To misquote Shelley, if September comes, can worries about the health service be far behind? People can’t say they haven’t been warned; the outgoing head of the Health Service Executive, Paul Reid, thinks another wave of Covid-19 is likely and fears a “dual hit” to already overcrowded hospitals from coronavirus and flu. A splurge of spending has failed to effect any significant improvement in waiting lists or trolley numbers. More people were waiting to be admitted to hospital in August than in the same month any previous year. Despite a €200 million investment, there is little or no sign of an improvement in the numbers of patients waiting for a hospital appointment or procedure.
The after-effects of Covid is one reason for the lack of progress; a big increase in demand at emergency departments is another. An ageing population and delayed care due to the pandemic lie behind the soaring number of attendances, but there are other issues. EDs are, as Reid acknowledges, “the primary port of call” for many people, despite the long waits and the difficult environment in many hospitals. Growing GP shortages in many parts of the country mean people feel they have nowhere else to turn for medical help.
Reid is leaving in early October, after just three years in the job. He’s hardly alone; the pandemic has sparked a “great retirement” of workers, particularly those who were on the front-line when Covid was raging. It is however worrying that interim staff will occupy the two most senior HSE posts, chief executive officer and chief operating officer, during the worst of the overcrowding that is likely to come this winter.
Improvements are being made, many under the umbrella of the Sláintecare reforms first unveiled five years ago. Several thousand new staff have been recruited to provide health in the community. Dozens of new teams to treat older people, or manage chronic disease, have been set up. GPs can order scans for their patients without having to send them to hospital. Doubtless, the staff involved in these initiatives are providing improved care for patients and helping to cut the flow of unnecessary hospital visits. But how is success to be defined except through a reduction in waiting times? Could more health intervention end up increasing demand for hospital services, rather than reducing it?
Reid says there is no “short-term fix” to the problem of long waiting lists, yet the plans in place to deal with the problem are of short duration. A more comprehensive plan to eliminate waiting lists within five years was buried by the Department of Health last year amid disagreements with those in charge of leading Sláintecare at the time; we have yet to see proposals for long-term solutions. Separately, the provision of electronic health records, a basic foundation for any 21st-century health service, is clearly years away.