We saw that public sector workers are paying the price for the Government’s failure on job creation. A massive hole in the budget emerged when the Government had to admit it was missing its employment targets. To fill that hole, the Government went after workers’ wages and incomes.
But public sector workers are paying another price – for the failure of the Government’s reform agenda. The fact is that the Government – both this one and the last one – has never engaged in reform. The issue of high-quality, cost-efficient public services have never been on the agenda. In the recent Croke Park renegotiations, the management not only refused to negotiate reform proposals from the trade unions, they even refused to listen. Reform was just not part of the plan.
Senator and Professor John Crown outlined the problems in the Irish healthcare system – which he describes as ‘the least efficient healthcare system in the world’:
‘As it is currently structured, the Irish healthcare system ensures that people spend an inordinate amount of time not being treated. The current structure incentivises inactivity, not efficiency. Patients are seen as a cost, and one that only has to be realised when a patient enters the hospital. We spend an inordinate amount of money on patients who are waiting for expert treatment, while those who run the bureaucracy think that they are saving money by not treating the patients properly.’
In his article Professor Crown compares the Irish system with the US and German systems, the latter being a system based on ‘solidarity’, on ‘need, not wealth’. He goes on:
‘We do not have the worst quality of healthcare in the developed world, we have instead the worst managed healthcare system in the developed world . . .’
And while he criticises the managers of the system, he also states that there is little that can be done since the system itself is ‘dysfunctional’.
All this cries out for reform. Instead, the Government cuts the payroll – through cutting wages and employment. Last October a senior HSE executive described this strategy:
‘Around €2.5 billion has been taken off the health budget since the beginning of 2010, with a further cut, speculated to be around €500 million, due to be made next year. The hospital system was currently at the limits of the current approach to reduce its costs. It is sustainable but not repeatable.’
Not repeatable – but that’s exactly what the Government is doing. Just today the HSE announced further cutbacks, with ward closures in addition to removing the medical card from 40,000 people.
But cutting payroll is easy. You just cut. Reform – real reform in the delivery of quality services in a cost-efficient manner – is hard. It requires working towards a well thought-out goal; but this can present problems. It steps on the toes of vested interests and in the case of the health sector, these interests are private profit. It challenges a deeply entrenched and conservative management culture which is more comfortable with inertia than change. It requires cooperation and consensus (contrast this to the Government’s approach in the negotiations – agree the cuts or we will impose it on you anyway). And it requires time. There is not short-cut to the hard work of reform. If we had started the process of reform when the crisis broke out, we’d be some ways down the road. As it is now, we don’t even know where the road is.
That we are not likely to get reform in the future can be seen from the internal divisions in Government. Prior to her resignation, Roisin Shortall, TD, spoke in the Dail:
‘We cannot cut our way out of problems. We must reform and that reform must happen quickly. Unless there is substantial reform there will be cuts and the poor will be hardest hit . . . Are we going to reform and strengthen our public health service or are we going to privatise large parts of it? How do we ensure access and equity in the health service? What model of universal health insurance best suits the situation here in Ireland? Should it be a commercial insurance model or a social insurance model?’
Only a short-time later – either because she could not get an answer to her questions or because the answers amounted to privatisation and commercialisation – Deputy Shortall resigned her ministerial post.
When Ministers cannot agree on what kind of reform, when management refuses to consider proposals for reform, no wonder reform is left off the agenda.
There are two losers in all this: the public and the men and women who work in the health sector. The former, because they do not get a high quality service at an efficient cost; and the latter because the Government takes the easy way out and cuts wages.
In the end, we are all the losers.