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Nov. 30, 2016, 12:52 p.m.
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The health service urgently needs €1.4 billion to replace ageing equipment such as ambulances, MRIs and x-ray machines, according to its director general.
HSE head Tony O’Brien says he has “great concern” over the amount of money available to replace critical equipment bought during the boom, which is now ageing.
This posed a safety and quality concern and was an “immediate problem,” he told the Dáil committee on the future of healthcare. An additional €1.4 billion was needed over the next five years to address the issue, he said.
Mr O’Brien warned of imminent decisions in rationalising the delivery of health services that could prove controversial in parts of the country.
Health had become a political football, where the 80 per cent of services that were well run are overshadowed by the 20 per cent that are not delivered “as well as we would like”.
Mr O’Brien said there have been numerous improvements in the health service in recent years, including stroke, cancer and cardiac care and vaccine programmes.
The improvement in cancer services followed a successful centralisation of services that became a political football but, thankfully, the view of doctors prevailed, he said. “I have no doubt that we will face other decisions in healthcare very soon that are equally as contentious where local views diverge from those of clinical experts.
Mr O’Brien said it was “good news” that Irish people were living longer - with an additional 20,000 over-65s each year - but this posed challenges.
“Unless we plan for these changes now we are going to run into significant difficulties in ten years’ time. In fact - we are facing those difficulties already as we can see in the 5 per cent to 6 per cent increase in the presentations to our emergency departments year-on-year.”
As a result, the health service is doing more emergency work and less elective work each year. This meant less space for elective procedures. “If these trends continue, all work will be emergency work and we will be unable to accommodate elective work.”
Mr O’Brien said the way the HSE was set up led to a “command and control “ type of system that disempowered managers and stifled creativity. “Overall, we have learned that you simply cannot manage 105,000 staff from one central location.”
What was needed was a decisive switch away from hospitals to treating people in primary care, but this would need significant additional resources and time, he said.
Mr O’Brien called for the building of a general public consensus on the maximum feasible investment in the health service over the next 15 to 20 years. The service was being transformed and improved but this could not happen “for free”.
The state of New York is currently spending €8.5 billion on an improvement programme aimed at saving €17 billion, he pointed out.

http://www.irishtimes.com/news/health/hse-faces-1-4-billion-bill-to-replace-ageing-ambulances-1.2887567