MEDICAL MATTERS:'It's the 1980s again, only this time, it's worse'
THOSE OF US who worked as healthcare professionals in the 1980s are experiencing an unwelcome deja vu. It’s the horrible feeling of a health service being dismantled around us. It may be quiet and insidious, but the effects are as bad as a wrecking ball swinging indiscriminately through a street of well-built houses.
What’s going on? It’s the sound of the beancounters “top-slicing” 10 to 20 per cent off existing hospital budgets. It’s the sight of accountants from the Health Service Executive (HSE) riding shotgun over local administrators as they negotiate new budgets with doctors, nurses and other health professionals. And it’s the realisation that preventive health programmes with long-term benefits are easy targets.
As a hospital consultant remarked to me recently: “It’s the 1980s – only worse”. As junior doctors back then, we worked in a health service that was similarly butchered. But in the 1980s the country had not experienced a decade of explosive, but necessary, growth, which now makes many parts of the health service more vulnerable to poorly thought-out cutting.
Some people shrug their shoulders and ask, “What else do you expect?” Well, actually, we expect more than letting accountants loose in unfocused and unsupervised rounds of top-slicing.
Inconsistencies abound. Going home after a stroke? A community team may offer you rehabilitation in one part of the country, but not in another. Need a wheelchair and other aids after being diagnosed with multiple sclerosis? Items under €100 are no longer funded in certain regions; if you need five aids costing €90 each, put your hand in your own pocket. Local authorities still accept applications for refurbishment grants to enable people with disabilities remain in their own homes, but very few applicants are seeing any money.
Unfortunately, cuts like these will erode the system’s capacity to look after people in their own homes and communities. Not only does this conflict with the main plank of public health policy – developing primary care services – but cutting services for the chronically ill directly affects waiting times in AE departments. These patients become acutely unwell following withdrawal of home supports and place additional pressure on hospital services.
According to the Association of Directors of Nursing, the situation is every bit as bad for inpatients. Noting the loss of more than 2,000 nursing posts from publicly-funded services, Irene O’Connor, the association’s chief, said: “Without nurses and midwives wards will have to close and services be reduced. Patients will be left waiting for fundamental nursing. Clinical signs will be missed, with the resulting delay in diagnosis and treatment. Diagnosis and treatment delayed prolong recovery, and failing to recognise a deteriorating condition can lead to possible death.”
It has already happened in the NHS, where an inquiry found an unusually high number of patient deaths in Mid-Staffordshire was directly linked to a policy of not replacing nurses. Writing in the British Medical Journalrecently, Dr James Drife, a consultant obstetrician, said of cutbacks in the UK: "In today's maternity services, senior midwives and doctors have to comfort younger colleagues reduced to tears by the disparity between what they want to do for patients and what they can do."
John Appleby, an economist with the health think tank The Kings Fund, warned: “The prospect of frozen budgets but increasing demand will prompt greater efforts to decommission relatively low value care in favour of high value care . . . But the trade-off between relatively low and high value care may also be a trade-off between one group of patients and another . . . The net outcome – allowing for one patient’s welfare to be traded off against another’s – could be a reduction in quality; it depends what values are placed on the loss of equity and the gains in efficiency.”
However, thoughts like these don’t register with decision-makers, who remain acutely aware of the price of everything and value of nothing.
mhouston@irishtimes.com