Our creaking health service is the problem – not our behaviour

TIME to hit the reset button, HSE chief Paul Reid tweeted yesterday. It appears he meant that we’ve all got to reset our behaviour to peak pandemic practices: hand hygiene, mask wearing, social distancing, self-isolating if we have suspicious symptoms.

It was an unfortunate choice of words, though, because it sounds as if they’re softening us up for a reset to the default position: restrictions, quarantine, even lockdowns. Instead of the planned resumption of relative normality on Friday, could we really be looking at an indefinite extension of all those measures we’d hoped we were leaving behind?

Don’t rule it out. The Taoiseach’s refusal to confirm that the easing of restrictions on the 22nd will go ahead as planned is definitely worrying. Hospital admissions are rising, we’re running out of ICU beds and, even with one of the EU’s most impressive vaccination uptake rates, we’re facing into the winter season with no real explanation as to why the impact of the disease seems so much greater here than in countries with far lower vaccine uptake levels. How come the French, with just 75% of their population jabbed, can take a chance on opening nightclubs and college lecture halls, with no restrictions on numbers in bars, restaurants or theatres?

Intensive

We’re being told that the 300,000 unvaccinated in our midst are a major part of the problem here, and that’s definitely the case. Two thirds of those in intensive care at present have not had the vaccine, suggesting that there’d be far less pressure on beds if everyone availed of the jab. But the French have far greater numbers of unvaccinated in their population, and they’ve still been able to go ahead with restoring public freedoms.

Our proximity to Britain, and the ease of movement between the two countries, is undoubtedly another factor. Death rates in the UK are currently running at around 1,000 per week, and as of last month some 16million people, or almost a quarter of the population, was unvaccinated. Yet they haven’t ‘reset to default’ on their reopenings.

The onset of winter is another factor getting the blame but, again, it’s October in France and Britain too. With our high vaccination levels, our unseasonably mild weather to date and the continued imposition of restrictions abandoned elsewhere, you’d imagine we should have far less to fear from the Delta variant over the coming months than most of our neighbours. So why are we so much more gloomy and cautious about the future?

The real reason, I suspect, is the very one that Paul Reid, Health Minister Stephen Donnelly and Taoiseach Micheál Martin don’t want to mention. They’re happier to blame the unvaccinated for their irresponsibility, and the rest of us for dropping our guard and getting sloppy in our habits, but the real problem is the one we’ve never tackled, the one that never really went away. Our health service is just not fit for purpose – it wasn’t fit for purpose before Covid, and it lacks the long-term capacity to handle the unpredictable trajectory of this disease.

The NHS’s stock of ICU beds is under pressure but, even with a huge unvaccinated cohort and even with 1,000 deaths a week, it can still handle the onslaught.

By contrast, 17 Irish hospitals had no free ICU beds on Sunday night, and there were just 11 ICU beds for adults available across the country. The HSE has a ‘surge capacity’, in the event that demand for ICU beds

outstrips current supply, which will mean sourcing places in private hospitals. There’s still a limit on availability, even if extreme measures are adopted. Very sick people can also be treated in high-dependency wards, if necessary, though the Irish Nurses and Midwives Organisation has described this solution as ‘not optimum’.

Overwhelmed

In other words, the single biggest factor determining whether or not we reopen on Friday is the question of whether, if numbers continue to rise at the current rate, our already struggling health service will be completely overwhelmed. And it’s not for want of throwing money at the problem. We spent more than €26billion on health in 2020, and Budget pledges will bring that to over €30billion next year. But an abject lack of accountability across the HSE – for everything from poor forward planning to cost overruns – means that bad management, needless waste and woeful decision-making go entirely unchecked.

Other countries anticipated a Covid surge related to the Delta variant, their vaccination rates, the onset of winter and the easing of restrictions, but it seems to have taken us completely by surprise. And now we need to hit the ‘reset button’ – in other words, the only plan for going forwards is to go backwards.