Hope amid the bad times

The year got off to a particularly bad start, with a new shameful record of 601 patients on trolleys across the country. High trolley numbers and long waits in emergency departments (EDs) have been a consistent issue during 2015, with ED nurses and doctors recently reaching breaking point.

Following slow progress with the ED Emergency Taskforce plan, the Department and the HSE recently signed the ED Congestion Escalation Directive, which makes it compulsory for each acute hospital to take specific steps to address overcrowding, such as extra ward rounds if trolley figures reach ‘red’ status. Whether it makes a real, sustained impact will be seen soon enough as we enter peak ED season.

Throughout the year, excessive outpatient and surgical lists have also been a regular feature in negative health service headlines. Cancelled operations, particularly for paediatric patients, and long waiting times for surgeries, particularly in orthopaedics, show no sign of improvement.

For most of the year, in excess of 400,000 patients have been listed as waiting for an outpatient appointment. The Minister had a target that by June, no patient would be waiting for an outpatient appointment for more than 18 months and that by the end of the year, no patient would be waiting for more than 15 months. Despite some progress brought by outsourcing appointments in the middle of the year, these targets have clearly not been met, despite being modest compared to the Minister’s predecessor’s targets.

The HSE continued this year to struggle to recruit and retain consultants and nurses, partly a legacy of ill-advised cuts to their salaries in recent years, which is clearly exacerbating the waiting list issues.

On the plus side for the Minister, but maybe not so much for GPs, 2015 will be remembered as the year that saw the introduction of free GP care for under-sixes and for all over-70s.

The confirmation last month by the Minister that the Government’s universal health insurance (UHI) plan, the key pillar of its healthcare policy upon entering government, is to be dropped was hardly a surprise. The cost of the plan was confirmed to be unaffordable and the current system clearly does not have the capacity to deal with the extra demand UHI would bring. However, the planned extension of free GP care to the entire population remains, and thus the excessive pressure on primary care.

There was a very strong response by the GP community to our last issue’s editorial on the pressing need for a new GMS contract. Negotiations between health management and the IMO have been described as painfully slow and the NAGP is still determined to get involved in the ongoing talks. In the meantime, GP frustration and GMS vacancies in both rural and urban areas continue to grow. It is vital that agreeing a new GMS contract early in 2016 is top of the agenda.

Also, the question remains about whether the HSE’s National Service Plan for 2016 will show a real and vital increase in funding for primary care, and whether the new GMS contract will be financially attractive.

However, with the seemingly never-ending negative headlines about the health service, it is easy to forget the many positive developments that are happening.

New long-overdue developments in ICT, like electronic health records, individual health identifiers and eReferrals, many of which commenced in 2015, are very welcome and should positively transform many aspects of our health service.

This year has also seen many new capital projects, clinical guidelines and strategies, and new draft legislation like the Public Health (Alcohol) Bill and the National Sexual Health Strategy.

So as we head into 2016, many significant challenges remain for our health service. However, so do many positives, not least the passion, dedication and quality of our clinicians.

Finally, all of us here in the <strong><em>Medical Independent</em></strong> would like to wish our readers and contributors a very merry Christmas and a happy New Year.