O’Brien may be gone but problems just as bad in HSE

YESTERDAY we learned that the HSE’s winter plan has not yet been finalised. How can we be expected to have faith in a health service that can’t even plan for the seasons? Winter rolls around at the same time every year.

Despite this, its arrival seems to take everyone in the HSE and the Department of Health by surprise.

Last year, when record numbers of patients lay languishing on trolleys throughout the winter months, there were promises that things would change. That plans would be rolled out early enough to address the crisis. That beds, and additional resources, would be in place to deal with the surge in patients that occurs at the same time every year.

None of these promises has been kept. Instead, we have the same indecision, the same inability to forward-plan and the same failure to deliver.

The result is that there are now warnings that in the coming months, in hospitals all around the country, the trolley crisis could be even worse than last year with thousands of patients affected. By the end of this year, doctors have forecast that the numbers on trolleys could reach a record 100,000.

Already, in the first three months of 2018, nearly 15,000 people over the age of 75 were left waiting for more than 24 hours to be seen in A&E units.

The total number of such cases in 2017 was 11,261.

Speaking to this newspaper at the end of October, Dr Peader Gilligan, A&E consultant and president of the Irish Medical Organisation, cautioned that the health service was facing into a “perfect storm”.

“We will be told in January that it is a ‘flu crisis’ or a ‘winter crisis’ – it is not. It is a failure of policy,” he said.

That failure of policy is so abject that, in the second week of November, the HSE’s finalised winter plan has not yet been submitted to the Department of Health. Any day now, is what they tell us.

Meanwhile, a HSE report into the fiasco that occurred last year recommended the winter plan be ready to go by September at the latest and it said ringfenced funding for the plan should be signed off by June.

That funding for this year, €10m, was only allocated in October, crippling the ability of the HSE to finalise its plans.

So, when Health Minister Simon Harris invariably blames the HSE for record numbers on trolleys this winter, remember that the Government tied its hands by refusing to sign off on a budget in time to allow it to come up with a timely plan.

If Mr Harris is notable to meet these deadlines in the interests of patients, one would think that naked self-interest would motivate him.

Without funding and a plan in place early enough to make a significant impact, the result will be a winter of negative media coverage engulfing the Government as thousands of patients, many of them elderly and frail, suffer.

Tweeting on Saturday, Mr Harris said that 240 additional hospital beds had been opened this year and a further 79 would be “open in the coming weeks”.

However, just two days later this timeline had changed.

Asked on Monday when those 79 beds would be open, he could only say “they will come on stream between now and early 2019”.

In any event, in the context of 1,600 public beds having been closed since 2004, and a national bed capacity review which has stated the system needs anywhere between 2,500 and 9,000 additional beds, those openings are a drop in the ocean.

At the weekend, former HSE director general Tony O’Brien gave a lengthy interview to the ‘Sunday Business Post’.

Since then, much of the coverage of his comments has focused on petty name-calling directed at politicians and his trenchant criticism of the “kangaroo court” at the Public Accounts Committee (PAC).

Regrettably, there has been little focus on the most interesting aspect of the interview – his view that political influence and cowardice is thwarting substantive reform of the health service.

The HSE was set up in 2005 to remove meddling from politicians from the sphere of health.

But the reality is that politicians remain in control.

Clearly, a government has to set broad health policy. But, what are civil servants in the HSE supposed to do when that policy changes every second year, as has happened under successive Fine Gael governments with the abandonment of Universal Health Insurance, the confusion surrounding the introduction of hospital trusts, and the aborted attempt to abolish the HSE itself?

Further, how can the HSE ever be expected to stop its haemorrhage of money when there are far too many A&E units in the country for our population size?

While much was made of Mr O’Brien’s catty description of Mr Harris as a “frightened little boy”, much more serious was his denigration of the A&E unit at Our Lady’s Hospital in Navan as “not an emergency department I personally would have a wish to be taken to”.

For the former head of the HSE to essentially say he has no confidence in the A&E unit of one of the country’s hospitals is an astonishing statement to make – and should have garnered a lot of attention.

Dublin, according to Mr O’Brien, only needs three A&E units, instead of the six it currently has.

But, even in Dublin, which doesn’t suffer from the isolation and poor transport links that afflicts rural Ireland, there are no plans to reduce the number as it is not politically palatable to do so.

FURTHER, Mr O’Brien described the ambulance service in Dublin, with some areas covered by Dublin Fire Brigade and some by the HSE with the result that the nearest ambulance available is not always directed to the scene of an emergency, as “crazy”.

Apparently, it is impossible to do anything about that because of resistance and lobbying from Siptu – an accusation which the union, and the Health Minister, needs to address.

Ultimately the depressing message from Mr O’Brien’s interview was that politicians believe reform of the health service – to ensure value for money, more efficiency and, ultimately, better health outcomes for patients – is career suicide. So, nobody will do it.

Instead, what we get is tinkering around the edges and €17bn annually being poured into a broken system.

Given neither the department nor the HSE can even plan for winter, should we really be surprised?

The HSE was set up in 2005 to remove meddling from politicians from the sphere of health. But the reality is that politicians remain in control