Gold stan­dard health­care re­mains noth­ing more than a vague as­pi­ra­tion

Bray People - - OPINION -

WHEN the HSE’s ser­vice plan for the next year was out­lined last week Min­is­ter Leo Varad­kar was in the happy po­si­tion of be­ing able to re­it­er­ate that, for the first time in six years, the health bud­get was not be­ing cut. In­deed there are some mod­est gains and yet, amid what was oth­er­wise good news, Min­is­ter Varad­kar had to ad­mit that the € 12.13 bil­lion bud­get is not enough to meet the de­mand on the State’s health ser­vice and even main­tain­ing the cur­rent in­ad­e­quate ser­vices will be a strug­gle.

It begs the ques­tion - how much is enough to fund a prop­erly func­tion­ing health ser­vice and whether this is sim­ply out of reach in a coun­try blighted by debt and taxes.

All told, the HSE’s Na­tional Ser­vice plan that was un­veiled last Thurs­day is pos­i­tive. There are some spend­ing in­creases in ar­eas such as home care and the Fair Deal Nurs­ing Home scheme that could ul­ti­mately free up hun­dreds of hos­pi­tal beds and help the health sys­tem to op­er­ate more ef­fi­ciently. There will be more ac­count­abil­ity for se­nior hos­pi­tal and HSE man­agers with sup­ports to help them work bet­ter and a threat of dis­ci­plinary ac­tion for those who fail to do their job prop­erly. The HSE re­cruit­ment em­bargo is be­ing lifted, which will al­low the HSE hire ad­di­tional staff where nec­es­sary rather than be­ing forced to per­se­vere with the failed cost-cut­ting strat­egy of ‘em­ploy­ing’ agency per­son­nel. Another very sig­nif­i­cant change is that if the HSE saves money next year it will be al­lowed carry over the sav­ing and spend money the fol­low­ing year rather than hand­ing it back to the Ex­che­quer. It’s ex­tremely un­likely the HSE will have any­thing left in the kitty at the end of the year of course, but at least the in­cen­tive is there and that is a pos­i­tive move.

it is also ex­pected that there will be 60,000 fewer med­i­cal cards at the end of the year and the sav­ings this pro­duces will be fed back into the health sys­tem. It re­mains to be seen how med­i­cal card re­duc­tions will fare in the run-in to a gen­eral elec­tion, but in gen­eral terms the idea of trans­fer­ring free care from those who it need it least to those who need it most is a noble as­pi­ra­tion and can be counted as a pos­i­tive - if po­ten­tially fraught - as­pi­ra­tion.

The thrust of this health ser­vice plan is to in­tro­duce more achiev­able ob­jec­tives than the broad re­form­ing strokes that were planned and failed un­der Min­is­ter Varad­kar’s pre­de­ces­sor. And yet Min­is­ter Varad­kar was cau­tious about promis­ing that even mod­est gain will be achieved. In­stead he ad­mit­ted that our health ser­vice is “un­der-funded and not or­gan­ised to de­liver best value for money”.

The “value for money” com­ment is re­veal­ing. Our €12.1 bil­lion health bud­get works out at over €2,600 to pro­vide health care for each of the 4.1 mil­lion peo­ple in the coun­try. Put another way it de­mands €2,600 per year in taxes from ev­ery man, woman and child in the State to fund the health ser­vice, and yet it doesn’t meet our needs.

There clearly is a press­ing need for the min­is­ter and the HSE to ex­am­ine the value for money side of the health ser­vice and un­til this is done we, the ser­vice users, need to tem­per our ex­pec­ta­tions. If we in­sist on a gold stan­dard health ser­vice we need to re­alise it will come at a price that is beyond our reach.

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