We must break cycle of political theatre around health funding
THE most recent National Treatment Purchase Fund (NTPF) figures highlight, once again, the inability of successive governments to put in place a credible and sustainable funding system for delivering healthcare. They also point to deeper issues.
The explanations offered by the Taoiseach to mitigate the seriousness of the NTPF figures, such as “double-counting”, do not stand up to scrutiny – the figures, and the movement in the figures, tell their own story. Similarly, the rehearsal of increased government expenditures – “This year alone we spent...”, which is cut and pasted into every press release – is basically spin, deflecting from the underlying issues. The subtext is hospitals and/or staff are not very cost-effective. But they are. They work miracles in keeping an underfunded system going – once you are actually inside that system.
As a former health minister, the Taoiseach is all too well aware of this. The fact is that, were he in opposition, he would be calling out this sort of ritualistic response.
The astonishing thing is, it keeps on happening. It wouldn’t in any domain other than politics. ‘Groundhog Day’ will be making its annual reappearance in a month or two when the winter flu kicks in and swamps A&E departments around the country – the whole narrative will be kickstarted.
There appears to be a tacit perception in party politics that the problems in the health system do not actually have to be solved – it’s about getting through a few leaders’ questions, some press releases and shuffling some existing funding around to conjure up the perception that “something is being done”.
But it’s not – not really. The NTPF figures and difficulties with consultant recruitment point to this fact. There are, of course, good things happening in some specialties, mostly under the radar. To take one example, the St Vincent’s radiotherapy services in Dublin are a model of patientfriendly staff and flexible service delivery, with good systems operating at a high capacity. Pioneering work in radiation oncology has been carried out in Galway too. But more such services are needed while, at the same time, the figures show that there is a shortage of staff in this field. It is a real concern that there are funding pressures reported in cancer services this year, even with all that’s happened in recent times.
The fact is that acute healthcare is – at the margins, which is where it counts – politicised and not ‘joined up’. The parameters are thoroughly familiar: staffing, capacity and capacity utilisation across the public and private sectors, ‘bed-blocking’... the list goes on, and on, and... that’s the stuff of politics in Ireland.
But it shouldn’t be. That’s the whole point: it shouldn’t be. If the NTPF figures are correct – and the professions are clear that they are – then an awful lot of people and families are hurting.
In all of this, there are a few big issues. The first is that healthcare is underfunded – oh, yes it is and let’s not get side-tracked by the value-formoney debate and all of that. This is made worse by the fact that private health insurance has long subsidised inadequate public spending.
The Government – all governments – plays the same game. It doesn’t provide sufficient funding in the first place. Then, as the overspend emerges, letters are issued, chiding those in the system and warning the overspend will have to be clawed back in next year’s allocation.
It’s all political theatre. Money – but not near enough to clear the backlog – is doled out via supplementary allocations and an inadequately funded NTPF. What’s the sense in that?
It’s happening again this year. Serious underfunding was reported as far back as January. Now, to the apparent surprise of ‘the system’, it has re-surfaced, right on schedule.
The second big issue is that healthcare budgeting is hostage to political and interdepartmental bargaining, especially in the lead-up to the Budget. Again, it shouldn’t be. The current stop-start, cut-then-spend cycle is counterproductive. It ends up costing more and it’s socially regressive.
The legacy of exporting trained nursing and medical staff, recruiting them again a year or two later and cutting consultant salaries to pieces is still with us: these are not solutions, they are at the heart of the current problems.
There is no appetite in Government for major reforms to tackle the sustainability problem, especially one such as the present ‘coalition of the willing’, and with an election in the nearish-term. This Government is almost certainly right – universal health insurance was very much a learning occasion.
There are, however, steps that could be considered by the Dáil Health Committee. Not a commission or task force or anything like that. It’s simply that we should seriously question a mind-set and methodologies that are endlessly repetitive and don’t deliver
as they should. A status report on funding, looking back as well as looking forward, of say three years would be a good start.
A ‘foresight’ exercise could assist the committee and inform the public on how companies that are operating in the field, and whose future depends on a sustainable business model, approach things – and what they think is coming down the line. Ryanair benchmarked its flight turnaround on Eddie Jordan’s F1 team.
Funding arrangements for our health system wouldn’t last a moment if it were a (very small) unit in, say, Microsoft.
The public health system is, of course, fundamentally different in nature to private enterprise. But it can learn from the private/vocational domain.
Most of all, we need to break the reactive and politicised annual estimates/budgeting cycle: to move beyond a mindset of control to one of co-responsibility and an end to the annual funding wrangle with the senior prefects in Merrion Street.