INTERVIEW:The Minister for Health says huge challenges lie ahead in 2012 and cuts of €868 million will have to be made
MINISTER FOR Health James Reilly is “cautiously optimistic” that progress is being made in key problem areas of the health service such as the number of people on trolleys in hospital emergency departments and those on waiting lists for procedures.
He warned “huge challenges” lie ahead, however, with hundreds of millions to be taken out of the health budget next year. He also believes work practices of a number of health care staff grades will have to change. He said he wanted to see reforms to the type of work carried out in both larger and smaller hospitals.
Since his appointment, Reilly has invested huge political capital in the development of his “special delivery unit” (SDU), tasked with making inroads into problem areas such as patients on trolleys and waiting lists, which have beset various ministers for years.
Reilly said there was now an awful lot more information available on which to make decisions. He said trolley counts, for example, now took place three times per day. Several hospitals have also been given additional funding on strict conditions that measures such as seven-day ward rounds to discharge patients are put in place.
However, for much of his time in office the numbers on trolleys have remained stubbornly high, bouncing along at a level of about 50 higher than last year.
In an interview conducted just before Christmas, the Minister indicated things may be beginning to turn around.
For the first time, he said, the 30-day moving average (the tracking system which measures numbers on trolleys) had dropped below the figure for the same period in 2010.
The situation had improved considerably in the emergency departments in hospitals such as Our Lady of Lourdes in Drogheda and in Tallaght, which faced severe problems over recent months, he added.
“In all those hospitals there is a sense amongst people on the ground that they can control their own environment, that they are empowered to fix their own situation.”
His target that no patient should be on a waiting list longer than 12 months by the end of December 2011 had been met in all hospitals in the country with the exception of Galway, he continued. About 300 patients there waiting longer than a year will be offered treatment in private centres, with Galway paying the bill.
The target for the maximum period on a waiting list will be reduced to nine months for 2012.
He acknowledged the health system faces a massive challenge in the year ahead. Cuts of €868 million will have to be made, he said.
In addition, there is huge uncertainty about how many staff will leave – and from what areas – before new pension arrangements come into effect at the end of February. So far, 2,600 personnel have either applied to go or have expressed an interest in leaving.
Changes to work practices and in the way work is carried out is essential under such a scenario, he argued.
He had already told the new management teams he appointed to the Mid West and West hospital groups that less intensive procedures should be moved out of main centres in Limerick and Galway to more peripheral hospitals.
He said the best example of a smaller hospital taking on different work was Louth County in Dundalk. He said while in the past it had not been doing any cataract procedures, about 1,000 of them would have been carried out by the end of 2011.
“It is utterly nonsensical to have people going into Galway University Hospital for a hernia repair when they could go to Portiuncula or Roscommon for it in far more calm surroundings.”
He also argued that changes to staff work practices were crucial.
As a result of the SDU and the Health Service Executive’s clinical programme schemes, he said, hospital consultants were coming in on a de facto basis at weekends to discharge patients. He wants this arrangement formalised very soon under the Croke Park agreement.
This may not necessarily involve a formal nationwide deal with all hospital consultants.
“The new way of doing business is far more successful and it simply is – instead of writing long sets of rules to achieve a goal, we are saying to the system, ‘Deliver the goal and we will not worry too much about the rules’.”
Reilly also signalled that nurses would face changes in work practices. “Everybody realises now and has to accept that the idea you can work a full 36 hours in three days is not a runner. 450,000 people unemployed. The country is facing a financial struggle.
“I would like the Irish Nurses and Midwives Organisation to come up with solutions around that – – different solutions in different parts of the country. It does not necessarily have to be one size fits all.”