Friday, December 06, 2013

The Politics of Healthcare

I diagnose - money. Lots
and lots of money.
First published in the Western People on Monday.

The politics of healthcare are always difficult. You can only ever build so many hospitals and employ so many doctors. There will always be a gap between what people think they need and what a service can provide. Not every health care story will be good news, by the very nature of the business.

For all that, the politics of healthcare have taken an unedifying dip in recent years that reflects badly on all concerned. In arguing over budgets in the media instead of in their offices, where they belong, those involved in running the Irish health service are terrifying ordinary people who have enough to worry about as the nights continue to lengthen and the cold winter bites.

The most recent instance of this is the dispute over pay to the Chief Executive Officers of different hospitals in the State. It started some weeks ago, when the CEOs of the Mater, St James’s, Our Lady’s Hospital for Sick Children, Crumlin, and Tallaght Hospital published a letter they had written to the HSE, predicting all sorts of calamity should funding to those four hospitals be cut any further.

This letter was covered on Prime Time and made the main story on Morning Ireland the next day. Further calamity in the health service, doctors and nurses working 23-hour-days, what are the people to do?

At no stage did anyone stop and stay: wait a minute. Has anyone done the sums on this? Do these people have a point?

The wheel has come full circle now, as someone – goodness knows who – has leaked the salaries of certain hospitals CEOs to the media, and the shoe is now on the other foot. The salaries of the hospital CEOs who dare not cut one cent further are now in the news and, to the surprise of no-one, they are both big and fat.

This is what happens when amateurs play politics. They get your hands dirty. By entering the political arena, the CEOs have found themselves out of their depth, and are being outspun and outleaked at every turn.

And this would all be very funny if it weren’t for the fact that we’re talking about health spending. The story itself is now dead – the CEOs will be keeping their beaks tightly shut after this, while the HSE now says that the bonus money paid to the CEOs will be taken out of the relative hospitals’ grants. And that closes the book on the hospital CEOs’ shot across the HSE’s bows – the game ends in a score draw.

But while the story is dead, the smell of it lingers on. Pat Leahy noted in his recent book about the first two years of the present Government, The Path to Power, that the Government got blamed for the ideas that were floated but not implemented in their first budget.

The prospect of real cuts was fixed more firmly in people’s minds because they could relate to them. People don’t remember details of different budgets – how could they? But hearing that they’re losing their medical card or that a particular benefit was being cut – that’s very real and easy to relate to.

People will have forgotten the details of this storm in a teacup by Christmas – who got paid what and by whom. What they will remember is the chills that ran through them, in these times of austerity, when they first heard the details of the CEOs’ letter.

Future reductions in spending could “seriously threaten the quality and safety of patient services,” we were told, and that there are “unacceptable delays for treatment of certain cancer patients due to overwhelming demand.”  That’s what lasts in people’s heads, even though we don’t know if it’s right or wrong. The media has moved on, but the fear remains with ordinary people. And ordinary people have enough on their plates without being terrified out of their wits the next time they turn on the news.

Very few people on this island could estimate how much the CEO of a hospital should be paid. If you have to ring a man to come out and fix a gutter that got blown away in a storm, you’ll have your head well scratched figuring out how deep you’ll have to reach into the pocket to pay him. You haven’t a hope of having a correct option as to what Doctor O’Mahony of the Rotunda is worth.

When Liam Doran of the Irish Nurses Union comes on TV with his latest (long) list of grievances, you naturally sympathise with the nurses. But can you really make a call on whether or not their grievance is fair and just? How could you? The matters involved in health administration are so complex you’re lost as soon as you begin.

Better, then, for the media to be a little more judicious in how they report health stories, and not go for the terror angle. They ought to keep the narrative within certain bounds, and settle for that. For instance, here’s one way to go about it:

The British Government spends about seven hundred billion pounds sterling a year, give or take. One hundred billion of that spending is spent on the National Health Service – one pound in every seven.

The Irish Government spends about fifty billion Euro a year, give or take. Fourteen billion of that spending is spent on the health service – one Euro in every three.

Ireland is paying twice as much for half the service. How can that be? Where is the money going? Is it being wasted? Why is it being wasted? What’s being done to stop the waste? Who’s responsible? Who’s going to fix it?

Everyone can relate to those questions. It would be nice to hear the answer to even a few of them. Nice, but not at all likely.