A veteran of the HSE for almost his entire working life, my father has always boiled all issues with our health service down to one problem.
“It’s not that there’s not enough money being spent, it’s how badly that money is managed.”
Whatever the cause, there’s no overstating how major an issue people being left to wait on trolleys in our hospitals is. Interim Chief Executive of the HSE Stephen Mulvany said it was a “very realistic” possibility that preventable deaths are occurring as a result of overcrowding.
Overcrowding has been a problem for years now and it has reached a record level. It was already a plague afflicting our health service and it has been allowed to fester and grow into something no one in charge can get a handle on.
Doctors and nurses reach the very limits of their own wellbeing, time and patience every winter. The experience of being left on a trolley when there’s no bed available can be traumatic and demeaning. We’re awash with stories from people who witnessed fellow patients suffer in corridors with no privacy.
When we find ourselves faced with the exact same problems year after year and spending is rising at a not-insignificant rate, it’s difficult to say it’s as simple as throwing money at the problem until it’s fixed.
Health expenditure has been rising by an average of €1.3 billion a year since 2015 according to Central Statistics Office (CSO) figures, a rise skewed by ballooning spending during the pandemic but was already going up by almost €1 billion per year pre-Covid.
When the bill keeps rising, perhaps it’s an indication that my father’s right. A far-reaching health service (did you know the HSE oversees civil marriages?) with funding fast approaching over €30 billion couldn’t possibly be underfunded.
And yet it remains so drastically under resourced. According to figures compiled by the Organisation for Economic Cooperation and Development (OECD), the number of hospital beds in Ireland stood at almost 22,000 in 2008. Enter the crash, at which point we see beds plummet to at the lowest point, under 12,000.
We’ve rebounded to 14,000 beds as of 2020. We’re still well short of the mark once population growth comes into the mix. From a peak of 6 beds per person in Ireland in 2000, we’re at just half that now.
Rearming the health service with thousands more beds and staff is no silver bullet, but something has to change. The running of our hospitals as presently constituted is almost insane, doing the same thing over and over and encountering the same unsustainable overcrowding each year like clockwork.
The HSE has said that change is coming – years down the line. Stephen Mulvany told the Oireachtas Health Committee the service was effectively “playing catch-up” with population growth and aging. It will be some time yet before patients on trolleys becomes a thing of the past.
He also said the situation this winter “surpassed the most pessimistic modelling”. Realistically managing expectations is surely something that could be done in the short-term to help staff prepare themselves.
Beyond more beds, there must be a commitment to improving the working conditions for staff. Equal access to a full range of care and services must be made available to all regardless of geography or any other factor.
While University Hospital Limerick has dealt with a back-breaking level of record overcrowding, Waterford University Hospital has coped relatively well. That is as much of an indication of the system failing as any.
It is imperative that the HSE, government and Department of Health work together to heal a healthcare service that has been left to wait to be fixed for years if not decades.