By Deborah Condon and Niall Hunter
2012 was a year of dysfunction.
The dysfunction of a badly-run health service punctuated by safety probes and facing unprecedented Troika-driven cuts. The dysfunction of a flawed societal and political system that potentially allows women to die due to a lack of clarity on limited abortion when their lives are at risk.
And finally, the dysfunction of a well meaning but incident prone Minister who came under increasing pressure during the year but survived.
The Irish people too have undoubtedly faced major pressure in recent years thanks to our ongoing recession and 2012, unfortunately, did little to raise spirits, other than the tax raised on a glass in the Budget.
What we were told would be a period of austerity seems to be turning into an era of endless misery.
The year opened with the HSE announcing unprecedented health service cuts.
The HSE's service plan, however, turned out to be essentially a work of fiction, with its budget arithmetic all wrong, based as it was on expectations of income that never materialised and targeted levels of hospital and primary care activity and spending that were substantially exceeded, necessitating further cuts to be made later in the year.
Minister James Reilly got most of the blame for the HSE's continuing financial crisis in 2012, and deservedly so.
The CEO of the HSE, Cathal Magee, who would later resign from the job, warned that 2012 would be a very challenging year for health and social care services. He wasn't joking.
Meanwhile, research from Safefood revealed that Irish people were in denial about their weight. While two in three Irish adults were overweight, just four in 10 classed themselves as such.
And it wouldn't be the New Year without a health insurer announcing an increase in its prices. This month it was the turn of Quinn (now Laya) healthcare. Health insurance price increases are now becoming as frequent as job losses.
In fact, just a month later, VHI increased its prices- its third price hike in just over a year.
A report by the Steering Group on the National Substance Misuse Strategy revealed that Irish adults drink in a more dangerous way than nearly any other country, with the average adult drinking almost 12 litres of pure alcohol in one year. That is the equivalent of 45 bottles of vodka or 125 bottles of wine. We also have the dubious honor of being the biggest binge drinkers in Europe.
Meanwhile, figures from the Department of Health also revealed this month that the average waiting time for public orthodontic (dental) treatment in some parts of the country was three-and-a-half years, with over 11,000 people waiting for treatment.
In a shock decision, An Bord Pleanala rejected planning permission for the proposed National Children's Hospital at the Mater site in Dublin.
Irishhealth.com reached a milestone this month, with the signing of the site's 150,000th registered member.
The Cabinet agreed terms of reference for a review group tasked with looking at the options for a new children's hospital following An Bord Pleanala's rejection of the Mater site.
Meanwhile, a poll by irishhealth.com revealed that less than one in five people (18%) believed that the hospital should still be built on the Mater site.
In an exclusive report, we revealed that the HSE had paid out over €4 million to outside consultancy services in the first six months of 2011, while it was implementing major cuts in its budget and shedding thousands of permanent staff.
Meanwhile, over 4,000 HSE staff quit under the ‘grace period' early retirement scheme.
Figures from the HSE revealed that almost 800 hospital inpatient beds were closed nationwide, with nearly 600 of these closures due to budget cuts.
The HSE also revealed that almost 178,000 people were on waiting lists for public hospital outpatient appointments, with 60,000 of these waiting six months or more.
The Mental Health Commission said it was concerned about the number of children still being admitted to adult psychiatric wards.
Meanwhile an irishhealth.com poll found that just one in five people felt that Dr James Reilly was putting in a good performance as Minister for Health, with over half rating his performance as 'poor'.
We also exclusively revealed that Health Minister James Reilly's Special Delivery Unit (SDU) had hired a second external consultant from the UK at a salary of around €160,000 to help it reduce waiting lists for hospital treatment. Dr Reilly managed to reduce treatment waiting lists and ED trolley waits this year, but it came at a price of having to hire expensive healthcare consultants to do so.
A new study revealed that social networking sites posed a significant danger to Irish teenagers, with most young people unsupervised while using them. Bullying was also found to be relatively common on these sites.
A report on Tallaght Hospital by the Health Information and Quality Authority (HIQA) revealed serious safety shortcomings in relation to patient care and safety. It noted that 14% of people who attended the ED (emergency department) for the first six months of 2011, left without completing their care, while some ED patients were left waiting for up to 61 hours before being discharged.
The HIQA probe followed two unexpected deaths of patients in an ED corridor.
Meanwhile the number of women giving Irish addresses when having abortions in the UK fell from just over 4,400 in 2010 to 4,149 in 2011. In 2001, this figure was over 6,600.
Figures from the Central Statistics Office showed that Ireland's birth rate was at its highest level since the late 19th century and we still have the highest fertility rate in the EU.
A consultant in emergency medicine at the Mater Hospital in Dublin, Mr John McInerney, told irishhealth.com that seriously ill patients sometimes had to be treated on the floor of the overcrowded ED there.
Health Minister James Reilly warned that the HSE was heading for a deficit of up to €500 million at the end of the year unless major saving measures were implemented.
The Department of Health admitted that as many as 350,000 people could now be on waiting lists for a hospital outpatient appointment.
This month saw a new private health insurer enter the market - GloHealth. It was hoped that this would spark increased competition with the other three health insurers and lead to price reductions. Dream on.
It emerged that the HSE had paid out over €11 million in 2011 to re-hire retired staff. It said it was working to phase out this policy of re-hiring retired staff by the end of 2012.
Meanwhile, HSE chief executive, Cathal Magee, announced he was stepping down as head of the organisation after less than two years in the job. The Health Minister and the Taoiseach denied he was 'pushed'. Mr Magee stepped down as a significant, and somewhat confusing reorganisation of the HSE was announced by James Reilly. The HSE will eventually disappear under Dr Reilly's health reforms, but what will actually replace it is as yet unclear.
Meanwhile, Dr Reilly's woes continued as his personal financial difficulties made the front pages.
New research by the Institute of Public Health in Ireland estimated that almost one in 10 people in Ireland aged 45 and older could have diabetes by 2020.
The Neurological Alliance of Ireland expressed major concern that thousands of public patients with brain conditions were having to wait years to see a neurologist. Figures from the HSE showed that over 5,300 people had been waiting at least a year for a hospital neurology clinic appointment, with almost 1,000 of these waiting four years or more.
As a new head of the CEO, Tony O'Brien, took over, major spending cuts were announced, including reduced home help hours and a big reduction in the use of agency staff and overtime, aimed at saving €130 million this year.
Over 40 drugs and other products were taken off the list of free medicines available to medical card patients as part of last month's spending cuts, it emerged. These items included gluten-free products prescribed for people with coeliac disease, and anti-obesity drugs.
After much deliberation, changes to hospital consultants' contracts were finally agreed. Consultants agreed to be available in hospitals through a longer working day and a longer working week. However, consultant organisations said they were vehemently opposed to plans by the HSE to introduce a new salary scale for all newly-appointed consultants that would be 30% less than current consultant salaries.
The Junior Minister for Health in charge of primary (GP) care, Roisin Shortall, resigned, citing a 'lack of support for the reforms in the Programme for Government and the values which underpin it'. While there had always been tension between her and Health Minister Reilly, his decision to add extra locations to a priority list of primary care centres without informing her, including two in his own constituency, seemed to be the last straw.
Mr Shortall was also concerned at the delay in implementing the roll-out of the promised free GP care scheme and at the failure to appoint extra primary care staffing.
The primary care centre controversy was to haunt Minister Reilly throughout the year, as his position came under increasing pressure and as he survived a Dail no-confidence vote.
As we moved closer to the end of the year, the HSE's deficit appeared to be growing bigger. The Dail Public Accounts Committee was told the HSE's deficit now stood at €374 million, up from €329 million in August.
It emerged that since March 2011, Health Minister Reilly had spent over €800,000 on commissioning external reports on various aspects of the health service, including €300,000 for a review of the health insurance market.
Latest figures from the HSE revealed that some public patients with suspected heart problems were having to wait more than four years to be seen by a consultant in a hospital outpatient clinic.
Meanwhile, we revealed that a review found that Dublin's Tallaght Hospital breached public tendering procedures when it hired outside management consultants at a cost of €1.4 million in 2010.
After the Mater debacle and major rumours about Connolly Hospital in west Dublin, St James's Hospital in Dublin city was finally chosen by the government as the site for the new national children's hospital. Announcing the news, Health Minister Reilly admitted that significant funds already spent on planning the Mater project would never be recovered.
In one of the most shocking stories of this year, or any year, it emerged that 31-year-old Savita Halappanavar, who was suffering a miscarriage, had died the previous month at Galway University Hospital after reportedly requesting but being refused an abortion. The story made international headlines and put the Ireland's failure to provide clear guidance on limited abortion practice firmly into the spotlight.
The tragedy happened as a Government expert group was due to report on how abortion should be provided for in Ireland when a mother's life is at risk, in the wake of the X Case judgement 20 years previously and the more recent European Court of Human Rights ruling.
Meanwhile, a new study revealed that overweight and obesity costs the country over 1.1 billion every year, with two-thirds of these costs related to absenteeism and lost productivity, and the remainder spent on healthcare.
The abortion debate raged on as the Expert Group favoured legislation plus regulation to provide legal clarification for limited abortion where the mother's life is at risk. This proposal has since been adopted by the Government and is expected to be introduced early in 2014.
Meanwhile a much-criticised HSE probe and an independent HIQA inquiry began into the Savita Halappanavar case. Her family, however, is not cooperating with these investigations as it wants a full public inquiry, and is going to the European Court of Human rights to seek this.
Meanwhile, irishhealth.com revealed that the rate of maternal deaths in Ireland has been under-reported, and that 2011 had seen the highest number of maternal deaths in Dublin maternity hospitals in recent years.
And so to Budget month. Whose bright idea was it to have our Budgets just before Christmas?
The month started with a warning from a public health specialist that alcohol kills someone in Ireland every seven hours. Furthermore, there are more retail outlets in this country where you can purchase alcohol than fruit, vegetables or milk.
However, that news did not stop a rush on off-licences on December 5, when a €1 levy was placed on every bottle of wine in the Budget. Other measures taken included a 10c increase in the cost of a packet of cigarettes, restricted medical card eligibility criteria for the over-70s and others, a cut in child benefit, a tax on maternity benefit ,an increase in prescription charges for medical card holders, from 50c per item to 1.50, an increase in the Drug Repayment Scheme threshold, and a €5 increase in daily hospital charges (not officially revealed in the Budget itself).
Meanwhile, addressing a Dail health committee, Minister Reilly admitted that the HSE had been set 'extremely demanding' budget targets in 2012, but not surprisingly, these had not been achieved and the HSE had to be bailed out', amid continuing criticism of Dr Reilly's handling of the HSE's finances.
A further €781 million in cuts are planned in 2013 and more to come in 2014, as Minister Reilly praises the health service for doing more and more with less and less. The question is, can healthcare be provided better and safer with less and less money?
Happy New Year!
Groundhog Day on 2013 health cuts
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