James Sheehan, Orthopaedic surgeon, engineer, businessman and entrepreneur


Whenever we appear to have a crisis in healthcare, and politicians appear under pressure, they commission yet another health report. The latest report is Sláintecare, drawn up by 14 representatives of all the major political parties.

No country to date has satisfied the insatiable needs of modern healthcare. New technology, increased drug costs, manpower shortages, old plant and equipment, litigation,and an ageing population all increase the demands on the health service. It is a sobering thought that of the worlds 7 billion population only 2 billion people receive safe and effective anesthesia and surgery.

The Sláintecare report assumes that by having patients largely treated and investigated at primary care level, combined with public only hospitals, it will solve our problems with waiting lists and increasing costs. This is wishful thinking. What is required is not reform but reinventing of our health service.

It must become patient focused, not staff focused as it has become.

The mainstay of any health service is primary care, and it has been starved of manpower and financial support for decades.

A recent Government report suggests the need for 542 primary care centers. Currently there are 127 primary care centers and 30 additional centers have been announced over the next three years. One in five of the existing primary care facilities have no GP, the critical member of the facility and without whom such a centre cannot function. Recruitment of GP’s is currently a major concern, with many practices now unable to find replacements for retiring colleagues and 50% of the existing GP practices unable to take additional patients. The current GP training program currently admits only 50% of the numbers required to replace those retiring. None of these centers are equipped with diagnostic services such as MRI scanners, or modern diagnostic services, which again are an integral component of delivering an adequate service and thus to prevent patients queuing up at overloaded hospital facilities.

Our current service is neither efficient or cost effective. Most of our premises are obsolete. Our maternity hospitals have an average age of over 140 years. Our major teaching hospitals throughout the country average 46 years. The only recent build is the new Mater Hospital. What is required is good bulldozers!

Our planning and construction of facilities is pathetic. Just consider the New National Children’s Hospital.

Information technology used by three year olds is not available in most of our hospitals. We do not have a national electronic patient record.

Do we optimize the use of most of our equipment such as scanners? Most operate until 5 pm. And yet we have two years waiting lists.

Do we keep most of our elderly in their own homes and are we designing our homes for an ageing population as many European countries now do?

Is our health service evidence based? All hospitals should have mandatory outcome reporting.

Finally is our service equitable? If there were no waiting times, and a first class service could be delivered to all, then it would be equitable. Almost 50% of the population subscribe to private health insurance as they have no confidence in the public service in their hour of need. It would be grossly unfair to prevent people seeking out the best care for their families when our services leave so much to be desired. The mix of privately run facilities with public facilities encourages a healthy spirit of competition.
Eliminating private work from public hospitals as suggested in Slaintecare is a major error. Not alone will it deprive the public hospitals of substantial revenue but it will fail to attract the level of expertise that we are accustomed to in our teaching hospitals.

What is required is Universal Health Insurance so patients have a choice of facility when the need arises. In fairness to James Reilly, whatever about many of his suggestions he got this one right!

Is reinvention of our health service, with no further reports, a dream or could it be a reality?