Does healthcare need a reform?

Image Credit: Sinéad Mohan

The HSE has been perceived to be an ill-functioning service for the last number of years, Jack Collum examines why the HSE needs adequate reform.

As we move towards the winter season, the annual overrun of the health system, consisting of surplus patients on trolleys in Emergency Rooms and a lack of hospital beds, is expected. But, with Covid-19 there is a sense of fear stretching from the upper echelons of the health service to the ordinary person about what is about to come. 

Covid-19 aside, in its natural state, the Health Service Executive (HSE) is considered to be an inept and inefficient service by many. From long waiting times for urgently needed appointments to the widely excoriated bureaucracy which run the HSE, calls for reform across multiple sectors of the service are ever-present. The institution is criticised by not only disgruntled members of the public but across the 110,000 people the HSE employ, from healthcare assistants through to doctors and the management.

In 2019, the HSE announced in the coming year, following approval from the government, a serious reconstruction of HSE would be occurring. It was approved, and the plan brings about a structural change. According to the then Minister for Health Simon Harris, the plan will bring a long-needed change to the structure of the HSE which was previously “not workable”. The new reform of the HSE splits the country into six different zones, named from Zone A to Zone F, with the intention of providing a more people-centred system of health and social care. These new Zones are set to come into effect following the 2021 budget. 

Some would argue that these reforms are inadequate and not what is needed to better the HSE, that more of a change is needed in the management who run the service as opposed to restructuring the geographical boundaries of the HSE’s regional areas. CEO of the HSE Paul Reid argues that the geographical changing of the HSE’s regional area’s boundaries will allow for health service staff to “plan hospital and community services together”, thus providing “more integrated care at both regional and local level”.

These reforms do not answer the general concerns of the population regarding the reoccurring issues that nag the HSE. Particularly, it fails to highlight how specific sectors of the service will be fixed.

A prime example of this is the Child and Adolescent, and the Adult Mental Health services the HSE operate. The logistical issues of the Mental Health services seem to be something which these reforms alone simply will not be able to resolve. The disparity in the care which can be provided on the bases of the patients’ geographical location is a problem at the core of the dysfunctional psychiatric services. The lack of psychiatrists and psychologists required for the service to optimally operate creates a back-log in the frequency in which patients can be seen. This results in obscene waiting lists, even closed waiting lists, excluding people from being seen for even their first appointment. The geographical restructuring of the regional areas will do little to nothing to fix this problem. With the same sort of supply and demand issues being experienced across an array of the services the HSE provide, for instance care of older persons, it only reinforces the claims that these reforms are not enough. 

A consistent issue which arouses public dismay is the issue of beds, particularly the lack of them. The forefront issue is the insufficient numbers of beds available to patients who are not in a critical state. The second side of this coin is treating patients that require treatment in Intensive Care Units. Back in 2009, the HSE made a statement announcing the country needed at least 579 for the optimal functioning of hospitals throughout the country. Prior to the outbreak of Covid-19 in March, the ICU capacity in the country stood at 225 beds. With the surge in the number of severe Coronavirus cases nationally between March and May 2020, the HSE was able to increase the number of ICU beds to 354. After the national decrease in the virus, the number of ICU beds was reduced to 280. The HSE plans to bring this number up to 287 as part of their Winter Plan to deal with the expected increase in Covid-19 cases. The initial number of 579 was provided before we entered the world of Covid-19. For many winters past, the Health Service has been pushed to near breaking point. The times which are soon to come will be the true test. 

The HSE has been embroiled in a number of scandals which have questioned the aptness of the service to carry out what is discerned as basic health care services. The most infamous in recent times that gripped the attention of the nation was the CervicalCheck scandal which the HSE was involved in, in 2018. Ireland is aware of the stories of the many women who received negative results when in fact they were positive for cervical cancer. Ireland is less aware of the fact that from 2018 to 2019, 434 cervical cancer tests expired before they had the chance to be screened due to “unprecedented demand”.

The HSE is currently unable to carry out the services it intends to. Some of the main causations of the HSE’s ill service are the lack of apt staff and the right numbers of certain specialised staff to name only a few, which put a strain on the service. This prevents it from functioning as the most reliable and robust health service it could be.