Archive for January 13, 2018


January 13, 2018 Leave a comment

Lack of staff, beds to trigger ‘worst winter trolley crisis’-Hospital Consultants Association

Some 500 consultant posts – accounting for one in five specialists – remain vacant or filled on a temporary basis, the president of HCA added


Eilish O,Regan, Irish Idependent, September 3 2019

Hospital overcrowding is in danger of reaching record levels this winter as more patients endure long delays on trolleys before being moved to a ward, senior doctors warned yesterday.

Dr Donal O’Hanlon, president of the Irish Hospital Consultants Association (IHCA), warned: “Our acute hospital system is at breaking point due to a severe shortage of consultants and a lack of beds and other facilities.

“The quality and safety of patient care is deteriorating further due to persistent underinvestment.”

He was speaking at the launch of IHCA’s pre-Budget submission, calling on the Government to prioritise investment in medical staff and public hospital capacity deficits.

Some 500 consultant posts – accounting for one in five specialists – remain vacant or filled on a temporary basis, he added.

Talks are expected to begin this month on filling the gap which leaves new consultant recruits earning around €50,000 less than their long-serving colleagues.

However, the doctors’ body looks set to resist any move to make increased productivity measures part of any new deal, saying they are already seeing more patients than colleagues in other countries.

Secretary general Martin Varley also rejected any plan to make all new recruits work only for public patients with no private practice. He said it was tried on two occasions, including 2011, and it failed.

Commenting on yesterday’s capital plan, the IHCA said it only provides for 480 beds, or 100 fewer beds over each of the three years compared to National Development Plan promises.

————————————————————LONGER THAN 1 YEAR AND 3 MONTHS WAITING For IN-Patient Treatment

HSE:Analysis of waiting lists by the NTPF, as of February 2017, identified that 38,991 patients will be waiting for in-patient or day case treatment greater than 15 months at the end of October 2017.


LIMERICK AND CLONMEL- Hospitals Serving Co Tipperary Top THE TROLLY  COUNT

But Minister Harris tells people who are feeling sick to check a website to see how sick they are

 January 15, 2019 11:50 James Brennan Irish News

The former trainee journalist turned Minister for Health has decided to give advice to the public on minding their health.

University Hospital Limerick once again tops the shameful list, with 59 patients suffering while waiting for a bed, followed by South Tipperary Hospital with 50, and Cork University Hospital with 48.

As 600 people languished on trolleys around the country yesterday, according to figures just released by the Irish Nurses and Midwives Organisation (INMO), Minister for Health Simon Harris had a very simple Simon answer, check a website!

Speaking on VirginMedia News yesterday, Harris advised people who are feeling sick to check a website called “” to see just how sick they really are!

This is the highest figure recorded since March of last year.

University Hospital Limerick once again tops the shameful list, with 59 patients suffering while waiting for a bed, followed by South Tipperary Hospital with 50, and Cork University Hospital with 48.

It appears you’re not been advised by the actual Minister for Health himself to go to a website rather than A&E.


Support Petition

VACCINATION MUST BE PROVIDED FREE! Vulnerable Children with Medical Cards including those with Downs Syndrome and Diabetes born before October 2016 must pay 300 Euro for two Jabs. Children under 3 years must pay!



When Minister Harris Brought in Free Vaccinations in OCTOBER 2016, Children born even one day before that, still under 3 years of ageto-day were not covered

When a parent seeks free vaccination on behalf of a child covered by medical card, but born before October 2016, the HSE replies that it cannot supply the vaccine free as this is not provided for in law. The request for the vaccine, even for a disabled child over 2 years and 3 months, is “elective”  not “mandatory”



Mr Harris is looking to employ market research consultants to ask the general public, health workers, and others what they consider to be the key health issues and priorities and then devise a communications strategy based on their answers.
Minister badly afflicted by a case of out-of-touchitis
Irish Examiner, Friday, January 11, 2019 By Caroline O’Doherty
Flu and the winter vomiting bug may be the afflictions of the season, but out-of-touch-itis is the one that’s taken hold of Simon Harris.Emergency departments are overflowing, GPs are swamped, waiting lists are out of control, mental health services are in crisis, staff are in exodus, and nurses are about to strike — the list of ailments affecting the health service is long, serious, and, one would think, obvious.
Unless, it seems, you’re the minister for health.
Mr Harris is looking to employ consultants — of the market-research kind (we can’t afford the medical kind) — to ask the general public, health workers, and others what they consider to be the key health issues and priorities and then devise a communications strategy based on their answers.

VACCINATION MUST BE PROVIDED FREE! Vulnerable Children with Medical Cards including those with Downs Syndrome and Diabetes born before October 2016 must pay 300 Euro for two Jabs. Children under 3 years must pay


But when CHILDREN with MEDICAL CARD seek vaccination, parents are told that HSE is not required by Law to provide it free as it is “elective” for those born before October 2016!!!  Official Savagery!!!


When Minister Harris Brought in Free Vaccinations in OCTOBER 2016, Children born before that, still under 3 years to-day were nor


Irish Mirror 17 April, 2018 PLEASE SHARE

Student Nurse , Tara Nic Chormaic, pens powerful social media message to Health Minister Simon Harris after walking miles through snow to work during Storm Emma

Full Letter

Tara penned a furious open letter to Simon Harris voicing her fears for the future of the health service that is already at breaking point.


(Fourth-year Student Nurse, Tara Nic Chormaic, 28, says the hell of hospitals has left the Class of 2018 burnt out and disillusioned.Student nurses have as little as €6 a week left to buy food on their pathetic pay.The trainee from Tallaght, Dublin, will soon qualify as a Children’s and General Nurse.But crisis conditions are sparking a brain drain, she claims.)


The letter went as follows:

Dear Mr Harris,

I don’t know of any other undergraduate courses in Ireland, outside health-sciences, where one day your bringing life into the world, and the next holding the hands of someone leaving this world, comforting families who have been totally broken apart.



Nurses are glue. We hold teams, families, friends and patients together.

We try and stop people from taking their own lives, instil hope.

Many of us can’t do it for ourselves.

Why are student nurses going home crying at the end of a week of 39hours unpaid placements and a further 36 hours of their normal jobs to keep a roof over their heads, because student grants are just a drop in the ocean to helping with student debt?

Student nurses although officially “not counted in the numbers” are being counted in the numbers on wards – to the point without students the wards would collapse at times.

You keep talking about retaining nurses. If we don’t get treated well in training why would we think it’ll be any better when we qualify.

We see the stress qualified nurses are under to feed their families and keep a roof over their head as it is. Nurses sleeping in their cars.

New graduates not able to afford their rent and mortgages or even dream of ever getting a mortgage without moving away.

Despite this we go in day after day and care for everyone else when we can’t care for ourselves.

This week I had €6.49 to spend on food, more than normal, to keep me going for a week.


Not sure if you know, but nursing is a physically and mentally demanding job. You need energy. Energy comes from food and sleep. Two basics that I just don’t get, because I chose in the face of adversity to better myself. To do what I’ve always wanted to do and become a nurse. To help others.

I’m a Children’s and General Nursing student. Everyone tells me I’m incredibly lucky to be in such a prestigious course and how it’ll stand to me and be worth it in the end. €28,768 a year as a staff nurse. €2791 I earn extra a year for having dual qualification.

Four and a half years of studying and doing the same workloads as General Nursing students at the same time as covering the extra work, study, assignments, exams, placements and stress of doing the Children’s Nursing aspect for €2791 extra a year when I qualify.

That doesn’t even cover one years student contribution fee. That doesn’t touch the student loans I’ve had to take out because of the cost of living (and it’s far from a fancy life I live).

Student and Staff Nurses are burnt out.

The conditions and pay we are working under are beyond shocking.

The job we do is worth so much more. We are worth so much more. When will you see that?


——————————————————————————-WAITING LISTS

Martin Wall, Irish Times,: Friday, January 12, 2018, 18:23

There are now more than 500,000 people waiting for an out-patient appointment to see a hospital consultant, new figures show.

The National Treatment Purchase Fund (NTPF) on Friday published figures showing that overall the number of patients on hospital waiting lists is continuing to rise.

There were 81,468 people on waiting lists for hospital in-patient or day case procedures at the end of December, up from 80,595 at the end of November.

The number of patients waiting for an out-patient appointment in December was 500,800, up from 497,721 in November.

Minister for Health Simon Harris said the out-patient waiting list remained “a big challenge that needs to be addressed”. He said the budget for the NTPF and to deal with waiting lists had dramatically increased .

He said he expected “ to see good progress in driving down waiting lists as we come into the spring”.

However, Fianna Fáil’s health spokesman Billy Kelleher said it was “absolutely appalling” that more than half a million people were now waiting for an outpatient appointment.

He argued that Mr Harris had “clearly taken his eye off the ball as he attempts, and fails, to grapple with emergency department trolley crisis”

“A total of 138,584 of these patients spent all of 2017 waiting unsuccessfully for an outpatient consultation. And half of these have actually being waiting since the middle of 2016,” he said.

“We should remember too that Leo Varadkar promised that no-one would be waiting more than 18 months by the middle of 2015. Delivery on that commitment seems further away than ever.”

Mr Harris said it was worth highlighting that the number of patients waiting more than 12 months was lower in December than at any point last year and there were marked decreases in those waiting for treatment for a number of specialities including cataracts; ear, nose and throat; urology and scopes.

“At present over 57 per cent of patients on the in-patient list wait less than six months, and over 84 per cent wait less than 12 months for their procedure. This is despite the additional demands on our hospitals,” he said.

“The out-patient waiting list remains a big challenge that needs to be addressed. It is worth noting that last year almost half a million (479,000) outpatients did not attend their appointment. This is something that must be tackled.”

Mr Kelleher said it was “ bitterly disappointing” that after four months of modest improvements, the numbers waiting on the inpatient day case list have edged upwards again.”

“Sadly the chaos we have seen in our emergency departments so far in 2018 means that we are likely to see a further increase in January,” he said. “It is critical that the Minister for Health publishes the bed capacity review as soon as possible and bring forward a costed plan for its swift implementation.”


RTE:Almost 679,000 patients waiting for hospital care, new figures show

Updated / Friday, 6 Oct 2017 22:55

Over 101,460 were waiting for inpatient or day case treatment, down slightly on the August figure

Over 678,800 patients are now waiting for hospital care, according to the latest figures from the National Treatment Purchase Fund.

The figures released this evening are up to the end of September.

While the overall figures represent an increase of about 19,000 on the previous month, some lists have seen reductions.

Of the 678,800 total, over 101,460 were waiting for inpatient or day case treatment, down slightly on the August figure.

19,100 were waiting for a gastrointestinal endoscopy check.

Over 495,300 were waiting to be seen by a consultant at an outpatient clinic, down slightly on the August figures.

A further 62,800 people were scheduled for follow-up care soon having had initial treatment already.

In August, the National Treatment Purchase Fund changed the way the waiting list figures are presented.

The figures now detail patients who have a date set to be seen, patients waiting for a date, and suspended patients – those who are temporarily unfit or unable to attend due to clinical or personal reasons.

The total number in the suspended list is 10,317.

Included in the suspended list are patients whose treatment is being outsourced to another hospital, possibly a private hospital.

The NTPF also publishes a list of what are called ‘planned procedures’ – a list of patients who have had an initial episode of care and who are waiting for further treatment.

Minister for Health Simon Harris has said he welcomes that there has been a reduction in the total number of patients waiting for both procedures and outpatient appointments.

In a statement, Mr Harris said: “This is evidence that the measures being taken to reduce waiting lists are beginning to work. We are seeing a downward trend and we expect that to continue. This is the second month in a row that we have seen a reduction in the number of patients waiting for Inpatient or Day Case procedures.

Mr Harris said that “good progress” was being made, before noting the long waiting list times faced by patients, saying: “I acknowledge that waiting times are too long and I am keenly aware of the burden that long waiting times for treatment places on patient and their families.

“That is why we now need to do more and that is why funding for the NTPT is to rise in 2018, so that more procedures can be carried out and more people can be treated.”

He added that the reduction of waiting times for patients and improving access to health services is one of his key priorities.

Mother waiting over two years for procedure

Serena Guilfoyle from Portlaoise is 34 years old and is the mother of four young children.

She was recently treated for breast cancer and has ongoing problems with her stomach and had part of her bowel removed.

Ms Guilfoyle is awaiting news on a possible diagnosis of coeliac disease.


She is on the waiting list at the Midland Regional Hospital Tullamore for a stomach biopsy – with an appointment date over two years away.

She told RTÉ News she is terrified of the wait.

The Midland Regional Hospital in Tullamore said it cannot comment on individual patient care.

The hospital said it is actively working with the HSE to ensure no patient is waiting more than 18 months and to meet targets set for those waiting less than 15 months.

It said it is committed to ensuring that those with the greatest clinical need are prioritised for treatment.

The Private Hospitals Association has called on the Minister for Health Simon Harris to convene a crisis summit over hospital waiting lists.

The Association said radical solutions are now required to drive down waiting lists and to keep them down for good.

Its Chief Executive, Simon Nugent, said it was like a chronic ‘Groundhog Day’ for hundreds of thousands of patients and their families who every month are being told that their wait must go on.



Current hospital crisis will seem like picnic if more beds not provided in future – HSE

Martin Wall, Irish times,Wednesday, January 10, 2018, 11:07

The current level of hospital overcrowding will “look like a picnic” compared to what will happen in the future unless capacity is increased, the head of the HSE has said.

Tony O’Brien said the population was growing and ageing and people would need more access to healthcare. He said this meant the healthcare system would have to be “differently shaped and differently sized”.

He said he was pleased that there was now a political consensus about the issue.

Speaking on RTÉ’s News at One, Mr O’Brien said if additional bed capacity was not provided, the healthcare system would face “an existential crisis” in the years ahead.

“We cannot go through the next five years without addressing this issue, because what we’re seeing today will look like a picnic if we don’t,” he said.

“If we continue with the healthcare system in the shape that it is, with only the number of beds that it has, with the population changing and increasing, the level of demand for emergency care will continue to grow with a static bed stock.”

Mr O’Brien made his comments after new figures compiled by nurses revealed there were 551 patients on trolleys in emergency departments or on wards awaiting admission to a hospital bed.

Mr O’Brien said he acknowledged that the experience for many patients in hospitals at present was not good.

He said the trolley figures for Wednesday were much too high but they were also clearly evident of the tremendous work being carried out by staff and the fact that some of the planning put in place over the last year had been effective in part.

Mr O’Brien said the Irish public health system was structured for a different time, as was its level of capacity.

He said bed occupancy in many of the country’s major hospital was running at well over 100 per cent.

“Last week in the UK, because it exceeded 85 per cent (bed occupancy levels) we saw the prime minister apologising for the cancellation of all elective treatment. If we followed that we would not be doing elective treatment at all.”

He said he was pleased that with the forthcoming report of the Government’s bed capacity review and the Slaintecare reforms “we are on the brink of changes which will mean in the future we will not see what we are seeing now”.

Not competitive

The Irish Times reported on Saturday that the review will call for the provision of an additional 2,000 – 2,500 acute hospital beds if planned healthcare reforms were implemented and up to 9,000 additional beds if the changes were not put in place.

Mr O’Brien warned, however, that increasing capacity in hospitals did not involve “going down to Bargaintown and buying a few beds”.

He said providing infrastructure in hospitals was a complex, long and expensive business.

He said additional staff would also have to be found and he acknowledged that Ireland was not internationally competitive in recruiting healthcare personnel.

New figures released by the Irish Nurses and Midwives Organisation (INMO) said there were 43 patients at LetterkennyGeneral Hospital and 42 patients at Galway University Hospital waiting for a bed after being deemed by doctors to require admission .

The INMO figures suggest that the number of people on trolleys is down from the 575 recorded on Tuesday and the record levels of 677 reached last week.

The INMO figures show that in Dublin the largest number of people waiting for a bed was at Tallaght Hospital while 29 people were on trolleys or on wards awaiting admission to a bed.


Meanwhile the Irish Medical Organisation (IMO) urged the Government to acknowledge that the health service was experiencing a system-wide problem of lack of capacity and not just an emergency department or trolley crisis.

“ What we are seeing in our emergency departments is only the manifestation of the wider problems – and we are now seeing the same problems in other parts of our services as they struggle to cope with capacity and patient demand.”

“It is not sustainable to have solutions that:

*cancel elective procedures. In many of these cases the patient will simply present back in the emergency department and in all cases will add to the already unmanageable waiting lists.

*transfer patients from hospitals to private facilities. Continuing a policy of investing much needed resources into the private system with no corresponding investment in our public system will simply maintain the status quo – it is the same number of patients requiring treatment but we are putting taxpayers’ monies into a private profit based system.”

The IMO said all the problems being experienced centred around capacity:

“capacity with regards to the number of beds in both acute hospitals and the community setting; capacity with respect to the number of medical staff. We need to attract more consultants and capacity in general practice – we must deliver a wider range of services at GP surgeries .

“The unfortunate truth that Government seems to be avoiding, is that all this requires a seismic shift in the way we deliver and fund our health services and that costs money. It would be truly revolutionary to hear the Government saying not only have they decided on the priorities but they are actually going to fund them. As a society we cannot continue to simply give out about our health services, we need to agree on the solutions and agree that these will have to be paid for.”

Meanwhile the trade union Siptu called on health service watchdog HIQA to investigate the overcrowding being experienced in hospital emergency departments.

HIQA said it did not have the power to regulate acute general hospital services and had no enforcement powers.


Population projections spell trouble for struggling hospitals

Peter Murtagh, Irish Times, Saturday, January 6, 2018,

Capacity problems currently facing hospitals, and evidently defying effective measures to resolve them, can only get far worse, if recent population and life expectancy projections come to pass.

Based on data from the 2016 Census, an Economic and Social Research Institute report, Projections of Demand for Healthcare in Ireland, 2015-2030, published last October postulated a population growth of up to 23 per cent, or 640,000-1.1 million extra people.

All of those people will, by definition, place additional demands on maternity and childcare services, with a proportion of them needing ongoing care. But it is the ageing nature of the population that will place a disproportionately greater burden on services.

The number of people aged 65 and over is expected to grow from its present one in eight to one in six. The number of people aged over 85 will almost double.

Older people’s dependency on support services and greater proneness to illness will probably translate into greater demands for elective operations, such as hip and knee replacements, and on care prompted by other ailments related to age such as oncology care, dementia and respiratory care, circulatory problems related to heart disease and strokes and, ultimately, home help and residential nursing home care.

The ESRI projected that demand for home help and for residential and intermediate care places in nursing homes and other settings would increase by up to 54 per cent.

Demand for public hospital services is projected to increase by up to 37 per cent for inpatient bed days and up to 30 per cent for inpatient cases; and demand for GP visits is projected to increase by up to 27 per cent.

The report’s authors suggested additional demand projected for the years to 2030 will give rise to demand for additional expenditure, capital investment and expanded staffing and will have major implications for capacity planning, workforce planning and training.

In public hospitals, they suggested demand for inpatient bed days would increase by 32-37 per cent by 2030, from 3.27 million in 2015. Demand for inpatient cases is projected to increase by between 24-30 per cent by 2030, from 510,000 in 2015.

Demand for day-patient cases is projected to increase by 23-29 per cent by 2030, from 1.01 million in 2015.

Private trends

Regarding private hospitals, which are often colocated with public hospitals and share staff, demand for inpatient bed days is projected to increase by 28-32 per cent by 2030 from 610,000 in 2015.

Demand for private hospital inpatient cases is projected to increase by 20-25 per cent by 2030, from 130,000 in 2015; and demand for private hospital day-patient cases is projected to increase by 24-28 per cent by 2030 from 460,000 in 2015.

The report projected that demand for GP visits would increase by 20-27 per cent by 2030, from 17.55 million in 2015; and demand for practice nurse visits is projected to increase by 26-32 per cent by 2030, from 5.94 million in 2015.

Demand for long-term and intermediate care places in nursing homes and other settings is projected to increase by 40-54 per cent by 2030, from 29,000 in 2015.

Demand for home help hours is projected to increase by 38-54 per cent by 2030 from 14.3 million in 2015.

Up to 9,000 additional hospital beds needed, review finds

Martin Wall, Sarah Bardon
Last Updated: Saturday, January 6, 2018, 03:00

Between 7,000 and 9,000 additional hospital beds will be required over the next decade or so if the existing model of healthcare continues, the Government’s long-awaited review of capacity requirements has found.

The review has concluded, however, that the number of additional beds needed could be reduced to 2,000-2,500 in the years up to 2030 if Sláintecare reform proposals, such as investing heavily in healthcare services in the community, are implemented.

In addition, the review recommends that a number of hospitals should be established to deal exclusively with elective or non-urgent cases. It argues this would assist in reducing waiting lists and emergency department overcrowding in acute hospitals.

Health service sources said this could involve a reconfiguration of existing services in some parts of the country including potentially closing some emergency departments.

Existing reform plans along these lines in Portlaoise have prompted strong criticism from local politicians and campaign groups in the midlands.

The bed capacity review also calls for dramatic increases in long-term residential places. This would assist in reducing the number of delayed discharge patients in hospitals; those whose acute phase of treatment has concluded, but cannot be sent home or transferred to other healthcare facilities.

The Minister for Health Simon Harris has repeatedly pointed to the forthcoming bed capacity review as the way to deal with the overcrowding and trolley crisis in public hospitals.

Trolley count

Nurses on Friday maintained that more than 2,400 patients had to spend time on trolleys in hospitals in the first few days of 2018 while waiting on a bed.

The number of people deemed to require admission to hospital by a doctor and waiting for a bed fell to 483 on Friday, from record levels of 677 experienced early this week. However doctors and health service administrators forecast that the numbers could rise again in the next week or so as the peak of the flu season hits.

The HSE said on Friday it expected non-urgent elective procedures would not take place in hospitals next week but maintained this would be considered on a hospital-by-hospital basis.

However, the HSE stressed hospital groups and individual hospitals were ensuring that cancer and other urgent elective procedures were continuing to be carried out.

“Other non-urgent elective work will be reviewed on a site by site on a clinically prioritised basis during the course of the next week. We expect that non-urgent elective procedures will not proceed but stress that this will be considered on a site by site prioritised basis.”

Community facilities

The bed capacity review is expected to be published within the next three weeks and will feed into the Government’s overall 10-year capital plan.

The provision of additional hospital beds along the lines of the recommendations in the forthcoming capacity review would cost hundreds of millions of euro.

The Department of Health told the Oireachtas committee on the future of healthcare last year that the construction and capital cost of providing an additional hospital bed was about €325,000.

On this basis it would cost in excess of €800 million to provide the 2,500 additional beds proposed by the capacity review as part of a reformed health service.

Mr Harris told The Irish Times in an interview prior to Christmas that thousands of additional beds in acute hospitals and community facilities would be required in the future and that the forthcoming review would set out specific numbers.

He said on Thursday that significant additional funding would have to be provided by Government to meet the cost of opening additional hospital beds.

Almost 680,000 on public hospital waiting lists, latest figures show

Mark Hilliard

Irish Times Friday, October 6, 2017, 20:55

Almost 680,000 people remain on public hospital waiting lists for various procedures, according to the latest published figures.

By the end of September, outpatients, the largest group of those awaiting treatment, has approached half a million, now at 495,318, figures from the National Treatment Purchase fund show. That compares to 497,300 at the end of August.

There were just over 83,000 existing or active inpatients awaiting treatment while a further 18,423 who had been given first appointment dates are also now among those listed.

Just over 10,000 patients had procedures suspended which can happen for a variety of reasons, whether through voluntary postponement of a previous appointment or because an individual is not well enough to undergo a procedure.

A further 62,874 people are awaiting follow-up appointments having completed initial treatment.

Simon Nugent, chief executive of the Private Hospitals Association, noted a welcome slight reduction of 909 inpatients awaiting treatment.

“Endoscopy waiting lists are up by 682 which is similar to the number of patients to be treated by [the Health] Minister’s endoscopy NTPF initiative announced in the last couple of weeks,” he said in a statement. “It looks like this will just address this one month’s increase. This is worrying.”

Specialist appointments

He also noted that while the out-patient total had dropped by 2,000, the number of those waiting for a specialist appointment for longer than 18 months has gone up by almost 1,500.

“We still need dramatic new thinking to stop tinkering with the numbers at the margin and to see real reductions,” he said. “That’s why the Minister for Health Simon Harris needs to convene an emergency summit bringing all players together to see what approaches could be most effective.”

In its own analysis, the Health Service Executive (HSE) said the number of patients waiting more than five months has fallen by 1,333 from 10,791 in August to 9,458 in September.

The total number of patients on the in-patient and day case list has reduced by 900 in the same month.


Fintan O’Toole: The A&E crisis is perfectly acceptable

Fintan O’Toole Saturday, January 13, 2018,

Exactly seven years ago this weekend, The Irish Times reported: “Waiting times for patients attending emergency departments in many hospitals earlier this month were unacceptable, Minister of Health Mary Harney told the Dáil. She said she had discussed plans with the HSE for ensuring that this situation did not recur.”

This week, the Minister for Health Simon Harris used that same word, declaring the current crisis in hospital emergency departments “unacceptable”.

It is a word that returns again and again in almost every discussion of the inadequacies of Ireland’s public hospital system. “Unacceptable” or its variants was used five times, for example, in the 2002 Acute Hospital Bed Capacity report.

In the foreword, the then minister for health, Micheál Martin, wrote of “cancellation of elective admissions, long delays in accident and emergency departments, waiting lists for elective procedures and unacceptably high bed occupancy levels in the major hospitals”.

It is time we admitted that “unacceptable” is a big lie. By definition, if a situation is unacceptable, it does not become an annual event, a kind of grotesque winter festival of suffering that is now as much a part of the calendar as Christmas and New Year.

National emergency

Each year, it is greeted with the same language: unacceptable, intolerable, “bloody awful” (Leo Varadkar, 2015) or even, as Harney declared it in 2006, a “national emergency”. (“People who need to be admitted will have beds, not trolleys, and the basics for human dignity. This will be put in place in the coming months. Anything less than this is not acceptable to the public, not acceptable to me and not acceptable to the HSE.”)

It took an outsider to tell the truth. Tracy Cooper, who came in from Britain to establish the Health Information & Quality Authority, spoke in May 2012, after a patient had died on a trolley, of the “persistent, and generally accepted, tolerance of patients lying on trolleys in corridors for long periods of time”.

‘Generally accepted’ is the honest description of the misery inflicted every winter on vulnerable, sick people. ‘Unacceptable’ is a self-serving pretence

“Generally accepted” is the honest description of the misery inflicted every winter on vulnerable, sick people, most of them elderly. “Unacceptable” is a self-serving pretence.

It sounds good. It suggests that there is a collective public and political shock at the realisation that something “bloody awful” is being done to real people. And it suggests that this will end simply because it must, that all stops are being pulled out, that loins are being girded, that this is the very last time. None of this has ever been true.

Because “unacceptable” is a lie, everything that follows it has to be regarded with extreme scepticism. What follows, invariably, is the firm purpose of amendment – the capacity review, the task force, the promise that this time it’s different.

Harris this week declared that 2018 would be the “year of reform”. Like, presumably, the year of reform that has been announced by every one of his predecessors since the late 1990s.

Acceptable cruelty

The UK home secretary Reginald Maudling got into trouble in 1971 when he spoke of “an acceptable level of violence” in Northern Ireland. But we have to confront the fact that there is an acceptable level of cruelty in the Irish healthcare system. Not acceptable to the patients or their families or the medical staff who are doing their considerable best to alleviate the suffering – but collectively tolerable nonetheless.

It is the price that must be paid if we are to maintain a refusal to create a rational national health service that allocates resources efficiently, effectively and above all fairly.

The underlying problem is not money. Ireland spends about €20 billion a year on healthcare, €8 billion of it on hospitals. This is relatively high, especially if we take into account that we have a young (and thus healthy) population. Per capita, it is about the same as Austria, Sweden, the Netherlands or Germany – all countries that seem to be able to avoid the scale of inbuilt cruelties that Ireland routinely inflicts on patients.

We spend enough on a current annual basis to have a decent healthcare system. (There is an obvious need, of course, for major capital investments.) So why don’t we have one?

There are many reasons, but the core problem is not the money itself. It is the way we raise it and spend it. The headline figures for health expenditure mask something that is quite distinctive about Ireland: the weird mix of public and private spending.

Our fragmented, illogical and inefficient health system is full of perverse incentives for hospitals and consultants to chase private money at the expense of public patients

Only 70 per cent of Irish health spending comes from Government revenues – a figure that has declined drastically since 2000 when it was nearly 80 per cent. The rest comes from private insurance and from out-of-pocket payments to GPs and pharmacists. This creates a fragmented, illogical and inefficient system, full of perverse incentives for hospitals and consultants to chase the private money at the expense of public patients. The private 30 per cent distorts the purposes of the public 70 per cent.

Why do we have this system? The answer is quite bizarre and it goes right back to the 1950s. This was the postwar era in which most European countries were creating national health services. But the Catholic Church and much of the medical establishment was ideologically opposed to the creation of a single, unified NHS in Ireland.

Irish compromise

An Irish compromise was reached – 85 per cent of people would be entitled to free care in public hospitals but the top 15 per cent of earners would buy private insurance, thus guaranteeing the consultants they could still have extra, “private” income and guaranteeing Catholic “voluntary” hospitals that they would not become State entities.

Weirdly, however, this “private” care would be provided in public hospitals. The two-tier system was born. And it got weirder over time: entitlement to public hospital care became universal in the 1990s but at the same time the number of people buying private health insurance rose from the initial 15 per cent to almost 50 per cent.

Nobody thinks this system makes any sense. It has many people paying twice for the same service and many other people being displaced because they can’t afford private insurance. It allocates resources chaotically and in ways that are hard to track, never mind justify.

On the one hand, highly efficient parts of the system, such as local general practice, are starved of resources, pushing patients into the emergency-department nightmare. On the other, highly skilled professionals are incentivised to treat people on the basis of money, not of need.

The absurdities multiply to the point where public hospitals are now putting pressure on patients who have private insurance to declare that they are “private patients” and thus cash cows.

But do we really want to change this system? Do we really want a coherent national health service that spends money where there is greatest need? Do we really want a system that starts by ruling out the “unacceptable” – a regular, predictable and “bloody awful” ritual of suffering – and works back from there?

Doing this would limit the incentives for professionals to chase private patients while drawing public salaries. It would also limit the ability of those private patients to skip ahead of the long queues for elective procedures. It would take away the sense of healthcare as a private commodity and make it a public good.

The annual A&E crisis reveals one brutal truth behind all the rhetorical reassurances: you can’t buy your way off a chair or a trolley and into a public bed. The public emergency departments are the arenas in which all are equal – and equally miserable. This truth waits for us all. The question is whether we want to change it before we have to experience it.

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