The return on our investment in healthcare in Ireland might surprise us

Denis Doherty
Denis Doherty

Credit where it’s due. The Minister for Health announced recently that a dedicated paediatric spinal surgery unit is to be set up here. That is, in my view, one of his best decisions as Minister for Health. Writes Denis Doherty.

For many years past, children requiring spinal surgery have been badly served by our health services. Many have waited for years, often in great pain, to receive the surgical, rehabilitation and support services they required. Where children are concerned, service delayed may result in forfeiture of potential.

The Minister’s announcement stated that the new unit would ensure that there are dedicated beds and healthcare workers so that surgeries will take place in a timely manner. The report that I read of the Minister’s announcement did not deal with the very important question of the funding of the new unit.

The report did say that the Minister was not satisfied that millions of euro in funding given in 2022 was used solely for orthopedic and spinal care. He went on to complain that waiting times for children in need of spinal surgery did not reduce dramatically. It seems that surgeries went up but the number of children waiting had not reduced to anywhere near zero.

His stated dissatisfaction seems understandable. Based on that experience, it seems that the financial management of the new dedicated pediatric surgery unit needs to be fit for purpose and capable of meeting the management information needs of all stakeholders. There is a well – founded maxim pertaining to financial management that ‘what gets measured, gets managed’. Leading healthcare organisations place financial efficiency on a par with the quality of care provided on the grounds that judgment of a service ought to take account of all the elements that contribute to the overall reputation of the unit.

In all of the extensive media, political and public discourse on our health services, the matter of return on investment in healthcare, in measureable terms, rarely features. The reality is that good healthcare is expensive and becoming ever more expensive as improved diagnostic and treatment modalities become available. That is not going to change anytime soon. Interestingly, the rising cost of private healthcare in Ireland is receiving more media coverage at present than it has for some time past.

Many studies have shown that the lived experience of the vast majority of health service users reveal that they are either satisfied or very satisfied with the quality of the service they received. Perhaps understandably, matters such as waiting times, beds shortages and the like appeal more to politicians and media outlets.

Over time, the cumulative effect of negativity has grown and is influencing matters as important as staff recruitment and retention as well as difficulty in conveying understanding of how well our health services perform, relatively speaking, to systems that tend to be assumed to be better than ours.

In the past, in the NHS in particular but also in Ireland, much interesting pioneering work was done in developing systems that contributed to measuring return on investment in healthcare. The term ‘health gain’ was used to describe return on investment and became well understood over time. It encompassed investment across the broad spectrum of healthcare from antenatal-care all the way along to palliative-care. If only because the healthcare budget has increased so much in recent years, is a planned regular focus on return on investment not overdue? The results might surprise us.  

Hopefully, Ireland will soon be in a position to achieve transformational change in the way we treat the needs of those requiring spinal surgery. The new spinal surgical unit and the new National Children’s Hospital provide a great opportunity to meet the needs of our children requiring specialist tertiary care.

The new hospital needs to overcome the negative time and cost experience of the construction phase of the project. The role of the new hospital and its relationship with pediatric services more generally needs to be clearly set out also. There appears to be a reluctance to prepare our people for the potential the new hospital offers to bring hospital services for children in Ireland to a level we can still only aspire to. That needs to change and soon.

To satisfy justifiable expectations, the hospital will need to demonstrate that services provided there meet best standards internationally and that their costs compare favorably with the cost of similar services elsewhere. We have ample knowledge of how inadequate our services have been for many years past and can access data on state of the art services already available to many of our fellow EU citizens. By adopting a progressive, best practice approach we can, in time, put to rest the negativity that has bedeviled the construction phase of the new hospital and demonstrate the high worth of that important hospital in patient service provision.