Gold standard healthcare remains nothing more than a vague aspiration
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.