Monday, October 2, 2023

Healthcare is a special case, and needs special treatment

As the autumn Budget approaches, traditionally, it is time for our old friends, the ‘Vested Interests’ to lay claim to special needs and sector-specific funds for the good of the Nation.

It’s always framed that way, in any case. The Guards – for example – do not want more money for themselves per se, they want it to protect the people of Ireland. Which can only be done with better-paid Gardai.

How can we be sure of Garda dedication if we don’t pay them the proper rate? Equally, will we subject the children of the Republic to teachers who are not being paid what they desire for a four-hour day, most days of the week, with five months a year off?

It’s the definition of cliché. I know that because when my primary school teacher was asked by the class to define a cliché, she used the example of a trade union leader stating: “We’re not getting a big enough slice of the national pie.”

And this slice is, to date, purely comprising money. When the Irish State gets into other means of compensation, it usually goes awry – people in RTÉ without cars having car allowances, politicians claiming milage while Covid kept us in our homes – you all know the usual con jobs that are specific to various public employments.

Governments have always been keen to keep the rates down because of the optics – a five per cent raise is a five per cent raise after all, and surely must be applied everywhere if it’s applied to anyone. Whereas an education allowance for, say TDs, might be in the public interest and of great value to the individual, but not needed by doctors, for example.

This kind of ‘robbing Peter to pay Paul’ goes on with obscure and undefined rules which have characterised our system of government for a long time, and it’s unlikely to change soon.

When I did the first story comparing grocery prices in the EU with prices here following the introduction of the euro 20 years ago, it set off a series of national stories, the career of Eddie Hobbs (apologies!), a series of embarrassing responses from the grocery industry, and a whole new area of journalism in Ireland – the consumer journalist. You’re welcome, Conor Pope.

Now grocery prices in Ireland had long been much higher than elsewhere – either in the UK or the Continent – so I decided to compare Superquinn in Blackrock to an equivalent store on the French Riviera and guess what – the same goods cost much more here. Around 30 per cent more, as I recall. It explained why the industry internationally referred to Ireland as ‘Treasure Island’.

But my point here is that these price differentials had existed for years but were hidden because they weren’t exactly like-for-like. They weren’t all in euros. It might seem silly, it might seem stupid, but when everything was in euros, it became harder to justify price-gouging. And we even had a name for it – “Rip-Off Ireland”.

That’s just a fact. People can see and understand equivalence when it’s simple and straightforward. Allowances, benefits specific to one sector, bonuses, pensions and free accommodations distort what is fair, and allow the government (the taxpayer really) to have a bit of flexibility when negotiating with different sectors of the economy. It allows for a fudge – and not the tasty kind.

And in this upcoming Budget, we need to get real about what’s happening in the healthcare sector and what needs to be done to ameliorate it. We just can’t get the consultants in hospitals in remote locations, and nurses are finding it difficult – if not impossible – to live and work in Dublin.

This problem is not unique to the healthcare sector, but it’s part of the change in public consciousness and attitudes towards work since the pandemic. The value to a worker of being able to work remotely can be enormous – reducing childcare costs, allowing for a flexible lifestyle, reducing the amount of time spent commuting – not to mention the reduction in carbon footprint.

The market will ultimately determine what value employees place on these benefits, but one thing is sure – people who have to show up at an employer’s location have more costs and less time than their work-from-home colleagues. And this is being reflected in shortages because the Minister for Finance doesn’t feel he can differentiate between public servants on the same wage.

It’s an old-fashioned notion and a road that is rapidly ageing.

My point is that we can wail and gnash our teeth but there is unlikely to be a ground-breaking increase in the healthcare Budget for next year. And we need rapid and fundamental change to bring the system up to a level where it is delivering for patients. In all parts of Ireland.

The other alternative would be a rapid and expedited roll-out of digital technologies, but as we reported yesterday, that day is a long way off.

We are still waiting for the report which should set out the path for using digital technologies in the healthcare sector. In a world that moves at cyber speeds, we are trailing across the desert in a donkey cart. The solutions that might help, and the funding for those solutions are as far off as ever.

Of course, no-one wants this situation. But it would require a Minister with extraordinary charm, charisma and a persuasive manner to get the Irish system to change and adapt to new and faster ways of doing things.

We need to get our quota of consultants up to international standards. We need more hospital beds. We need more and better technology to move people more quickly through the system. We need higher standards of care, oversight and management. We need to pay whatever premium is required to make sure that there are enough hospital consultants in all parts of the country.

And we need a Minister of Health who can convince a Minister for Finance that healthcare is a special case, and that it needs special treatment, and an innovative approach, if more money is not forthcoming.

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