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When healthcare struggles to make ends meet

County View

County View
John Healy

The HSE has acquired a new director general. Paul Reid, who lives in Leitrim, has been selected to succeed Tony O’Brien at a salary of €300,000 a year, one-and-a-half times that of his predecessor. It is a generous salary by any measure, but if Mr Reid is able to meet even half the targets he has set himself, it will be money well earned.
The new man takes over an organisation that cries out for reform from top to bottom, a disjointed structure without integration of its many parts, top heavy with administrative bureaucracy, and with layer after layer of management so overlapping as to make individual accountability count for nothing. Small wonder, then, with a staff of 100,000 and a budget of €16 billion, that Mr Reid’s predecessor should have referred to the organisation as ‘an amorphous blob that nobody fully understands’.
Reid inherits a myriad of problems, but arguably none more urgent than that of keeping elderly people in their own homes and away from long-term nursing-home care or, worse still, from acute hospitals. It is an objective, however, for which the Government appears not to have the political will, or the HSE itself the required resources. With an ageing population, more and more people are waiting to be provided with home-help services which, in reality, are no longer available.
The rationale behind keeping elderly people in their own homes and communities has long been accepted as a given. Older people enjoy better health and a far superior quality of life when they are helped to live in their homes and close to their neighbours. Home living is a win-win situation both on social grounds and by any monetary criteria, since providing home help to the elderly is vastly less expensive than the alternative of paying for nursing-home care. It is one of the all too rare issues where compassion and cost-effectiveness share common ground and where society is the winner.
And yet, all too often, the HSE fails to see the obvious connect between these two complementary objectives. A consultant at Sligo University Hospital recently reported that an elderly patient, ready for discharge, had been retained in his hospital bed for 70 days simply because the HSE did not have the arrangements in place to support him at home. When he was eventually discharged, the critical tipping point of recovery had come and gone. The patient was just beyond the stage of semi-independent home living and, within a couple of weeks, had to be admitted permanently to a nursing home.
The demands of an ageing population are sharply diverging from what the resources can offer. With 6,000 people now waiting to be provided with home-support services, and ever tighter budgetary constraints, there will come the inevitable grasping of the nettle and a recommendation to start charging for home help services. But whether any government would be prepared to take the electoral risk of such a decision would be another story entirely.
The new head of the HSE finds himself faced with an unenviable task. With the Government growing increasingly impatient with the annual over spending of the health budget, he must choose between cutting his cloth according to measure, or else exacting greater efficiencies out of his bloated beast of burden.
And while the latter might present itself as the obvious option, he will be confronted with entrenched interests, an established pecking order of rights and privileges, and staff morale which hovers not far above zero.