A chara, – The reported removal of spending powers from four of the HSE’s six health regions raises serious questions about the direction of health reform (“Four HSE regions to lose power over day-to-day spending”, Politics, September 10th).
The regions were established specifically to decentralise decision-making, thereby giving regional management responsibility for budgets, staffing and service delivery. Considerable public money, management time and organisational effort have since gone into establishing six regional executive officers, 20 integrated healthcare areas and the associated regional management structures.
Yet scarcely two years into the new system, financial authority is being pulled back towards the centre for four of the six regions. At the same time, the HSE’s Pay and Numbers Strategy and more recent central controls mean that essential recruitment, including posts that have already undergone lengthy approval processes, is being delayed and often restricted. Frontline services are struggling to replace staff who retire, resign, take maternity leave or are absent through illness.
There is a striking contrast between these restrictions on frontline recruitment and the considerable resources devoted over the past two years to establishing the new regional structures. More fundamentally, there is an obvious contradiction in building a system around devolution and local accountability, only to recentralise financial and workforce decisions when budgets come under pressure.
Financial discipline is necessary. However, Ireland also has a genuine capacity problem. We have approximately 2.9 hospital beds per 1,000 population compared with an OECD average of 4.2, while the ESRI estimates that public acute inpatient capacity will need to increase by at least 40 per cent by 2040. Our population is simultaneously growing and ageing.
Indeed, the HSE was €580 million over budget by the end of July despite months of spending controls. That should prompt a more fundamental question: are the regions simply failing to control expenditure, or are we attempting to provide an expanding healthcare service within a workforce and financial limits that do not reflect population need?
A larger and older population inevitably requires more healthcare professionals, beds, theatres, diagnostics and community capacity. Expenditure cannot simply be constrained to an arbitrary ceiling without consequences.
Ireland needs financial accountability and improved productivity. But repeatedly reorganising management structures while restricting recruitment at the frontline is not healthcare reform. If four of six health regions have already lost meaningful financial autonomy, we are entitled to ask what the decentralisation was for in the first place. – Is mise le meas,
DR DAVID J TANSEY,
Consultant Endocrinologist,
Sligo.