OFFICIAL REASSURANCES that "patients come first" lack credibility in circumstances where Minister for Health Mary Harney directs the Health Service Executive to operate within its budget and the agency prepares to cut expenditure by more than €900 million next year.
Our two-tier health system is set to fail an increasing number of sick, elderly and uninsured patients because 600 acute hospital beds will close in 2009, on top of the 500 beds that have already been taken out of the system. Accident and emergency services will be reduced also.
There is a tradition that public services are organised around the interests of their providers, rather than their customers. Only in recent years have the rights of consumers been considered. Change is urgently required, particularly in healthcare, where a sluggish reform agenda has been largely dictated by consultants, doctors, nurses and other vested interests. Many of these professionals work extremely long hours and in difficult circumstances. But they, or their representative bodies, invariably oppose reorganisation that would place the patient centre stage if it affects their own interests.
The HSE is struggling to address decades of administrative neglect. And it has yet to slim down its own bloated corporate structure. While it wrestles with those demons, its senior management could set an example for all health workers and mark the severity of the downturn by forgoing bonuses and wage increases.
A ballot for strike action has been organised by trade union Siptu because of proposals to cut overtime by up to 50 per cent, along with redeployment and work practice changes. Perhaps the full extent of our financial difficulties was not realised at the time. Certainly, the HSE service plan for 2009 had to be recast within two months in order to secure extra savings of €400 million. Additional costs were anticipated because of rising unemployment, medical card demands and drug prices.
Taoiseach Brian Cowen assured the Dáil yesterday that management and staff within the health service will be fully consulted about proposed cuts and changes to work practices. That is as it should be. Co-operation, rather than confrontation, is always the most effective way forward. The Irish Nurses Organisation is also prepared to engage constructively with the HSE in proposing alternative savings. That is a welcome development. In all of this, however, the most important consideration is the quality of care being provided for patients. Their interests must come first.