IT HAS been another eventful year in the health services. Concerns over patient safety were to the fore as further cancer misdiagnoses were revealed. And a full-scale political crisis developed following a Budget decision to remove the automatic entitlement to medical cards from people aged over 70.
The finalisation of a new hospital consultants’ contract after almost four years of frustrating negotiations opens the door to consultant-provided care for the first time in the Republic’s public hospital system. However, the planned recruitment of 1,000 new consultants under the new contract must now be in doubt due to financial pressures on the Health Service Executive (HSE).
The rapid deterioration in economic circumstances combined with the credit crunch has seen a significant slowdown in the development of private co-located hospitals on the grounds of public institutions. The transferring of private patients from public hospitals into these new facilities has yet to take place, and so additional public beds have yet to come on stream. The autumn volte-face by Minister for Health Mary Harney on the planned national cervical cancer vaccination programme means the Republic now lags behind its EU counterparts in this life-saving public health initiative.
On a positive note, 2008 saw the election of a new Medical Council which will operate under much changed legislation that provides for a lay majority on the doctors’ regulatory body for the first time. Prof Tom Keane’s cancer control programme continues to meet its targets. And the recent appointment of Dr Tony Holohan as the Department of Health’s new chief medical officer is a significant boost for patient advocacy and safety.
But a cut in the HSE budget by almost €1 billion in 2009 points to an extremely difficult year ahead for both patients and healthcare professionals. Despite assurances that frontline services will be protected, it will be a Herculean task to cut more than 6 per cent from healthcare spending without affecting patient wellbeing. It is difficult to see how a renewed emphasis on patient safety can be given practical momentum against a background of severe financial pruning. The temptation to provide a patchwork solution to patient safety crises must be resisted.
The planned rationalisation of accident and emergency services in Dublin is a throwback to a system operated in the 1980s, when just one public hospital on each side of the Liffey was on call for ambulance cases each night. The system had the advantage that for two in every three days a hospital could deal with its emergency department backlog. However both population growth and advances in medical care mean a more sophisticated rationalisation of services will be needed in 2009.
A key challenge in the year ahead will be the HSE’s and the Minister for Health’s ability to trim some administrative fat from the health system while minimising the impact of cutbacks on patient services. It will not be an easy task.