There’s no mystery about hospital chaos

Having shredded the system, we’re now spending huge sums just to maintain a standard of failure, writes Gene Kerrigan

DO we really have to face yet another year pretending we don’t know what’s wrong with the hospitals? Because that’s what we’re doing now — we’re pretending we don’t know what’s wrong.

We discuss the public health service as though it’s been struck down by some mystery disease. If only we knew what it was, we’d fix it, regardless of cost.

And we’ll continue to speak of “reforming” this, and “reconfiguring” that. We’ll say it’s all because there are too many administrators, we’ll set “targets” and say we need “efficiencies”.

Politicians speak of efficiencies as though there’s a chemical with “Efficiencies” on the label, and all you have to do is spray it from the ward ceilings and bingo!

Right now, the collapse of the health service is politically embarrassing — so the politicians will shovel money into the mix, snipping a bit off a queue here, filling a gap in a ward there.

We’ll wince at new horror stories that are just variations on the old horror stories. We’ll listen to an embarrassed Simon Harris say again how “ashamed” he is when the latest horror show occurs, and how he’ll move heaven and earth to make sure it doesn’t happen again.

But there’s no mystery disease afflicting the health service. We all know what happened. Politics. And numbers. Politically, since the mid1980s, a semi-religious belief has prevailed — it says that government spending is bad, cuts are good, regardless of long-term effects. Fiscal conservatism, in itself, without regard to the consequences, was and is considered the ultimate and overriding factor in Irish politics.

This continues to underlie Fine Gael policy and Fianna Fail. And Labour (except when they’re in Opposition).

In a great wave of austerity, in the decade after 1984, the right-wing parties cut about 6,000 hospital beds.

Coincidentally, this ideology suited the comfortable classes of the time. In that period, the Ansbacher and the Dirt frauds were just the edges of a widespread network of organised crime. Household names, people who preached business ethics, created criminal rackets. In large firms, executives compared tax fraud mechanisms and shopped around for better illegal schemes to move to. Hundreds of millions were siphoned out of the lawful economy.

This wasn’t the usual individual tax dodging, this was a great number from the business and professional classes, operating criminal rackets set up by bankers, over a period of years.

In that period, great fortunes were made.

The heavy tax on PAYE classes made up for some of this money siphoned off, but there also had to be a lot of spending cuts to facilitate the criminality.

By 2006, the trolley culture was in place — the public health system was beginning to collapse.

And it was then that Health Minister Mary Harney, genuinely alarmed by what was happening, declared a “national emergency”.

Now, some of us look back with affection to the Harney years, emergency and all. We then had 527 beds for every 100,000 of population, according to Eurostat, the statistical arm of the EU. That was 94pc of the EU norm.

With a “national emergency” to cope with, what do you think our politicians did about the number of hospital beds? They cut them, of course. Remember, when the “emergency” began in 2006 we had 94pc of the EU norm?

Well, by 2010 we had only 275 beds per 100,000 (52pc of the EU norm).

Today, we’re stuck around 52pc of the norm in comparable countries.

We used to have a safe bed occupancy rate, but now we have a 94pc rate, which is dangerous.

And these reduced resources have had to cope with an increased population, and a population that’s ageing and in need of more treatment.

Oh, and, of course, nurses — at the end of 2013, we had about 5,000 fewer nurses than we had when the “national emergency” began.

And we have fewer doctors than the EU norm.

Asked recently if there’s now a national emergency, Health Minister Simon Harris said there isn’t. When and how the emergency ended, your guess is as bad as Simon’s.

When in Opposition, politicians bewail the blatantly damaged health system and promise to repair it. When in office, they live with the deliberately depleted system, and continue to demand “efficiencies” and to set “targets”, regardless of continued failures. Why is it like this? How come, following a declaration of emergency, things got worse?

After all, these people are not stupid. They can see what’s happening.

Well, we can write off Fianna Fail. When Micheal Martin was Minister for Health, he sought to bring the health system to European standards, in a great one-off improvement.

Finance Minister Charlie McCreevy didn’t approve. FF went with McCreevy. And that was the end of that argument.

Micheal Martin could have resigned, forced a division on a basic conflict over the health of the nation. He could have sought to rally the members of FF, but that’s not what career politicians do. He deferred to the fashionable orthodoxy.

And, after all, FF is not that kind of party. It isn’t policy-driven, it’s about getting into office and spreading the spoils among the faithful.

So, the fiscal conservatism, whatever the consequences, continues. FG is ideologically committed to it, to an even greater extent than FF.

The theory is that the private sector will respond to market forces and fill the gaps that the public sector can’t reach — it’s nonsense, but they hold to that like kids hold on to their teddies.

They use all sorts of tricks to convince themselves that the “efficiencies” can be made more efficient, if they can get the right managers and set the right targets. They tell themselves bed numbers can be reduced because of increased day procedures.

It says so in the rightwing economic theories that have prevailed since McCreevy’s day, so it can’t be failing, it simply can’t be failing, even though it transparently is failing.

At one stage about a dozen years ago, they claimed to be providing greater numbers of beds — but it was a mirage. They had noticed people were being treated on trolleys, in chairs and on couches, so they stopped saying “beds” and used the term “day places”, and bingo! They had an extra 500 “day places”, but no one believed them.

Having deliberately shredded the system over a period of years, trying the same managerial solutions over and over, knowing they don’t work, we are now spending huge amounts of money just to maintain a standard of failure.

Most of that money goes into the private sector — agencies and consultants and private purchase — so the comfortable classes benefit again. And that’s seen as an upside.

It’s a bit troubling that we have to keep up the pretence that some mystery affliction has elderly people lying for days on trolleys, getting enemas in corridors, while overworked staff remain terrified that the slightest mistake might have catastrophic consequences.

How long more can we tell each other that we don’t need to replace those thousands of beds we threw away? How long can we pretend we don’t need the thousands of nurses we trained and who had to emigrate? That we don’t need a system geared to social needs? That we can continue indefinitely to juggle a declining public system and a thriving source of private profit?

And a happy new year to you, too, on your trolley.

‘They use all sorts of tricks to convince themselves that the ‘efficiencies’ can be made more efficient’