HEART BEAT/Maurice Neligan: It is the shortest day of the year as I write. It is crystal clear and cold. The sun has just crept over Seefin, and the flanks of Carrantuohill are powdered with snow.
It is high water, the little wavelets flecked with gold from the rising sun. In the opposite direction looking across Dingle Bay to the mountains of the peninsula, a beautiful and complete rainbow stretches in an uninterrupted arc. Every prospect pleases, but the completion of the quotation most certainly does not hold here.
It is against this background, that I contemplate the year ahead. I am an optimist by nature, and I would hope that in the health services, things can only get better. There is no point in recrimination, other than to understand how we arrived at the present doleful situation. Thus understanding, to be resolved not to simply repeat the mistakes of the past.
We hold the Ireland in the heart,
More than the land our eyes have seen,
And love the goal for which we start
More than the tale of what has been
I don't think George Russell was thinking of the Irish health services when he wrote the above, rather with what he perceived to be a pernicious obsession with the past and its wrongs and tragedies. We should look instead to the dawn and a future to be made bright by ourselves, by our ideas and our labours.
Clearly, we do not know what lies ahead. Aspirations, so prevalent at this time of year, however well meaning, are not solutions to problems of the magnitude besetting our health services. This is now obvious to everybody, and despite endless reports, expensively acquired, the problems inexorably get worse.
We are promised new beginnings but as yet we see no improvements. Indeed there is a presentiment, that despite the brave new words, all that appears to be happening is a re-arrangement, of the same old tired and discredited players who got us here in the first place. Nobody can be impressed with the maladroit handling of the pensioners entitlements regarding long-term residential care; it bears all the hallmarks of the bungling of the past. It is shameful and uncaring.
What else is new? Nobody is responsible, it just happened. That is no longer good enough, somebody is responsible, if not the then Minister then the officials who apparently omitted to brief him. Where we stand now, is uncertain. Ill considered legislation rushed through Dáil Éireann, is no answer to measured debate of what is a difficult problem. Our President, herself a lawyer, has called the Council of State together to discuss the proposed legislation.
As for our crisis in the health service, is it insoluble? I do not think it is, but I do not think it can be achieved by any Government unwilling to lose office at the next election, or alternately by an all-party agreed solution to the measures that need to be undertaken. Piecemeal solutions provide no long-term answers. Troubles simply break out again elsewhere. We need new people with new ideas. There is precious little sign of their acquisition. Proposition 1: the same people in the same numbers, who are responsible for the collapse of our jerry-built edifice, are not those who should be entrusted with its rebuilding.
Proposition 2: Identify the problems.
We are a nation of 4.1 million people, how many doctors, nurses, paramedics do we need to serve a population of this size? In what disciplines should they be enrolled? How many should be community-based, and what should be their responsibilities? Should all primary care practices be grouped and given specific areas to cover. What resources would be needed by such groups for them to function properly?
How many hospitals do we need and where? How are they to be resourced and staffed? Should every hospital provide every service?
How are medical, nursing, and paramedical staffs to be trained? Are their training institutions funded to internationally accepted levels? Are we going to train health service administrators to understand the problems and suggest solutions? These are over simplified starting points.
In the real world people get paid for work done and verified. They do not get paid for just being there, attending pointless meetings and pushing bits of paper at each other.
This is not rocket science. It's about figuring out a way to deliver acceptable medical care to only 4.1 million people in a relatively wealthy state. Can we accept the concept of paying people for what they do, and for the results they achieve? Can we accept the concept that some, by the nature of their work should be remunerated above the average? There will be well entrenched opposition. Have we the stomach for the fight? For this it will be necessary to enlist the working doctors and nurses, and not the talking heads. It will be necessary to remove the politics, in so far as is realistic, from the service.
Forget the red herring about public and private patients, let all be private patients, and let those institutions and staff accepting them be responsible for the delivery of the service. This is far too important an area to be left to the profit driven entrepreneur; such will not provide an all encompassing service. The self accepted buck stops with you Minister and as you are a clever woman; you realise that you cannot make an omelette without breaking eggs.
Happy New Year to all.
Dr Maurice Neligan is a cardiac surgeon