Ahead of the IHCA’s AGM, President of the Association Prof Alan Irvine calls for more honesty and transparency in how health services are delivered
We need an imaginative, focused and detailed plan over the next two to three years to expand and staff the hospital capacity that Government reports have shown is required to provide high quality and timely healthcare. Additional capacity is needed to run our hospitals at 80 to 85 per cent capacity, without trolleys and to provide elective care in timely fashion.
We also must decide if we are going to be bold, to build and expand our way out of the current economic and healthcare problem or if we should take the austerity approaches of the 1980s and 2010s, which were disastrous in removing capacity, the consequences of which continue to be felt today. It is imperative that the discrimination against new-entrant consultants is ended. We must treat our new consultants with equity; it is the only way we will fill the 500 vacant permanent posts in the service.
Covid-19 has changed everything in medicine for now and for the foreseeable future. There is no clear exit strategy from Covid. The key immediate challenges relate to the additional stress Covid-19 has placed on the already under-resourced system. We have the longest waiting lists in Europe and the lowest number of consultants per head of the population in the EU. Government reports have shown we need an additional 2,600 acute beds and a doubling of our ICU beds (the Prospectus ICU report has been on the shelf for 11 years). We must fill the 500 permanent consultant posts that are vacant and in addition create additional posts in virtually all specialities.
The Covid-19 pandemic has underlined how dependent our society and economy are on frontline healthcare professionals. The HSE’s Winter Plan is a welcome recognition that the system is playing catch-up, but the plan will not succeed unless and until we invest in the people patients depend upon. The plan is a promise to invest in services but not in the professionals required to deliver them. The big promises in the plan can only be realised if we have additional consultants and healthcare professionals. The plan includes few specifics. Building capacity requires both investing in space and in more hospital consultants. Two-thirds of the €600 million will not be deployed until 2021. These factors immediately cause concern about the ability of this plan to adequately address the challenge of a ‘winter like no other’.
The patient waiting list currently stands at over 840,000 people. On the surface, the headline promise of 1,500 additional beds is striking and would go a long way to addressing current concerns, but looking deeper, it appears that over 800 of these beds are already in the system. Now more than ever, we need to level with people. We must be honest as to how achievable it is to keep the promises made in the plan given that 500 consultant posts remain unfilled.
The Winter Plan 2020/21 has merits; the fact that it is published in September, rather than in the grip of winter is very welcome. The core interaction in healthcare, what makes it work and what makes it rewarding for patients and professionals is people with skills looking after people who need these skills in well supported and adequately resourced environments. This plan as currently set out fails to show a clear path to enabling these necessary changes.
We needed a level of honesty and transparency about what we can and cannot provide in our health service and following from that explain clearly how the system rations what is being provided. In more sophisticated countries, care is rationed by consciously not providing treatment for certain low-grade interventions, in an open and transparent way. In Ireland, we ration by waiting lists and by restricting access to new treatments. It is a more dishonest way of rationing. A waiting list for four years is not providing any service at all.
We need more reflection and honesty. We have some of the leading pharmaceutical manufacturers in Europe in Ireland, yet our people are routinely at the back of the European queue in getting access to many new drugs, because the drug budget is relatively easy to curtail. This is not good care, consistent with an advanced health system. New medicines that meet safety, efficacy and health economic target assessments should be made available to patients in a timely fashion.
We need more local ownership of the means to solve local problems. For too long there has been a drift towards centralisation of management. That is no reflection on the current HSE management, it’s a common pattern seen in many large bureaucratic organisations. We need more non-centralised, devolved, local functions. Centralised protocols for many competencies such as setting standards, key performance indicators, and centralised purchasing among others make sense, but local administrative units need to be more autonomous and be in a position to innovate local solutions to local problems.
For example, local HSE managers should be in a position to explore where appropriate local private provision, and how that might work for the specific needs of their public patients. There needs to be more local autonomy on recruitment; local clinicians and managers know what is required for local service needs. This is bottom up, devolved problem-solving.
Sláintecare was announced in May 2017, but realistically it has not been funded to any significant degree and hasn’t expanded any capacity so far. The worry is that will become a slogan, under which all new health innovation is branded, rather than a truly cohesive, transformative multi-year, costed initiative that delivers meaningful change for patients.
I would like to thank my predecessor, Dr Donal O’Hanlon, who led the Association in developing and rolling out our ongoing #CareCantWait campaign aimed at raising awareness of solutions to resolve the consultant recruitment and retention crisis in Ireland and other hospital deficits.
The IHCA will continue this campaign, holding Government to account for the fact that there are now almost one million people waiting for some form of hospital care in Ireland.
I look forward to engaging and working with all health stakeholders including Minister for Health Stephen Donnelly and the Chief Executive of the HSE, Mr Paul Reid.
32nd IHCA AGM – Annual Conference Programme
First Session: Statutory Reports & Motions
9:00 am Chair: Prof Alan Irvine, President
9.05 am Statutory Reports
- Mr Martin Varley, Secretary General
- Dr Conor O’Riordan, Membership Secretary
- Prof Clare Fallon, Treasurer
9:30 am Motions
9.50 am Break
10:00am Resourcing and Provision of Acute Hospital and Mental Healthcare in a Challenging Environment
- Prof Alan Irvine, President, Consultant Dermatologist, Children’s Health Ireland, Crumlin
- Mr Stephen Donnelly, Minister for Health
- Mr David Cullinane, Health Spokesperson, Sinn Féin
- Mr Alan Kelly, Health Spokesperson and Labour Leader (TBC)
- Panel Discussion and Q&A Session: Moderator – TBC
11.30 am Practising Medicine alongside Covid-19
- Mr Paul Reid, CEO, HSE
- Dr Noirin Russell, Clinical Director of CervicalCheck and Consultant
- Obstetrician and Gynaecologist, CUMH
- Public Health Speaker (TBC)
- Dr Graham Billingham, Chief Medical Officer, MedPro, Berkshire Hathaway
- Dr Chei Wei Fan, Consultant Geriatrician; Mater Hospital and St Mary’s Phoenix Park
- Medical Protection Society Speaker (TBC)
- Mr Brian Fitzgerald, Deputy CEO, Beacon Hospital
- Panel Discussion and Q&A Session: Moderator – TBC
2.00pm Closed Sessions – Concurrent
- Public Contract Issues: Chair: Prof Alan Irvine
- Private Practice Issues: Chair: TBC
3.30pm Conference Closes