By Eamon Delaney
I found myself back in a hospital A&E again after Christmas, this time for a dislocated shoulder. Thankfully, it was sorted out, apart from some ongoing pain and future physio. But my casualty department experience, mercifully just before the recent deluge, was a personal reminder, as all these visits are, of everything that is good and bad about our emergency health service.
My observations are always the same : the heroic work done by the nurses and doctors. But the sense that they are on their own in a closed down hospital (I’ve mostly been there at weekends or at night time) and that they are dealing with so much more than they should be, like the high number of lost souls or inebriated people hanging around and using the A&E as much as a warm and social hangout as a place to have their ailments addressed.
This element seems to have reduced somewhat, which is surprising give the number of people who are homeless, and have addiction or mental health problems.
The other element is the high number of people who really should not be in A&E but who have been referred there by doctors ‘just in case’ or have decided themselves to join the queque. If anything this seems to have grown. Perhaps it is the medics fear of legal action, or perhaps it’s the constant public announcements of ‘getting everything checked out’, but some of the patients you meet are astonishing.
One elderly lady was in for a nosebleed which had stopped but which she was going to have checked out anyway.
Another case involved a family looking in on their mother, who’d been sent in by a medic known locally as ‘Doctor Do Little’ such is his propensity for referring patients to A&E. Quite seperately, a close friend in another area of Dublin had a bad cold which hurt her chest and caused a small bit of blood in the saliva.
On this basis, the doctor, recommended my friend go to A&E despite the long quegues and get a ECG, for a possible cardiac event. The doctor could even get her an ambulance. My incredulous friend declined and was fine within a day.
I list these, as they are an indication of what our A&E is facing. If you magnify them, you get lot of unnecessary blockage in the system.
Nevertheless, what I also saw in A&E were the many genuinely sick and miserable people sitting there for hours, and it makes you so frustrated and angry.
How can a country as rich as Ireland still let this happen? Ireland has one of the highest spends on health per capita, so how can we still be having this conversation all these years later. In 2007 – 2007 ! – I sat in a TV audience watching a debate about our health service delays.
At a time of prosperity, indeed, it had become a big electoral topic. Not any more. And nothing was done. The experts and politicians just shrug and move on. Short termism and a ‘sure it’ll do’ attitude prevails.
This winter the problem was predicted to be even worse, given the flu threat and our rapidly growing and aging population
But even without this, we know the reasons for the ongoing crisis – vested interests, resistance to work reforms by trade unions and by consultants, too much management, including the dead wood retained from the creation of the HSE, and not enough step-down facilities or primary care to prevent people going or staying in hospital.
And, of course, we have too many smaller acute hospitals spread around the country. But what politicians will suggest closure of these, and what politician will take on the entrenched vested interests?
When are we going to tackle this as a national emergency with cross party involvement, instead of commissioning another report and just moving on?
Put bluntly, how do people sleep comfortably at night knowing that because of their actions, and lack of actions, people in their 70s and 80s are lying on trollies on hospital corridors? It is absolutely shocking.
Instead, the Taoiseach (pictured above) offered a strange, sad apology. No wonder Ann Hogan President of Irish Medical Organisation slammed what she described as the detached ignorance of our political culture from the issue. ‘We thought that successive ministers were trying to fool the public, and now it seems that they fooled themselves as well’ she said.
The Irish Hospital Consultants Association echoed these sentiments as did predictably the Irish Nurses and Midwives Organisation (INMO) but are these self preserving bodies not also part of the problem?
After all, why is the fact that we pay so much and get so little in return not vigorously addressed? Is it because it doesn’t suit the mantra of these organisations, and the lazy politicians, of simply conceding to demands for ‘more money, please.’ Is it really too much to expect a more mature and involved response?
The fact that this high spend is combined with such a poor outcome should be the real debate. We often hear how our nurses and doctors are leaving for better jobs elsewhere, but the evidence suggests that HSE spending and resources goes on staffing, not capital investment.
Exactly three years ago, the then Health Minister Leo Varadar said he was ‘sick to death’of the problem of overcrowding in hospital emergency departments and that he planned to ‘tackle the long standing problem once and for all.’. He even said he had a specific plan to ‘break the back of this problem once and for all.’ Strong language but three years later the situation has only worsened.
Varadkar went to Social Protection from where he could work on his real priority: becoming Fine Gael leader and Taoiseach. He was successful, even though he made no impact on health except to ask for another billion. As Taoiseach, he seems to have another priorities and photo-ops which is just incredible given the problem.
The limited response of Fianna Fail has also been equally disappointing. It has few big picture solutions, even though it was under Michael Martin that HSE spending, and management, got out of control.
We know from a revealed FG whatsapp message that Simon Harris apparently ‘wanted out’ of health. This is a shocking evasion.
It reminds me of that damning remark attributed to Brian Lenihan Sr when he visited an industrial school as a Minister back in the 1960s and saw the miserable children at their labour. ‘Get me out of here!’ he allegedly muttered when, as one historian put it, his response should have been ‘get me into here.’ That would be the brave and courageous thing to do and something that a politician might be remembered for. And it is exactly the same with our ongoing health crisis.
This article appeared in The Times.ie on 10 January 2018.