Blog 25_ Doctor Doctor
"If Slaintecare were fully implemented in the next five years, would all our healthcare woes be over?", reads one email. Let me start by quoting a distinguished former leader of Fine Gael who most would agree has "done the state some service", namely Alan Dukes. He said recently in an interview that "Slaintecare was always a utopian project".
When the Slaintecare proposals were being developed in the early 2010s, it seemed as if other healthcare systems like for example the NHS in the UK and the public system in Canada, were forging ahead and leaving us behind; providing services free at the point of entry and available to everyone, in a timely fashion. Ten years plus later all has changed.
Headlines from Canada talk about a healthcare system "on the verge of collapse", about a "hospital crisis only getting worse" and "Canadian patients want other options outside crumbling health-care system". I have relatives living in Vancouver so I can confirm the accuracy of these reports.
Meanwhile, in Northern Ireland, NHS waiting times for elective procedures are even longer than here. Almost 200,000 adults have taken out private health insurance, even though they have free access to the NHS and that figure is increasing all the time. A significant number of NI medical consultants have applied for and been appointed to, positions in the Republic.
What about the UK mainland? I was in London recently with a close relative receiving a Fellowship from one of the Royal Colleges of Medicine. Most of the recipients were UK nationals. I was astonished at the negativity in the speeches from the President of the college and a number of the other senior officers. "Congratulations on your Fellowship", he said, "but I am sorry to say that you are entering the senior ranks of the profession at a time when the NHS is starved of funding , beds and staff; you will be frustrated; you will be unable to use your skills to the best extent for your patients; you will find it very difficult to do your job" and more like this.
Does this mean that the NHS no longer boasts some of the best Nurses, Doctors and Hospitals in the world? No, absolutely not - they still have all that. You have only to think of Great Ormond Street and other world leading hospitals there. What it does say is that they are now finding it a huge challenge to provide everything for everyone free and in a timely fashion.
What about elsewhere in the world? My wife is a Doctor involved with a Medical visiting group. Each year they visit a different country for an exchange of ideas and practices. I have accompanied her on these trips.While I do not attend the Science sessions, the closing thank-you dinner has given me the opportunity to interact with senior clinicians from all over Europe plus North and South America. Last year we were in Italy and the 2025 trip is to Penang. My first question is always to ask about how health system is funded and then to enquire regarding the current status. I can report that Public health care services everywhere have the same problems. Not enough budget, not enough beds and not enough staff. Sound familiar?
Why is this happening now? I believe that one reason is because our health care systems are victims of their own success. It's within many peoples’ lifetimes that a heart attack was treated with bed rest and an aspirin and if you broke your leg, you probably died of an infection. But now, diseases which, as little as five years ago were fatal, thanks to our wonderful nurses, doctors and researchers, to the pharmaceutical and the medical devices industries, are treatable as merely chronic conditions. So people are living longer, a lot longer, which is unquestionably a good thing, ("Do not go gently into that good night", Dylan Thomas), but older people need more healthcare. In our case add a rapidly increasing population and the demands placed on the system are soaring.
In the light of that should we persist with Slaintecare? Yes most definitely. We are off to a slow start but, if excuted on, it will immeasurably improve the present outcomes. Will it result in a publically funded and free to all, single tier, wrap around healthcare system, as originally envisaged? That seems unlikely. We will almost certainly still need a parallel private system funded by insurance. Those who can pay for insurance should be encouraged to do so, leaving more public capacity for those who can't and for all when needed. Let's be clear: if you are gravely ill and require a heart lung transplant or have a very serious brain injury, for example, you need to be in a public hospital, insurance or no insurance.
Many GPs here are due to retire in the years ahead and even at present some hospital consultant posts, particularly in smaller hospitals, attract no applicants. We are filling the gaps by recruiting from abroad, often from the third world, where these health professionals are even more badly needed. This is in defiance of WHO codes of practice and some would consider it bordering on the unethical.The new Programme for Government talks about addressing this problem by creating more medical school places but we need to be careful here.
About a decade ago, in Argentina, restrictions on entry to Medicine were lifted, resulting in a large intake to the universities. This worked fine for the first few years, even if PA systems in corridors outside lecture rooms were needed to accommodate students. The problems arose once clinical year training and in particular intern year was reached. There were simply not enough hospital places for all the students. The hospitals could no longer treat patients if required to facilitate such a large increase in interns. Training the next generation of doctors is absolutely necessary but doing so is an added burden on hospitals and senior medics. There's a joke in Rio de Janero that half the taxi drivers have medical degrees!
The medical schools in Ireland train a large cohort of students from abroad. Full fees are charged, often paid for by their respective governments. Our colleges depend on these fees to balance the books, as medicine is a very expensive course to run. No Irish student is allowed apply for these places and pay the fees. The Irish who are passionate about studying medicine but lose out in the CAO points race however often go abroad to study and stay there. The foreign students we train may remain here for a couple of junior doctor years but then go back to their own countries as they never intended to practice here.
Here's a controversial suggestion: Reduce the number of training places for foreign students and allow Irish students to apply and pay. Give a substantial fee reduction to those in this cohort who sign up to work in Ireland for a minimum of five years post qualification. With the same number of medical school places and no additional training pressure on hospitals, we get an increase in doctors working for the HSE.