SHUNNING REAL REFORMS FOR STABILITY, SPIN AND HSE CRISIS MANAGEMENT

WITH the extension of free GP care to the under 12s, we move another step closer to ‘Universal GP care’, to quote Minister Howlin. Presumably that is a step further away from the 2011 promise of ‘Universal Healthcare’.

GP care is a large part of our health system but only three per cent of health spending. It is not where the problems lie. GP care is one of the few parts of healthcare that works well. Unlike Britain, where GP care absorbs seven per cent of health spending, we have a system where GP waiting lists don’t exist.

I’m concerned that as the Government starts to manage GP care, they’ll manage it like the HSE.

As it is, the GMS system which allows GPs to take public patients is having difficulties recruiting doctors where demand is highest. Each GP can only take a limited number of patients. So some parents could face situations where one child is treated by one GP, and others by a different practice. What’s more, the GP card has i ncreased the bureaucratic burden on GPs who spend more and more time filling in forms instead of seeing patients.

These two effects give corporate, commercial GP practices an advantage over small traditional practices. This would be okay if big practices were as good for patients as small ones. In our system, a public patient’s visit to a GP costs the State about €30. Complicating and corporatising this will make it both worse and more costly.

While I welcome the extension of State-funded healthcare, the under 12s card is pencilled in for late next year. So it cannot be implemented by this Government and is a promise that won’t be fulfilled until after the election. That’s like promising your bride that you’ll always be faithful, starting next year.

In recent years the health section of the Budget has represented a synthesis of aphorism, wishful thinking and outright fiction. The announced spending projections bear only a passing resemblance to a reality which routinely includes supplementary budgets by year end. Thus statements concerning budgetary increases over prior years must be taken with a pinch of salt. This year is no different, and we cannot yet know if the announced €13.2billion spend for 2016 is actually an increase, a decrease or no change.

As the Department of Health was the recipient of a €350million windfall i n 2015, it i s not certain i f the budgeted amount f or 2016 will actually leave it with the promised €100million, or less. Time will tell.

As health policy is usually inspired by the politics of the last healthcare atrocity, there is predictably vague commitment to dealing with emergency room overcrowding, and our mediocre maternity services. We are told that 440 new inpatient beds in 2015 (i.e. within the next two months) will deal with the problem. So will the necessary staff be hired in the next few weeks to allow this to happen?

Across our hospitals, there are 580 open nursing posts waiting to be filled, 130 consultant posts seeking doctors, 370 more consultant posts currently filled by temporary locums.

It is nice that the Budget mentions the need for funding for a national maternity strategy, but the amount is not specified.

I also fear that ‘funding a strategy’ does not translate i nto funding improved services. It might just fund an expert committee, a new bureaucracy, new cushy-job national directorships, without any commitment to actually employ the desperately needed obstetricians, nurses and paediatricians. After the Titanic struck the iceberg it needed lifeboats − not a new life-boat strategy.

ONLY bureaucrats think that medical problems are best solved by throwing bureaucrats at the patients. While I understand the need f or bereavement specialists in maternity units, I can’t help but wonder that if we didn’t have the lowest numbers of professionally active obstetricians in Europe, maybe there would be fewer tragedies.

Overall, there is little for health reform enthusiasts to cheer about in this Budget. The Minister’s goals seem to be financial stability, crisis management and a dollop of pre-election spin. That’s not because the Minister has failed, it’s that we have a healthcare rationing system.

It costs about €18 billion – private and public included – to run the system each year and those resources are stretched to fit demand. Given that 39 of our 41 hospitals were incapable of hitting waiting list targets suggests that the problem is not the targets, but the system.

The increase in cigarette tax is the most welcome aspect of the Budget. I wish it was more, and I wish it was ring-fenced for health spending.