Fix What Needs Fixing

Denis Doherty
Denis Doherty

The Sláintecare report, published in May 2017, proposes a 10 year timeframe to implement the recommendations it contains. The halfway point of that timeframe has been passed without much to show that can be attributed to recommendations in the Sláintecare report, writes Denis Doherty.

Did the committee members ask themselves any ‘what if’ questions?

In fairness, back in 2017, the world was a very different place compared to what it has become since. The major global players appeared tolerant of each other. The USA and China were still friends. Chinese leader Xi Jinping championed globalisation when he spoke at Davos that year. The recession, caused by the great financial crash, had receded, economic growth around the world was accelerating and stock markets were hitting historic highs. The UK had voted to leave the EU but the Sláintecare committee appeared to view the implications of that event only in terms of how cross border healthcare in Ireland might be effected.

So, what could go wrong? The Slántecare Report was cleared for takeoff under a clear blue sky. Soon though, the former British Minister, Harold Mc Millan’s reply of ‘events, dear boy, events’ to the question of why things had gone so badly wrong in his time seemed apt. Events, since 2017, have impacted our health services very severely. First, there was the COVID-19 pandemic followed by a major cyber attack that our health services IT infrastructure was inadequately equipped to cope with. The pandemic demonstrated that globalisation, as we then experienced it, was fatally flawed and incapable of delivering essential supplies when they were most needed. When the chips were down, we discovered we had fewer friends than we thought we had. Management of the pandemic on our island was characterised more by demonstrating difference rather than co-operation. The cyber attack provided a salutary lesson in relation to the scale, scope, reach and seemingly low risks, to the perpetrators, associated with that form of organised crime.

Who would have predicted in 2017, that five years on, a major war would be taking place in Europe and that Ireland would take in more than 50,000 refugees from Ukraine during the first nine months of that war? All is changed, changed utterly, and the Sláintecare report may be consigned to the receptacle that contains the remains of earlier healthcare reports that met with a similar fate.

That said, there is much in the Sláintecare report that is worthy of consideration in informing future healthcare policy. Fairness in the allocation of resources, a sharp focus on efficiency, effectiveness and accountability are just some examples of that.

It needs to be acknowledged that our health services performed really well in the role they played in the management of the Covid pandemic. The number of excess deaths recorded in Ireland relative to other European countries is strong evidence of that. During the pandemic, I was struck by the volume of sustained praise that was directed at NHS staff in the UK.  For what it might be worth, I suspect a bit more deserved praise and appreciation towards beleaguered healthcare staff here would not have gone astray.

Work experienced during the pandemic has taken its toll on the health and morale of health care staff here and is not receiving the attention it merits. There has never been a time like now when really strong emphasis needs to be placed on the working conditions of staff, their training and development, the environments they work in, and how they are treated in workplaces that are often under-resourced and physically unfit for purpose.

New regional structures are due to be activated next year and need to make early gains in demonstrating their ability to fix what needs early fixing.

To do that, clarity in relation to their authority, responsibilities and accountability is needed. They need to be adequately resourced and held accountable, in financial and service delivery terms. The overriding priority needs to be the creation of workplaces capable of attracting, retaining and developing staff in the numbers needed to deliver services of the standard we aspire to. They will inherit a good crop of low hanging fruit.

We don’t need 57 varieties of change; the new organisations need to focus on what needs fixing.

We need:

  • A primary care system that is fit for purpose.
  • An acute care service that is resourced to cope with the seasonal variations in demand that are, for the most part, predictable.
  • A first world mental health service, for children, adolescents and adults.
  • An ambulance service that is capable of meeting the response times that affords their patients optimal prospects of survival and recovery.

But, ‘what if’, for example:-

  • The salary only Consultants Contract being portrayed as the future norm does not attract Consultants in the numbers and of the calibre required?

 The project plan for the implementation of change on the scale envisaged, involving so many key service providers, will need to contain contingency provisions aimed at ensuring that shortcomings associated with the changes involved do not result in a currently inadequate service worsening further.

  • The cost of funding the changes that need to be introduced greatly exceeds funding levels currently envisaged?

 In 2020, the cost of resourcing and managing the pandemic would have been judged to be unaffordable. But, ‘needs must’ and the cost was met. Our services demonstrated an ability to apply the extra resources to good effect when compared to the results achieved across Europe. The additional costs now required were identified from the experience of managing the pandemic and the fallout from the cyber attack on our health services. Other countries are addressing this issue; I expect Ireland may be doing so too. It is an issue that won’t go away.

That said, we are likely to continue to live in interesting times for the foreseeable future and the likelihood of what McMillan termed ‘events’ intervening must be a very strong possibility.