, rather than simply worshiping at mammon’s crumbling altar.
There are such people in all walks of Irish life, from those working often heroically in the health system and in other parts of the public and voluntary services, to the admirable and unsung looking after family members in need of constant care.
Special mention, however, should also go to this group of people referred to by Judge Yvonne Murphy:
“The Commission has been impressed by the extraordinary charity shown by complainants and their families towards offenders. It is very clear to the Commission that complainants and their families frequently behaved in a much more Christian and charitable way than the Church authorities did. Many indeed expressed concern for the welfare of the priest(s) concerned.”
Out of all the passages in all the reports about our health and social system I have read over the past decade, that is the one I will remember when we complain about how cynical and selfish our country has become.
View below some of the major health events, along with comments and discussions during the past year as they appeared on irishhealth.com:
|Anonymous Posted: 23/12/2009 11:01|
During the celtic tiger era, never was so much money poured into the heatlh service with so little in return and so litte accountability
|Oldtimer Posted: 11/01/2010 14:28|
As someone working for 30 years in the HSE (i.e. 25 years in the old HB system), this new monstrosity, in my opinion, has done nothing but steamroll the patient and front line staff in its determination to survive. A large organisation will defend itself as an instinct and thus proper discussion and disclosure will be suppressed. Recent scandals in the private corporate world will attest to that. The upper levels lose all grasp of reality and live in the rarified atmosphere of ‘corporate governance’ whatever that means. Interestingly some senior HSE appointments have some from this same private sector, i.e. banks.
The HSE is a failed ideological entity; there was a definite need for reform of the old health board structure AND the Dept. of Health. This was indentified in many reports in the 80’s, 90’s and again in 2001. There were actually some modest and effective proposals under discussion before 2005 to improve efficiencies in the old health board structures; for example, streamlining some administrative areas like purchasing, HR and ICT. Further work on agreeing proper structures for service delivery could have been built on this. This could have been acted on using tried and trusted mechanisms, with experienced health professionals across all grades and some imagination. The work on the Cancer Control programme shows that there are still people within the system willing to embrace change. A chance to offer proper redundancy packages was also lost in the rush to create the HSE and so there were more people in this new model than actual work to be done. More layers, less actual results.
The HSE is an example of deciding to tear something down without an alternative, if you like an answer to a question that was never asked. The HSE was brought into existence up by a small number of unelected ‘experts’ with no direct health experience, a right wing influenced minister who believed the ‘market’ (whatever that is) could ‘fix’ health and a government that just wanted to say it had ‘reformed’ health. Meanwhile, those who had experience, ideas and willingness to engage were ignored. The former CEOs were dumped out and a new generation of incompetents was drafted in. Patients were patted on the head and more layers of ‘compliance’ were created, supposedly for their benefit. It was there to tick a box for this new entiy to say it was "compliant" or had "oversight" (what an ironic word that is).
Add in the new ‘corporatism’, where holding a corporate line is more important than doing something for the patient first and you have the mess we’re in now.
The fact that there are improvements in services is in spite of the HSE, not because of it.
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