In the wake of an opinion poll prior to the election, one shrewd political analyst observed candidly that the factor which seemed to be motivating voters in the run-in to the election was not whether any one party could run the health services better, but if any other could make them worse.
The poll was taken amid the continuing work-to-rule by nursing staff, and in the aftermath of a decision by hospital consultants to ratchet up the pressure on public-only hospital contracts. It inevitably fuelled a widespread, if often mistaken view, of a public health service in permanent crisis.
Despite all the changes, for many the conclusion is the same: the health services and/or public perceptions of them are getting worse, or the message about the improvements being made isn’t getting through. I can’t remember the health issue looming larger in any election since the late 1980s. The difference between then and now is that the country has moved on, but the public sector and health services have yet to catch on.
For all of its strengths, our model of social partnership has been a singular failure in delivering the best health services. Why? Because any project that proceeds on the basis of common ground between those groups which are in the loop, and only then on the basis of their shared interests, is necessarily a suspect arrangement for everyone outside of it.
Yet, if there is any lesson to be drawn from the prominence of the health issue in this election, it is that while the voters appreciate the need for government by discussion, they also demand government by decision. This in turn, demands that the health services achieve real results.
Regardless of who makes up the next government, that issue will loom large on the agenda. When all of the fanfare around the promises of extra hospital beds, step-down beds and emergency care centres has died down, that core issue will remain. Politics really will have to matter then.
But will they? In France, the sun is setting on the 35-hour week. Here, we’re just getting into our stride with it. Where then for all those election pledges? Will partnership scuttle the promises and the productivity? In the world beyond the public sector, which incidentally is inhabited by some of the public health service’s most skilled people, a 35-hour week is the exception and the productivity is there to prove it. We could well end up with a situation that costs more, delivers less, and will annoy the people even more at the next election.
Listening to Prof Drumm’s interview after the deadlock in the nurse’s dispute appeared to be broken, one could be forgiven for thinking he wasn’t all that confident that better working practices would arrive before the shorter working week was achieved.
The other interesting point about that interview was the reference he made to the expense of delivering health services in a hospital context. Fine Gael and Labour have pencilled in an extra 2,300 hospital beds over the next five years. What isn’t clear is how this promise will be fulfilled, given that we are already looking at delivery schedules of up to eight years for the new children’s hospital and the North Eastern regional hospital.
This will be interesting to see how it gets played out. Either the current rule book for public sector tendering gets torn up, or the public sector will have to contract the private sector to develop turnkey facilities. The end result would be co-location, albeit with a different dress sense.
Politics obviously matter. Whatever the complexion of the new Government, if there is going to be a massive hospital building programme, then it will be the result of a political choice, which the vote-holder will have to implement. But if most of the money available is diverted, and all the effort is averted, from remedying the chronic lack of primary and community services, we’ll soon be back to square one.
True, we need more beds, but we also need much more in primary and community services. We also need to be careful to avoid a situation where limited funding is soaked up in higher wages but shorter working hours and lost productivity.
The other imponderable at this stage is the Health Service Executive (HSE) itself. I don’t think there is any likelihood that the organisation will be abolished, but a changed landscape in terms of national priorities would have an impact.
The legislation may need to be revisited to put in place mechanisms to assure the level of services for patients and clients, which in turn, would force the thrust of reform in a new direction. This would be no bad thing.
The new Government will get some leeway as it attempts to grapple with deeply-entrenched problems that have evaded the outgoing administration. It will need to act quickly and decisively to remain credible.