AS I SEE IT
To say that there were ruffled feathers at Budget time over the Department of Health’s whopping over -spend of a billion plus is putting it mildly. The situation, as other ministers feared that they would get less of the Budget cake due to the HSE’s insatiable appetite for funds, put me in mind of a cuckoo in the nest which leaves the smaller nestlings starving.
Health is a big spender with €22.5bn allocated for the next year, second only to social protection at €25.2bn and more than double the spend on housing and education. However much the Department of Health gets – this year the increase of €800 million was over 6% – it is never enough. Health Minister Stephen Donnelley had been seeking €2bn. There was an outcry that that the Budget amount was a shortfall, prompting an immediate halt on recruitment for the HSE and warnings that the public would suffer even longer waiting lists for treatment.
Nothing like weaponising long-suffering patients in the run up to a General Election as a means of getting more money is there? Our spending on health is about average for the EU, according to Eurostat, with their recent report suggesting that we could do better on prevention and that we need more doctors and nurses. Meanwhile, nearly half of us are covered by health insurance to ease access to health care.
Given a long list of headlined problems from the delays and cost overruns of the children’s hospital now only due to open in 2026 at a cost of over €2bn to the ongoing crisis in overcrowded A&E department and Camhs, the Child and Adolescent Mental Health Service , it’s not unfair to say that our health system is unhealthy and that no amount of spending has provided the cure. What is wrong here?
Bernard Gloster, HSE CEO, interviewed on radio recently’ mentioned a long list of reasons for runaway spending from increased demand for health services to the soaring cost of electricity food and services. In all the debate over funds the elephant in the room question wasn’t asked. Is the HSE badly managed and inefficient?
There are plenty of managers in the HSE, hired at twice the rate of medical staff recently, but they don’t seem able to improve the outcomes for the health service. The HSE is a huge employer with around 150,000 on the pay roll. The biggest category are nurses and midwives at 42, 657 according to 2022 figures, managers and administrators accounted for 22,635.
When it came to hiring staff between December 2019 and September 2022 managers and administrators accounted for a 20% increase compared with an 11.7% increase in nurses, isn’t the ratio of bureaucrats a bit high? Bernard Gloster admitted last week that 6,000 managers were hired last year.
Health Minister Stephen Donnelly has promised savings next year of €600m with the savings to be made mainly on hospitals and a cutback in the costly use of agency staff, currently three times what it should be, and plans for a further 7000 staff were abandoned. Now, a bit confusingly, Bernard Gloster has just announced that a further 2,200 staff will be hired next year.
The Green’s Eamon Ryan said on air recently that reform was needed in the HSE as well as funding and that digital technology was one area that would make a difference together with having a universal system for administration. Other reforms that would make a difference would be to improve the underdeveloped primary and community healthcare services which would deal with treatment earlier and prevent so many cases ending up in hospital.
There is the point that having too many penpushers may not be best use of resources. Large organisations have a tendency to end up running themselves, having meetings about meetings) or running performance studies, rather than providing the service they were set up to do – in tis case, concentrating on patient care.
Next year Bernard Gloster has promised a shake-up of the HSE’s head office dividing it into two teams with a corporate division and national office in charge of delivery of health services under regional managers for six new health regions.
Isn’t this back to where we were with regional health divisions before we had the HSE?
Whether adding yet more managers and layers of bureaucracy to the system will improve the health of our health service remains to be seen.