Contemporary Issues in the Irish Health Services - Essay Example

Contemporary Issues in Irish Health Services: an Introduction Available literature onthe Irish health sector reveals the fact that the administration or Government of Ireland seems serious in addressing the issues of health both on the part of the people who serve in this sector and the ones who manage it. It also seems to take serious measures to address the needs and wants of its population in general. The contemporary health issues in Ireland are diverse springing from one end to another. There are the ones that are related to in-house people and their problems. They maybe the nursing staff, the doctors, the consultants, and so on. The other part of the picture takes onto the canvas the outward population, that is to say, the Irish people in general who come to the health care centres like hospitals, clinics, nursing homes, and so on. As my paper is related to the contemporary issues born on the front of the health services, I would like to bring into discussion any of the above-mentioned set of population in the present paper. Irish Health Services: the Management The health service provision in Ireland is headed by three major sources of administration: The first is the Government itself, the other is the Minister for Health and Children, and the third is the Department of Health and Children. It is the Department of Health and Children that actually backs up the Minister in all the phases of planning, implementing, and evaluating. This department particularly takes into consideration the policy formulating and so on. There is another department that is in contact with what we call the deliverance of public health care and services. This department is named as Health Services Executive or HSE for short. The coming into operation of HSE is only fairly recently (on 1st January 2005). It actually replaced regionally run ten former health boards. The decision to form a single body on the national front was taken for the view that one body solely can be responsible for the deliverance of health care and the like. The funding to HSE (Health Service Executive) is allocated by the Department of Health and Children. After funding the HSE Areas form plans and take decisions as how to disburse and further allocate the funding. HSE and Its Services The range of services in the circle of HSE is very vast. It: “provides a wide range of different services in hospitals and communities throughout the country. Health services can be broadly defined as those services that are concerned with the: Promotion of good health Prevention of illness (for example, food safety services, immunisation and vaccinations services, health screening, infant and child health services) The diagnosis and treatment of illness (for example, family doctor (GP) services and hospital services)” (Irishhealth.com). There are two broad categories of health services of Ireland health administration department. They are Community care and personal social services that help people continue living a healthy life. Nursing homes help provided in homes, therapy done occupationally, and social work services. (Irishhealth.com) Issues in Irish Health Services: an Overview According to the published Irish National Pandemic Plan3, the “key decision makers” in the health service department are the senior health physician. These people are the ones who bear the risk and responsibilities “for ensuring health protection, maintenance of services, and providing calming leadership in what are likely to be very difficult times” (proquest.umi.com). In the same issue, the research conducted by Sandra Mounier-Jack and Richard Coker, the very first issue of health service in Ireland is directly related to these key players. In the same issue, we are informed that against the need of 60 such senior physicians of public health, there are only 40 in Ireland working on the posts. This may be regarded a burning issue at hand as that the sufficient numbers of key rollers is not installed in the body of health services in Ireland which can create many a problems both for the in house workers (doctors, nurses, and working staff, and so on) and the patients directly or indirectly in contact with any health department. This issue is also to be critically evaluated for the planning phase of HSE and its working criteria. Moreover, there are people like Nicoll and Kaiser who aver that this study is more like looking at things from a limited perspective and that the number of physicians being short or insufficient cannot be rightly judged by just looking at things from outer circle (proquest.umi.com). Whatever it maybe, it seems obvious that starting from the top of the pyramid of our discussion we find issues in Irish health services springing from nowhere subtly, and finely. This is then to keep in mind that a thorough discussion related to the issues is needed which the present paper aims to do. In the following lines, I will discuss the problems, issues of each of the major areas related to Irish health services. 1: Funding and the Flow of Funding Getting into the scene of the Irish health services and the contemporary issues related to it, we find out that the most burning and talked about issue is the allocated funding and the flow and proper utilisation of the funding. Now the taxpayers, public speakers, scholars, Government policy critics, and so on, are raising stronger voices in this regard. Fergal Bowers, the editor of the website IrishHealth.com, informs us in his review of these policies that today more money than ever is being spent on the Irish hospital management and the services of the family doctors. However, he views the present situation of management as well and tells us that despite all this progress, the number of tragic failings in hospitals is no more a wonder. There are long and long waiting lists of the people for operation. Related to this, thus, are the “bust-ups between the Health Minister and medical organizations”. Bowers regards all this as a symptom of “an ailing health service” (Irishhealth.com). However, more funding is not bringing stronger results as the public today is being more dissatisfied with the health system of Ireland. Thus, the Government of Ireland has introduced some reforms (such as HSE) to bring better effects as far as the Irish health services are concerned. Bowers points out one very note-worthy element that with the planning of the Government, that the expectations of the public have also gone high and this will be a challenge for the Government then. As far as the allocation of funding in concerned, the 2003 Brennan Commission report informs us that between the years from 1997 to 2002, the spending on health sector increased by 125%. Today, in Ireland, each individual taxpayer has to turn in to the health service sector an amount of something like 6,800 Euro every year (Irishhealth.com). However, one wonders and wants to ask: Why so much chaos if allocated funds are more than ever before? To this question, the answer is the more flow of funds has only been recently allocated so the problems that are long-emerging, will take time to come a reduced number; and that there are some other subtle issues lying inside the framework of the operation of the Irish health services management. There are critical issues on the hierarchy of management here. First of all, for instance, the most talked-of matter is the system through which all the allocated funds are being placed into operation of the health services. It includes and addresses all the areas of the health services sector. On the top of this bundle of criticism stays the matter of the 100,000 people who are presently working in the health services of Ireland. As the system is labour-intensive, the salaries that the senior doctors of hospitals and the senior nurses and the consultants acquire, are considerably on a high figure. In fact, “consultants and junior doctors are one of the highest paid groups in a European context the Health Minister, Micheal [sic] Martin says” (Irishhealth.com). Moreover to the above issue, a more important one is related to the management of the on-going health service provision to the public. In this regard, it is noticeable from reports that the key area of concern is the accountability system of the Irish public health services. Professor Niamh Brennan, in this connection, points out that: “Unfortunately in every single aspect of the health services the Commission examined, low standards of accountability and a complacent and casual attitude in this respect from the public servants in charge of taxpayers’ monies were found” (Irishhealth.com). We are further informed in the same source that in 2001 the Irish Government commissioned a report: Deloitte & Touche Report on the system of health provision. The findings revealed significant data about the inefficiency of the health department in financial, social, and strategic grounds. The reports say that “the Department of Health had little or no personnel with experience in financial, statistical or social analysis, strategic planning, health economics or people with direct experience in the health service” (Irishhealth.com). The issue of fund management and placement of more efficient staff-structure is one of the challenges and needs for the betterment of the present system of Ireland’s health system. 2: Issues with the Staff Moving along the lines of our analysis, we find another critical issue that is catching more of the critical attention of scholars as well as the common person. This is the negotiation of the health service staff with the Government. For instance, Minister Martin “has strongly criticised medical organisations representing consultants and GPs for what he argues is a failure to engage in reform talks” (Irishhealth.com). The organisations, however, have their own say in return. They criticise the Minister in that he has himself failed to understand their viewpoint and that he has failed to be committed to the cause of the improvement of the system. Then there is a comparison to the status of the health service staff themselves. For example, if the doctors and the nursing staff are compared, it is noticed that the doctors in the Irish health service system are more at ease and on freedom of movement. They have more opportunities to make their way into public than the nursing staff. In this very connection, we are reminded of the 1999-nursing strike which simply stands as a reminder from the past of the sense of deprivation on the side of the nursing staff. Moreover, since the time of the strike, the nursing staff have been examined to be low on the professional morale and high on dispute on the industrial relations. The problems of the nursing staff are also far and varied. They complain about their salary, the benefits allowed to them by the Government and so on. However, one very important aspect in this regard is the recent study taken by related departments of University College Dublin, and St. Vincents University hospital, Dublin. The report states that “The health services sector has been identified as a high-risk work sector for low back pain (LBP) and related absenteeism” (oxfordjournals.org). The reports reveal that it is the nursing staff that is found more in the danger of suffering from the low back pain problem than the doctors. This problem has given rise to sick leave resulting in grave absenteeism especially among the nursing staff. As such the nursing staff have their own milk to circle around and to voice their problems. There is no doubt that their problem, like the one of low back pain (LBP), are genuine and the Government has to address their issues as well for a better and harmonised culture in the health services sector. The one reason with the doctors and their strength also springs from the fact that “Public polls show that people trust doctors much more than they do politicians” (Irishhealth.com). Then GPs are more at freedom because they have many patients whom they know from time to time contact. This is one advantage that they have made a use of and some of them successfully entered either local or national politics. However, the GPs go about crying over their fee structure that is, in their view, is low. On the same continuum of the Irish health service staff come the hospital staff who are among the most influential line of the staff hierarchy because they are highly-skilled professionals and are well-paid. They are, thus, a “fundamental element of the hospital system”. The Government, in its running programme of reforms, aims at this group to be the most important when it comes to bringing better result in the health services. The word is that without the help of this group, the Government cannot successfully work out reforms. However, this very group is also at bay with the Government over some issues like a “row over a deferred pay review and the manner in which [the consultants’] malpractice arrangements were unilaterally changed earlier this year” (Irishhealth.com). 3: Issues with Operation The issues of deploying health services or the operations of the health services including physical environment are another critical area of the contemporary Irish health department. There are problems related to the waiting lists, the resources available to the sector, and so on. For example, Professor Miriam Wiley, who is the head of the institute’s health policy research centre, told in a meeting about the utilisation of the 14000 beds in the Irish hospitals by private patients. She said that “Although 20% of beds in public hospitals in Ireland are allocated to private patients, insured patients are taking up as much as 30% of the space, it was revealed last week” (proquest.umi.com). The situation was regarded as a matter that needs immediate measures so that problem can be adequately handled. According to the Economic and Social Research Institute of Ireland, this unhealthy utilisation of public beds made possible for a bundle of 14000 private patients to utilise the beds who were not at all in any emergency to occupy the beds. Professor Miriam Wiley, told the meeting that if the under-discussion 14000 beds had been used only by the public patients, the present list of waiting public could have been halved. Against the promise made by the Government to provide 3,000 extra beds to fight the present state of the lack of beds against the number of patients, only 600 beds were provided. The picture presents a very sharp state of affairs. On the one hand, public beds are being allocated to non-emergency private patients; on the other hand, provision of beds with the growing number of patients on the waiting lists has been too low. With the issues related to operation of health services, there is stark need of more hospitals, health service staff, both doctors and nursing personnel, and better policies to reduce the ever-increasing dissatisfaction of the general public with the health department. 4: Political Issues The Health portfolio in Government is regarded the one which can explode any time doing damage to the holder of the bad: the Minister. As such, the Minister of Health in Ireland is the one person who is always under great pressure both from the cabinet and from the running system and its issues. The problems studded with the operation of the Minister of health are also in need of certain address. For example, the “Minister is asked to intervene in most local health issues” and if he is up to do so, he may be regarded as being too interventionist, and if he does not, the cabinet may rush on him to crash his stature. Moreover, the Minister has also to work out the passing of the recommendations formed by any special group of experts (Irishhealth.com). The Minister has also to work out the funding and the like for the projects he intends deems to carry out. This all puts great pressure on the Minister and to me it seems more like a pressure balloon working as the Minister of health in Ireland. The Minister has to be very careful in taking any steps against a hospital in Ireland. As a general rule, playing with issues of a hospital is like playing with fire for a Minister because the public views this as strange game of carelessness hence it is more about public emotion something about correcting a flaw. How can a person stand so much pressure from so many sides, not to speak of the opposition who are always looking for loopholes be it artificial crying of some issue? Moreover, the policies made to date are also criticised for being slow or non-resultant. According to the Hanly Report, it was repeatedly brought to attention of the concerned people that “the influence of politics, whether local or national on decision making in health services generally and hospital services in particular” is to be recognised and handled with due concentration. The Report also criticised the decisions made recently as the ones that focused more on “sectional interests rather than on objective measures of service need, quality and patient care” (Irishhealth.com). Against the European system of decentralisation of the health department, the recently centralisation of the health department by the Irish administration has also been criticised. Although the Government says that the decentralisation is not going to work in the context of Ireland as for thirty years, it did not bring results that were needed from this policy; the public opinion is that of dissatisfaction and there is criticism on the block of those concerned. Additionally, the termination of the health board from the Irish national front is seen “as a way of reducing local politics in health. The danger is that local democratic input is gone and there may be less transparency in how the system works” (Irishhealth.com). The appointment of the new Health Service Executive is also suspected. The watchdogs are up with their eyes focused on these Health Service Executives as to what extent will they be influential in elevating the health service sector; and that what kind of control is exercised by the Minister on these Health Service Executives. 5: The Public and the Issues When it comes to the discussion and examination of the Irish health services department, the most important area is to discuss the public for which the entire system is erected. In Ireland, the public, or to say patients, have their own problems that are the highest of all quoted above. The reason is simple; all the above issues simply add to the already-growing number of problems of the patients. Either it is the doctors, the nursing staff, the provision of beds and medicine, or the political mayhem, all that always suffers are the people who “have no redress to a complaints system, underpinned by law. Such a Statutory system has been promised by the Health Minister. It could help reduce dissatisfaction with services, resolve problems earlier and cut the number of costly court actions taken by patients” (Irishhealth.com). This is very easy to note that in a country where the patient do no hold a right to file or register a complain, how efficient the health service of that country can be! I 100% agree with Bowers that unless and until Statutory system is working in Ireland, the level of dissatisfaction of the common people will go higher and higher and this may result in some kind of fight erupting from the deprived souls. The other benefit that is visible from such a Statutory system will be that the on-going activities and operations of the health service staff will be monitored. The staff will be more closely examined with their real efficiency especially seen from the perspective of the public, the hardcore of all this health game. When we talk about patients, we have the long waiting lists that never seem to end. The number of beds in hospitals is needed to be increased. The ones, however, available are frequently occupied by the private patients reducing the chances for the common people to have treated. This alone is one of the major challenges present to the Government’s strategic planning. The free health coverage of Irish health sector is often criticised in respect to the waiting list. It is a kind of common maxim in Ireland now that with a free health care system the patients are also free to wait: “Waiting lists for those without private insurance can stretch into years - even for critical operations like heart operations. There are tens of thousands of people waiting for their "free" medical services [italics added]. Governments are always promising to clear these infamous waiting lists, but generations of neglect mean that even quadrupling the health budget by many billions of pounds hasnt seemed to make a den” (movetoireland.com). Besides this criticism, people want to bring into account the money that they pay in their taxes and the money paid for private health insurance which is “almost a requirement despite the free converge” (movetoireland.com). As for the exact number of people who are waiting to be treated in Irish hospital, there is no clear-cut figure. What there are, are only estimates! However, according to an estimate put on the Ireland website, the number of people waiting to be treated is something in between from 19,000 to 27,000! The huge amount of waiting people plainly says what the Irish Government does not want to. One thing also comes to our notice that the unclear figure of the people waiting on the lists to be treated in hospitals suggests the callousness of the Government when it comes to the health and care of its own people. The waiting lists are not counted only for the major operations or major treatments. The problem is even more evident when it comes to pregnancies and the deliverance of the baby. It is uncertain to say that a mother will have a bed in the hospital if registered only before weeks. The wait for the baby deliverance may exceed nine month! Hence critics say that a lady in Ireland should enlist herself for a bed to deliver a baby right after a guy looks at her cross-eyed. However, the more important problem related to pregnancy is to get proper treatment during pregnancy (movetoireland.com). The Government must look into this matter and try to come up with better policies so that the maternity-related problem can be solved. Another issue related to the waiting lists is the occupation of the limited number of beds by the elderly who are in the hospitals because no proper arrangement of nursing homes by the Government is on the national front. If there are enough nursing homes, the elderly won’t have to stay in hospitals and so the occupancy rate of the hospital beds can come to a decline. It will then be easy to see more beds for the service of health care to the waiting. See, only the waiting list problem is so complex that it needs discussion at length. Moreover, looking into the matters of the elderly, we find more examples of mismanagement. The elderly are in no more away from the dissatisfied general masses. They are not provided beds very easily either, in the hospitals. Hence, the elderly are compelled to seek for private care. There are so many other issues related to the problems of the elderly that cannot be discussed here on this paper for the reason of space and the main focus of the present discussion. The matter of health and care did not give more attention to the matters men’s health. It was only until recently that a nation-wide study was undertaken. They study prolonged for three years. According to the study report, only less the half of the total men population in Ireland know the function of the Prostate Gland. If this shows the illiteracy of the Irish men, it, on the other hand, simply shows the Government’s lack to address the issue of men’s health. According to the report’s further tow major findings, Irish “men’s knowledge of fundamental health issues remains poor with less than half of men surveyed knowing the function of the prostate gland, while over a third were not aware of some of the most common prostate cancer symptoms. The lack of preventative health ethos amongst Irish men means that just one in five drinkers monitor their own alcohol consumption and a mere one in seven men, aged 18-29, reported practising Testicular Self Examinations monthly” (healthpromotion.com). If the report suggests that more operation has been started by the Government to expedite the issues present in the health service, it also suggests that in the past serious attempts to have an understanding of such matters like Irish men’s health had been neglected. This also gives us a clear ground for exercising our conjecture that there is a long queue of problems and issues in the pipeline that are in immediate need to be addressed. In addition to the issues above, there is one more very important issue. This is the health insurance and the problems related to it. The dissatisfaction of the people with the Government’s policies regarding the health insurance is all the more visible. The serious block of Irish population demands that this issue should also be taken into serious consideration. Summing up all that has passed above, we can have the following points as our broad categories with regard to the contemporary issues in the Irish health service sector and after the outlines, I will propose some suggestions that can be followed to have better results in the concerned area:  management is the one area that lacks the installment of proper human force with regard to the demands of the health sector.  allocation of the funding and the flow of the allocated funding are also not properly operationalised. This leaves the Irish health care sector in the similar state of mismanagement of the past.  the staff of the health sector, GPs, consultants, nursing staff all, one way or another, have issues to settle from the Government. This is another major problem that hinders the flow of suitable framework for the health services deployment.  the services and resources available to the health service department are not being utilized in a systematic way. This has given rise to such problems as long waiting lists of patient, shortage of beds, private patients occupying public beds elderly people not finding room in nursing homes shortage of hospitals  people look more dissatisfied with what is happening at present. The political operation in connection with the betterment of the health services of Ireland need to be taken into account.  the public does not have a legal system that can enable them to bring to front the complaints they have regarding issues in the health service sector. This itself is creating more frustration in the public.  elderly people are not being given the proper treatment and care that they are in need of.  systematic attempts are not seen to be thoroughly adequate so as to make available beds and other required treatment to the pregnant females. This is one issue that has given rise to higher level criticism both on local and international sides.  men’s health has not been regarded seriously to be an issue of health. Only recently a study has attempted to mark some change. But it shows that much complexity springing from the past negligence has come to stand as a giant on its own.  private health insurance payable by the people is also criticized to be an additional expense on the part of the public who are already paying annual taxes for health services.  all the present situation has created a dilemma in the people, and more frustration than before has been reported. Conclusion and Discussion Reviewing and thoroughly discussing the issues and problems present in the contemporary situation of the Irish health services, I propose the following suggestion that can better the state. 1: Funding The Government should form a body that can systematize all the flow of the funding. This body should look into every matter from A to Z when it comes to funding and the flow of funding. The critical areas in this regard are the allocation of funds with regard to the services staff specially the nursing staff and the consultants: Their problems must be taken seriously as they play the backbone of the system. The other phase of this body to tackle is the area of public treatment. It should completely take into account the flow of funds regarding the incoming and outgoing patients and the ones in-house patients. This body should monitor the areas where presently there is no accountability measures. This in one strong area by addressing which, certain results can be acquired that will benefit both the ends of the continuum: the Government and the public in particular. 2: Issues with the Staff All the problems and issues that are being raised by the staff of the health care sector of Ireland should be addressed with due respect and speed. Either they are the general physicians, the consultants, or the nursing staff, all must be given due respect as they are playing a very important role in the development of the sector. The salary structure, the other benefit criteria, for instance, should be scrutinize properly. Moreover, issues related to their own physical and mental problems should be looked at more carefully. If their problems are not tackled properly, there is not doubt in suggesting that events like the 1999-strike can be repeated. So the government cannot overlook this vast field of attention and concern. 3: Issues with Operation As the need for more beds, more hospitals, and more staff rises, it should be systematically put into deployment. This is one single issue that is related to the physical aspect of the health service sector of Ireland. There is nothing is throwing more funds if the desired results are not obtained. In this regard, we have what Bowers says that “Repairing the health service requires management and structural reform and not just extra investment” (Irishhealth.com). Whatever promises the Government is on the making, it must fulfill all those promises as it is a matter of national pride and stability. If it promises to provide a certain number of beds, equipment, units, and so on, it must come away with the supply of the demanded commodity. Otherwise, the distrust of the people, that is already highly grown, will grow more and more bringing some critical situation for the government. 4: Political Issues Political issues must be synthesized with due care and keeping the national interests more on the front than merely the interest of the cabinet. The Minister must be given freedom of movement and decision making so that this very person can be vitally working to bring results in the area that are badly in need of certain measure. It is not very important to introduce new name plates for the same department (HSE for instance). The major issue is that these newly-formed bodies must also prove a track record that is itself new and innovative being consequently result-oriented. If the other way around, I would say the same as Mr. Bowers says that: “Critics of the reform plan say that it will mean the same faces working in organisations with new name plates –rearranging the chairs on the Titanic. The real test of the reform plan will be whether it ensures that patients get a better service and whether a new era of accountability and performance measurement is created” (Irishhealth.com). 5: The Public and the Issues First and the foremost thing, related to the issues of public, is that the waiting list of the patient looking meagerly at the hospitals, must be reduced to a number that is immediately treatable. This is not, in any case, fair to have them wait for month and month. This is the one single aspect of the entire picture of the contemporary Irish health department that must and must be addressed with full consideration. This is so because it is related to the public that is the hub-focus of all the activities of the health care department. Maternity problems should also be adequately handled. There should not be more wait than the time a baby takes to come in this world! The people must be given the right to legally register compliant against any disorder or service observed anywhere in the area of the health sector. The issues of private insurance and taxes regarding the services and the public ought to be addressed with such result that put the miserable public at ease. It is to be made sure that such programmes are launched as can help the common person of Ireland to have adequate knowledge of the burning issues in the area of health care. I would like to end my paper with the precaution that “Irish men and women continue to have one of the lowest life expectancies in the EU. Cancer and heart disease remain the big killers” (Irishhealth.com). Hence, it is not a child’s play to introduce newer plans at the risk of a nation that has already suffered a lot. References Irishhealth.com: who governs the health services in Ireland. Retrieved on January 11th, 2007 from Pro Qeust.com – How prepared is Europe for pandemic influenza? Retrieved on January 11th, 2007 from Irishhealth.com: Bowers, F. where to from here? Retrieved on January 11th, 2007 from oxfordjournals.org- Low Back Pain among Irish health service workers. Retrieved on January 12th, 2007 from Proquest.umi.com- Admission of private patients to public hospitals in Ireland increase. Retrieved on January 13th, 2007 from movetoireland.com – Irish health system. Retrieved on January 13th, 2007 from healthpromotion.com- Key report on men’s health launched: ‘Getting inside men’s health. Retrieved on January 13th, 2007 from Read More