Rewarding success, rather than pouring money into inefficient hospital systems, is how Health Service Executive chief executive Brendan Drumm categorised the allocation of 60 consultancy posts to 24 hospitals during the week.
There was, however, an element of smoke and mirrors about the exercise. A preliminary hurdle requires the successful negotiation of a new consultants' contract with recalcitrant medical associations. Then the positions will have to be formally advertised and filled. A delay of 18 months could elapse before new white coats appear on hospital wards. This "live horse and you'll get grass" approach is fine and dandy, but delivering an immediate improvement in services would be better.
In spite of such reservations, Professor Drumm's action has much to recommend it. In the past, government funding was frequently related to the level of hospital dysfunction. The longer the waiting list, the bigger the problems, the more attention a hospital received. Of course, the State helped to create that mess in the first place by slashing spending and the number of hospital beds in the late 1980s. Then, instead of reforming and restructuring the outdated system, money was thrown at it. At this stage, it is unclear whether Professor Drumm will succeed in his efforts. He has powerful opponents among hospital consultants. And, as happens with all long-established companies, inefficiencies and poor work practices have crept in at all levels of hospital care.
By announcing rewards for those hospitals that operate the shortest lengths of patient-stay time, the HSE has marked a clear departure in policy. Getting the patient out of, rather than into, hospital has become the new priority. A rapid turn-around in patient numbers will save money, generate empty beds and make for greater efficiency in the use of expensive diagnostic equipment. That, in turn, may require altered employment practices, along with an increase in the level of shift and weekend working for some professional staff. Professor Drumm estimated that if hospital stay times here were reduced to Australian and Dutch levels it would be the equivalent of adding two large hospitals to the health service.
There are those who complain that the system being introduced by the HSE is unfair. Specifically, one Dublin hospital complained that it could not speed up the discharge of patients and eliminate the use of trolleys in A&E because of a shortage of step-down beds in the community. That issue should be addressed as a priority before new consultancy posts are allocated in the autumn. Transparency and fairness is vital if this new approach is to work.