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Consensus is possible

Do we in Ireland take the delivery of healthcare seriously, as they do in countries where it is done better? Politicians, public or professionals?

In the political realm, in my voting life at least, you have two types of health minister. Some may or may not have an idea in their head but their sole priority and interest is in getting the hell out of Angola as quickly as they can without starting too many damaging fights or ruining their careers. Then you have the privateer ideologues, with affinity and sometimes tangible connections to the for-profit healthcare industry. Neither sort of minister has shown any real interest in providing the leadership required to develop the best public system possible.

It’s a cliché that the front-line staff are the biggest asset, but it’s true. Here in the UK, if they could staff the entire service with Irish-trained nurses, I think they would. In medicine, the Irish punch way above their weight in high-impact medical journals and conferences. Irish junior doctors have endured conditions above and beyond what anyone else in the world have been doing for 10 years. However, in mid-to-late career, when they ought to have the most potency, people have been banging their heads off the walls with transient and short-sighted managements for two decades and having reached a comfortable salary themselves, may not always be entirely motivated to overcome the steep barriers to change the world anymore. They’ll do their utmost for the person in front of them but the overall vision is obscured, too hard to change, and the professional organisations are too busy fire-fighting and have been patchy at best in advocating for meaningful change.

The professional organisations are too busy fire-fighting and have been patchy at best in advocating for meaningful change

Management of the health service is under-rated and unfairly vilified. For sure, no more so than the clinical side, it is pockmarked by the hopelessly over-promoted and the stubbornly inadequate, but I believe there’s a large, solid core of people who are highly competent but seem to get inadequate direction, motivation or career mentoring to develop to their full potential from the centre.

The fights that HSE central has picked this year tell a lot. General practice and St Vincent’s University Hospital. I reckon if you took a proper customer satisfaction survey of the entire acute service in Ireland, then these two entities would probably be among the highest ranking, but have long been relatively autonomous from the HSE. Therefore they must be stopped. Revealing.

Then you’ve got the public who, in spite of blowing off a load of steam, don’t really give that much of a damn either. Typically cack-handed, as the carry-on with Irish Water was, it’s enlightening that people will march day and night against the idea of paying a few quid a week for water, considerably less than the UK, but 500 of our most vulnerable folk lying around on draughty corridors every night is met with a shrug of the shoulders. The only thing that gets people onto the streets about healthcare in Ireland is abortion or the ‘don’t close our local hospital’ stuff.

For sure, emotive and worthy causes but beyond that, people don’t care as much as they’d like to think.

Ultimately though, the will must be political. The situation in Ireland now is the same as it was in the NHS in the mid-to-late 1990s. Labour, and Gordon Brown when he was Chancellor in particular, absolutely revolutionised it. They didn’t get it all right but the service is amazing in terms of breadth, access of services and value for money. Yet the voters crucified Brown and have put the Oxfordshire bacon-lover back in to sell bits of it off to his buddies. People will never reward politicians for health reform until such time as nobody ever dies again. Until then, people will crib.

So what’s the way forward? Well, when I was a little fella, the type of talk you hear about the health service now was the lingua Franca regards the North. ‘It’ll never be sorted’, blah, blah, blah. And while it’s not perfect (no health service is either), it’s immeasurably better.

The establishment of the New Ireland Forum and some mature political decisions on behalf of both Fine Gael and Fianna Fáil took it above politics and led to the Hume-Adams initiative and the pan-Nationalist front. Perhaps rather than having inertia due to one government tearing down the previous five years’ effort and starting again, a standing consensus could emerge on the best way forward. Get all the relevant stakeholders on board, get the right leadership and get them to come up with a plan and deliver it with everyone buying in.

It might work; it might not, but I think it’s worth a shot.

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