Myths, misconceptions and the media Irish health policy through the lens of the media Sara Burke 17 October 2008 Irish health policy through the lens of the media Sara Burke 17 October 2008

Budget 2009 »What were the media headlines? »What were the health stories? »Were they fairly covered? »Do they reflect the big issues in Irish health policy? »Why, why not? »What were the media headlines? »What were the health stories? »Were they fairly covered? »Do they reflect the big issues in Irish health policy? »Why, why not?

Budget 2009 (Health) »“Spending on health will increase by 2.1% to 15.8 billion” »“abolish the automatic entitlement to a medical card for over 70s above criteria” »“an annual cash grant of €400 euro per person to over 70’s without GP only or full medical card from1 January next year” »“an innovative proposal to fast track the roll-out of new GP practice units in collaboration with the private sector” »“Spending on health will increase by 2.1% to 15.8 billion” »“abolish the automatic entitlement to a medical card for over 70s above criteria” »“an annual cash grant of €400 euro per person to over 70’s without GP only or full medical card from1 January next year” »“an innovative proposal to fast track the roll-out of new GP practice units in collaboration with the private sector”

Budget 2009 »“a targeted voluntary retirement scheme for HSE targeting surplus middle management, admin & other surplus staff” »Standardise rate of tax relief for unreimbursed medical costs »Increased charges for hospitals »Increase threshold for drugs reimbursement »Increase charge of public beds in private hospitals by 20% »“a targeted voluntary retirement scheme for HSE targeting surplus middle management, admin & other surplus staff” »Standardise rate of tax relief for unreimbursed medical costs »Increased charges for hospitals »Increase threshold for drugs reimbursement »Increase charge of public beds in private hospitals by 20%

“The black hole” »“Spending on health has increased 293% since 1998” »“The OECD estimates that spending in Ireland on pension and healthcare may rise from 8% of GDP to 18% by 2030” »“We cannot sustain such a huge increase without basic changes in how we achieve common goals”  Brian Lenihan, 14 October 2008 »“Spending on health has increased 293% since 1998” »“The OECD estimates that spending in Ireland on pension and healthcare may rise from 8% of GDP to 18% by 2030” »“We cannot sustain such a huge increase without basic changes in how we achieve common goals”  Brian Lenihan, 14 October 2008

Maybe no black hole? »Still making up for decades of under spending »Include social as well as health spend in health budget »Just reaching EU average, still below OECD average of 9% at 7.5% of GDP. Capital € - 75% of EU average since’70 »In 1998, Ireland spent €3.6 billion on health, in 2008, it is €15.3 »Still making up for decades of under spending »Include social as well as health spend in health budget »Just reaching EU average, still below OECD average of 9% at 7.5% of GDP. Capital € - 75% of EU average since’70 »In 1998, Ireland spent €3.6 billion on health, in 2008, it is €15.3

The ‘bureaucrasic’ HSE »“Since the establishment of the HSE, the number of WTE has increased by 12%” »“The number of administrative staff alone is up by some 1900”  B Lenihan, 14 October 2008 »“Since the establishment of the HSE, the number of WTE has increased by 12%” »“The number of administrative staff alone is up by some 1900”  B Lenihan, 14 October 2008

Really? »Medical and dental staff from 5,000 in to 8000 between 1997 and 2007 – up 61% »Health and social care professionals from 6,000 in 1997 to 16,000 by 2007 – up 164% »Management/admin staffing from 8,844 to 18,043 up 104% but these include consultant’s secretaries, out patient departmental and medical record personnel - front line staff »Medical and dental staff from 5,000 in to 8000 between 1997 and 2007 – up 61% »Health and social care professionals from 6,000 in 1997 to 16,000 by 2007 – up 164% »Management/admin staffing from 8,844 to 18,043 up 104% but these include consultant’s secretaries, out patient departmental and medical record personnel - front line staff

Really? »“Health sector expenditure increases have led to staff increases” »“Global health employment in Ireland (30.8 per 1,000 inhabitants) remains just below the average of OECD countries” OECD 2008 »“most Irish hospitals appear to be efficiently run” Lasso for Thomas et al, 2008 »“Health sector expenditure increases have led to staff increases” »“Global health employment in Ireland (30.8 per 1,000 inhabitants) remains just below the average of OECD countries” OECD 2008 »“most Irish hospitals appear to be efficiently run” Lasso for Thomas et al, 2008

Emergency! »‘100’s wait on trolleys in over crowded A&E’s across the country’ »240 waiting on trolleys around the country, 14 October 2008 »Our Lady of Lourdes ED shut due to over crowding, 15 October 2008 »6 October, more people than ever before on trolleys in Galway, ‘third world conditions’ »‘100’s wait on trolleys in over crowded A&E’s across the country’ »240 waiting on trolleys around the country, 14 October 2008 »Our Lady of Lourdes ED shut due to over crowding, 15 October 2008 »6 October, more people than ever before on trolleys in Galway, ‘third world conditions’

Emergency? »People are waiting on trolleys »8 of 9 largest hospitals working at over 90% capacity and some wards at over 100% »In first week of October ,200 acute beds in public hospitals were currently closed or unavailable due to budgetary restrictions (513) or (682) were unavailable due to delayed discharges »People are waiting on trolleys »8 of 9 largest hospitals working at over 90% capacity and some wards at over 100% »In first week of October ,200 acute beds in public hospitals were currently closed or unavailable due to budgetary restrictions (513) or (682) were unavailable due to delayed discharges

Emergency? »In 2004, NHO was allocated just over €4 billion, in 2005, this rose to over €4.4 billion. In 2006, it was €4.5 billion. In 2007, it was €4.8 billion. By 2008, it was €5.1 billion. »In 2006, Ireland had 2.8 beds per 1,000 compared to OECD average of 3.9 per 1,000 »In 2004, NHO was allocated just over €4 billion, in 2005, this rose to over €4.4 billion. In 2006, it was €4.5 billion. In 2007, it was €4.8 billion. By 2008, it was €5.1 billion. »In 2006, Ireland had 2.8 beds per 1,000 compared to OECD average of 3.9 per 1,000

Emergency? »Shortage of primary, community and continuing care services »Between 1997 & 2006, there was a 13% increase in inpatients and a 130% increase in day treatments »13% of hospital admissions were inappropriate, 39% of hospital days were inappropriate PA Reporting/HSE 2008 »Shortage of primary, community and continuing care services »Between 1997 & 2006, there was a 13% increase in inpatients and a 130% increase in day treatments »13% of hospital admissions were inappropriate, 39% of hospital days were inappropriate PA Reporting/HSE 2008

Emergency? »ED Task Force Report June 2007 “no EDs fit for purpose, even the new ones are deficient”. »It also found that most EDs had inadequate physical infrastructure »The key causes of delays in EDs were inadequacies in hospital and community services »ED Task Force Report June 2007 “no EDs fit for purpose, even the new ones are deficient”. »It also found that most EDs had inadequate physical infrastructure »The key causes of delays in EDs were inadequacies in hospital and community services

Don’t close my local hospital »1936 Hospital Commission »1968 Fitzgerald Report »2003 Hanly Report »“Acute hospitals to be delivered by an integrated network of hospitals, serving populations of about 350,000. »A small number of more specialist services should continue to be provided on a supra-regional or national basis”. »1936 Hospital Commission »1968 Fitzgerald Report »2003 Hanly Report »“Acute hospitals to be delivered by an integrated network of hospitals, serving populations of about 350,000. »A small number of more specialist services should continue to be provided on a supra-regional or national basis”.

Don’t close my local hospital »To provide emergency care, a team made up of 21 consultants, 7 each in acute medicine, surgery anesthesia »For hospitals to provide ‘comprehensive acute care’, 45 to 50 consultants required »Many hospitals providing emergency and acute care such as complex surgery, A&E departments, obstetrics should not be doing so »To provide emergency care, a team made up of 21 consultants, 7 each in acute medicine, surgery anesthesia »For hospitals to provide ‘comprehensive acute care’, 45 to 50 consultants required »Many hospitals providing emergency and acute care such as complex surgery, A&E departments, obstetrics should not be doing so

Don’t close my local hospital »A political football, decision reneged upon, kicked to touch, Hanly abandoned »North East and cancer care is Hanly in action just not in name »Yet communities see local services closed and down graded without being able to see improvement in health care provision »A political football, decision reneged upon, kicked to touch, Hanly abandoned »North East and cancer care is Hanly in action just not in name »Yet communities see local services closed and down graded without being able to see improvement in health care provision

Myths and misconceptions? »So does the media fairly represent key issues? »What about public health? »Health inequality? »Access to health services? »Quality of healthcare? »The privatisation of health services? »So does the media fairly represent key issues? »What about public health? »Health inequality? »Access to health services? »Quality of healthcare? »The privatisation of health services?

Myths and misconceptions? »Media reflects HSE and DOH spin »Media tells the peoples’ stories »Reactive, often just cut and paste and human interest stories »Absence of analysis, uninformed »Tight deadlines, low budgets, difficult to communicate complex issues through media »Media reflects HSE and DOH spin »Media tells the peoples’ stories »Reactive, often just cut and paste and human interest stories »Absence of analysis, uninformed »Tight deadlines, low budgets, difficult to communicate complex issues through media

Misled and mismanaged? »Absence of political leadership and courage in health »Failure to deliver policy and service commitments »Virtual absence of good information »Poor communication with the public, communities and the press »Absence of political leadership and courage in health »Failure to deliver policy and service commitments »Virtual absence of good information »Poor communication with the public, communities and the press