Thread by @ohanloncmr

Questions I have on our healthcare crisis @HSELive @roinnslainte @DonnellyStephen @SusanMitchell_

1/ Ill admit I have questions. Questions wondering how it can be that our health service isn’t what our patients deserve.

2/ It’s a given that there aren’t enough beds in the public system. But there is extra capacity in the system. There are wards closed around the country due to staff shortages and/or renovations.

3/ There have been modular units built on hospital grounds for “Covid surges” which now lie empty- why are these beds not being used to take patients off trolleys and out of emergency departments. Is it a shortage of staff ? Is it a rostering issue?

4/ And everyone who works in the public system or had worked in the public system (I go back over 20 years) sees on a daily basis how patients lie in inpatient beds awaiting scans such at CT, MRI, or echocardiography.

5/ Others lie in beds unable to be discharged until a sub-specialist opinion is got. The fear is that if the specialist opinion isn’t got as an inpatient, the patient could wait months ( or longer) to get an appointment as an outpatient.

6/ Others have surgeries postponed due to a backlog from the day, where surgeries ran longer than expected, or there was an unexpected emergency that took precedence. Often that operation might be delayed another week until the surgeon’s next list.

7/ Similar delays events occur in endoscopy, the cath lab etc. So patients wait as inpatients. Could they go home and be readmitted the next week for the operation/procedure - this would be ideal.

8/ But this is usually impossible as there simply isn’t any way to guarantee the bed for the next week. Often theatre lists are cancelled due to the fact that there are no beds available to re admit patients, the hospital is already full.

9/ Patients often are ready for discharge but await a step down facility such as convalescence or a nursing home. Delays can be weeks and weeks as fair deal packages or home care packages are processed.

10/ So I ask again where is the money going, the significant budget given to the HSE each year. Every HCW (all the staff involved in looking after patients in hospital) I have worked with work hard, often well beyond their hours so as not to leave a patient or colleague in need.

11/ A key document to read budget.gov.ie/Budgets/2019/D… in fact raises for me many questions.

12/ Published in 2019, it reports that healthcare has received on average an extra 500 million each year for 5 years, hence the budget was 20% more in 2018 than it was in 2013. The health spend in 2018 was the highest on record in the State.

13/ In fact if we go back to 1997, the annual budget was 3.4 billion. In 2018 it was 16.2 billion. And between 2016 and 2018, a further 2.6 billion has been added to this spend owing to overruns. The truth is our health spend per capita is well above the rest of Europe!

14/ And this doesn’t actually take into account that 48% of people who also pay twice to access healthcare by having private health insurance, predominantly don’t use the public hospital services.
So where is this money going?

15/ Can we say that our system is better now than it was 10 years ago? We have less beds, a shortage of healthcare professionals, and the longest waiting lists on record (they were the longest even before COVID).

16/ Unfortunately there has been little or no HSE compliance with the legislated National Service Plan

17/ Since 2014, we have employed almost 14000 extra health care staff , but again I ask, where are these people? We still spend a massive amount of money on locum and agency staff owing to staff shortages each year despite having less hospital beds and no new hospitals to staff.

18/ Interestingly, medical card numbers peaked in 2013, but have been falling in number ever since, between 33000 and 71000 every year, despite the health budget being 2.6 billion higher in 2018 than in 2013. The majority of health funding increases have been to our hospitals.

19/ And again I ask the question - what do we have to show for it? Where is this money going. Images come to mind of Pablo Escobar burning dollar bills to keep warm.
Two thirds of the extra spend in healthcare relates to salaries. But to who ?

20/ This is the mystery. The productivity in both in numbers of day case procedures and inpatient numbers has remained unchanged for 5 years.

21/ So I ask once again some questions (to which I don’t have answers)
1. We seem to have a big health budget, one of the biggest in Europe, yet where is it going.
2. Our health crisis (pre Covid) is worse now than ever despite 14000 more staff and a far higher health spend

22/ 3. If our inpatient numbers are static for 5 years and numbers of day case procedures are also unchanged in the same time period - then what is the money being spent on?
4. We still spend large sums on locum and agency staff. Why is this when we have 14000 more HCWs?

23/ 5. Billions are needed to update old and failing hardware (CT/MRI/ultrasound/x ray/echo/Cath labs/theatre equipment etc) - yet only 25-30 million a year is set aside in the health budget for this.

24/ I’ve had these and many more questions for years. And yes, maybe I do think the system is broken but I continue to support all those that continue to graft and try to achieve change.