Having spent the best part of the last month undergoing treatment in a semi-private ward of a large public hospital, I’ve seen first-hand how our health service operates. It’s the same old story. Once you get through A&E and into the system, the care is excellent. But it’s not all a bed of roses.
In Ireland, we have a 2-tier public health service with a unique mix of public/private patients and public/private consultants. Approximately one third of hospital consultants work in public-only practice. That leaves 70% of consultants allowed to practice publicly and privately. These consultants enjoy the best of both worlds. They do not have a boss, their hours are not monitored and many enjoy extraordinary salaries. Granted, our Minister for Health, Mary Harney has tried to exert control over hospital consultants by introducing new contracts (terms and conditions with the State) and new posts of clinical directors (about 100) to manage and monitor hours. However, having watched the consultants do their ward rounds over the last month, I’ve come to the firm conclusion that we’re all being held to ransom. It’s time someone blew the whistle.
I witnessed consultants reassuring elderly patients that there was no hurry for them to go home. I’m talking here about patients who had very obviously recovered from the acute illness that brought them into hospital. These patients had homes to go to with family in support, they were not waiting to be allocated a nursing home bed. We hear so much about the shortage of beds in our acute hospitals. Why are the consultants not working hard to free-up beds?
I saw the look of disbelief on the faces of the junior doctors (NCHDs) as a consultant announced further tests on a young girl who’d been in hospital for many weeks and whose tests had all come back normal. This girl appeared very well to me so why was she occupying a hospital bed? Why were her investigations continuing as an in-patient?
Could it be that hospital consultants choose to have a proportion of beds occupied by patients who require minimal input of care/time? Patients whose health insurance will continue to reimburse both the hospital and private consultant as long as they occupy a bed? Is this the realistic truth? I presume that the NCHDs remain silent on this issue because their jobs depend on pleasing the consultant?
I don’t know about you but my conscience finds it very difficult to accept that ‘well’ patients are occupying hospital beds when I know that acutely ill patients are lying on trolleys in A&E?
We have some fantastic consultant doctors in this country who are totally dedicated to their profession and I’ve no wish to tarnish their reputation. However, as a patient, I feel a need to protect our health service. The fact is, I depend on it.
I’m back! Well, sort of… if you know what I mean. I got home from hospital on July 10th on oral antibiotics but unfortunately, it turned out to be a shortlived escape. Six days later, I was back in A&E with all the old symptoms again. The osteomyelitis has returned in the bones of my skull and the colitis has flared up again too.
There will be no white flag above my bed. I won’t put my hands up and surrender. I’ll let it pass (more anon).
I had a great bit of fun last week on my last night in the A&E department. If there’s one thing I’ve learnt over the years of being admitted to hospital, it’s to use humour to get through difficult situations. This time, it really helped me through a potential emotional meltdown. I won out in the end too!
Those of you who’ve read this blog before, will know that I have a past history of MRSA infection and although I am clear of this horribly resistant bacteria, I’m still regularly stigmatised by it when in hospital. On this occasion, on admission to A&E, I was carefully questioned about my MRSA status and swabs were taken for analysis. A very kind ward manager found me a bed rather than a trolley and it was pushed into a little side room to ‘protect’ the other patients in case the swabs came back MRSA positive.
The side room had four walls, a bed, one chair and a door. No television, nothing. No en suite either which means that potentially infective patients use the same facilities as everyone else. As I was only a ’suspected’ carrier of MRSA, no restrictions were placed on my movements around a very busy A&E department. On the third night, I came out of the side room to find a new sign on the door… “Do not enter, please contact staff desk first”. My immediate reaction to this was “Help! My swabs must have come back positive”. I went back into the room and lay down on the bed in despair. That’s when the fury hit. “How dare they put up this sign without first informing me of a change in status!”. I was tired and in danger of losing my cool. Humour was called for. I sat up and carefully made a sign which proclaimed “Enter at own risk, I bite!” and using a sticking plaster from my handbag, I stuck it to outside of the door below the other sign. About 30 mins later, a night nurse stormed into the room and asked if I was responsible for the sign. I smiled back at her cheekily and replied, “two can play at your game you know. Nobody consulted me about the restrictions placed so I didn’t consult you”. I demanded to know if my MRSA status had changed. She replied that it hadn’t and admitted that they were playing safe. She then left the room clearly annoyed. I chuckled to myself in victory.
Shortly afterwards, she returned with a smile. “You win”, she said. We’ve taken both signs down now”.
The following morning, I left the room briefly and on my return, my bed and all my belongings had disappeared. Nobody could tell me what was going on but I was hopeful it might be a sign I was about to be transferred to a ward. Another patient was wheeled into the side room and my bed was eventually found in the middle of the department, lined up with trolleys all groaning with patients. Later that day, I was informed that I was to be moved to a ward and as you can imagine, this news came as a huge relief.
The swab reports came back negative on my fourth day in the hospital. Phew! If I’d tested positive, it would’ve compromised my treatment and also meant that I’d been infective to others in the hospital, for a full four days. Countries like Holland, which has brought MRSA contamination under control in the hospitals, must laugh so hard at the Irish interpretation of infection control.
To: Ms Mary Harney, Minister for Health & Children
I’m writing to let you know my views on the public health service. Having spent three days last week residing in the busy A&E department of a large teaching hospital, I feel qualified to comment. The experience has left me wanting answers to many questions. Please listen to what I have to say.
Last Friday my doctor sent me to A&E for emergency care as I’d developed a serious complication following surgery some weeks earlier. On arrival in A&E, I was rapidly processed by a triage nurse and seen by the registrar on-call. An immediate decision was taken to admit me to the hospital. I finally reached a ward on Monday afternoon! During the 3 days and nights spent in A&E, I was extremely well-cared for but the conditions were hell. The staff were so busy, patients had long waits for help. It was like being in a war zone, people lying on trolleys everywhere with further casualties arriving by the hour. It was also extremely noisy with little or no privacy. These conditions do not aid recovery.
My first question to you, Mary, is this… why must sick and injured people be exposed to these awful conditions in order to be admitted to hospital? Where are the 1,000 extra beds you promised when you took over as Minister for Health 5 years ago? I sure could have done with one of those beds last Friday.
It was a great relief when I was finally transferred to a 4-bed semi-private ward where I remain. I’m receiving excellent medical and nursing care here. Thankfully, this hallmark of Irish healthcare remains intact despite the inadequate funding of our public health service. I’ve no doubt that this is due to the dedication of the staff who work in frontline services. The unit I’m in, has been recently refurbished and is beautifully fresh and clean. I’ve no complaints really except I’d obviously prefer to be in my own howm. The catering is good, plenty of good nutritional food and frequent offers of hot/cold drinks. I’m very aware that this aids a speedy recovery and subsequent discharge from hospital. I’ve not always hit this lucky.
Over the years, I’ve spent many weeks as a patient in this same hospital, on the public wards. It has always been a grim experience in terms of patient comfort, lack of facilities etc. I don’t think much has changed although I have heard that hygeine levels have improved on the big wards. My medical history is extensive so I choose to hold private health insurance to ensure that I can get care when needed. My case is complex and so I cannot be admitted to one of the smaller private hospitals for treatment although I’m fully insured to do so. These smaller hospitals cannot provide the care I require.
I want you to know, Mary, that it’s distressing to observe your clear policy of starving the public hospitals of funding while you promote the development of co-located private hospitals. The staff who work at the frontline in our public hospitals, are fantastic but they are being stretched to the limit to provide the care needed in our under-resourced public hospital system. I plead with you to stop bleeding our health service to death while you continue to promote an inequitable health service. Give us a break, Mary.
The semi-private unit I’m in, is excellent. I do not need for anything better as all my needs are being met here. I’ve hit lucky on this occasion as this is the most comfortable unit in the hospital. However, the WHOLE hospital should run like this unit. Instead, the majority of the rest of the hospital is no longer fit for purpose. It’s time to put our health resources to proper use. Surely everyone deserves fair and equitable healthcare?
I feel very out of touch with the blog world. It’s been a roller coaster week here. It’s got to the stage where when the phone rings, my heart falls. No news, really is good news.
It all started on the day of the Heineken cup rugby final when my father was rushed to hospital by ambulance with chest pains. After an anxious wait in A&E, news came through that his pain was non-cardiac in origin and so once my dad’s condition had stabilised, he was discharged back to the nursing home.
The following day, my mum-in-law’s health suddenly deteriorated and we were told that her end was nigh. Thus begun a round-the-clock family vigil at her bedside which lasted for five days. She died peacefully on Friday surrounded by her nearest and dearest. Her funeral will take place next weekend when family and friends will gather from around the world to celebrate a dear life. She was a wonderful mum and a real supergran and will be deeply missed.
In the midst of all this, my son Robin woke last Friday morning with a very swollen foot. He was due to leave at lunchtime on a walking holiday with friends so we had to act fast. His problem was solved by a visit to a VHI SwiftCare Clinic which had him assessed and processed in less than one hour and on his way to Kerry. The following morning Robin phoned to say that the swelling had moved up his leg and a phonecall to SwiftCare confirmed that he should return home. I collected him off the train several hours later and ferried him back to the clinic for re-assessment. Again, Robin was seen very quickly and thankfully, this time the news was better. He was instructed to rest-up and allow the antibiotics to take effect. SwiftCare is a privatised clinic funded by a health insurance company, to deal with minor injuries and illnesses. I could not fault the care that Robin received there. It would have been a very different story had we attended the A&E department at our local hospital. By lunchtime today, Robin was back on the train to Kerry to re-join his friends.
Thankfully, today has been a rest day. There’s been no news as yet on a date for my surgery. Right now the silence from Nottingham, is a welcome reprieve.
Right now this country lacks leadership. George Lee, the well-known economist, has thrown in a well-paid job with RTE to put himself forward for election. There’s no doubt that he has the expertise needed to sort out the financial mess in the country. I’m reassured by his knowledge and feel sure that given half a chance, he’s the right man to iron out the problems in our economy. Now wouldn’t it be good if some more bright sparks were to declare themselves willing and able to sort out our ailing health service? Harney and Drumm have clearly lost the plot. New blood is desperately needed.
Here’s a viewpoint from someone who does have a finger on the pulse. I’ll be back soon.
Overcrowding in A&E
Madam, – Can anyone explain why the persistent and dangerous overcrowding that afflicts Irish emergency departments remains unsolved and ignored? This Government moved very swiftly to deal with inadequacies in cancer services in the past two years when clinical errors, which had been highlighted in the press, made it obvious that improvements in service organisation and delivery were essential. Key elements in that improvement process were: a political will to sort it out, an analysis of the service as it was, a redirection of funding to key areas, reorganisation of services and, most importantly, co-ordination of all of this by the cancer tzar, Prof Tom Keane.
Emergency departments in the UK were the victims of overcrowding with in-patient boarders for many years, but the public outcry and the media’s persistent reporting on it was enough to stimulate Tony Blair, the then prime minister, to demand an improvement. What followed was a process that was a mirror image of what we have seen with cancer services here and, under the guidance of their emergency services tzar, Prof George Alberti, the problem was largely solved within two years.
What do we do in Ireland? Yes, we recognise that there is a “National Crisis” (Mary Harney 2006) and we set up a taskforce which produced an excellent document on changes required to improve matters (June 2007), but we fail to appoint a credible co-ordinator/implementor and we ignore all of the recommendations of the Taskforce Report.
Such inertia has not just led to a retention of the status quo, but to a gradual and serious deterioration of the care of patients presenting to emergency departments. There is ample evidence internationally that overcrowding of emergency departments with admitted patients puts them at a significant risk of medical complications and death. In that regard they are no different to the plight suffered by cancer victims in the past. Why then do the HSE, Professor Brendan Drumm and the Minister for Health and Children, Mary Harney, continue to obfuscate on this matter? – Yours, etc,
AIDAN GLEESON,
Consultant in Emergency Medicine, Beaumont Hospital, Dublin.
I’m fed-up listening to the mixed messages coming from the Department of Health and the HSE. One minute our Minister is vowing to provide extra beds in the health service and the next we’re being told that we’ve got too many beds. It’s time that Harney and those muppets in the HSE made their minds up.
We have a new chief medical officer (CMO) of the Department of Health, Dr Tony Holohan and in his first media interview since taking up his appointment, he announced that the Irish health system has too many hospital beds. Brendan Drumm, CEO of the HSE, is also peddling the same message. Meanwhile, our Minister for Health’s solution to relieving the bottleneck in A&E, has been to promote private for-profit co-located hospitals as a means of fast-tracking new beds into the system. At the same time, the Dept of Health has deemed our smaller hospitals ‘unsafe’ and is busily closing them down without first adjusting the conditions in the ‘centralised’ units’, with adverse consequences predicted.
The reality is that as things stand at the moment, our health service is in disarray. We have chaos in our A&E departments because of the bottleneck caused through lack of beds. The reason for the log-jam is because our tertiary healthcare services have been neglected over the years and many OAP’s now have no choice but to occupy hospital beds long term. Instead of Harney wasting her time and our money on privatising healthcare in this country, the focus should be put on developing primary care. Nobody refutes the fact that hospitals are not the safest place to be when recuperating from surgery. Primary care is the way forward, with enhanced outpatient care taking place in GP surgeries and public health clinics. This would cut the need for bed numbers with patient care moved to an outpatient or a community setting.
However, the Dept of Health and HSE have repeatedly failed to explain their role. The mixed messages emanating from the Health department are doing nothing to improve public confidence in the health service. Let the new CMO of the Dept of Health come out and tell us what the plans are. We need to know that the problem of overcrowding in our hospitals will be solved. We need to hear that primary care will get the investment needed to take the pressure off the hospitals. Stop the indecision, we need reason to be hopeful.
There’s one thing that mustn’t be forgotten in all of this and that is the patient. Think back to the last time you were in hospital. What meant the most to you? Was it the good/bad facilities or was it the friendly staff who cared for you? What really counts when one is ill, is kindness but sadly, this is rapidly disappearing as our health service is decimated by mismanagement. The Minister would do well to remember the need for a familiar smiling face.
Do you agree that all patients should be entitled to equal access to healthcare whatever their lifestyle choices? This was the motion put forward for last night’s Health Debate, the first of six debates to be held across Ireland in the 2009 Pfizer Health Debates series in association with The Irish Times. These debates on healthcare are open to the general public, free of charge, through advance registration and provide a forum for those attending to articulate perspectives and concerns. I couldn’t resist the temptation.
Last night’s debate was chaired by Irish Times columnist, Fintan O’Toole. Well-known economist, Jim Power argued against the motion along with Prof Charles Normand, professor of health policy and management at Trinity College, Dublin. They went head to head with Labour’s health spokeswoman, Jan O’Sullivan and Dr Donal O’Shea, consultant endocrinologist who spoke in favour of the motion. Before the debate commenced, the chairman asked the audience for a show of hands on the motion. Interestingly, there was fairly equal distribution of those ‘in favour’, those ‘against’ and the ‘don’t knows’.
Did you know that obesity accounts for 40% of all cancers? Add smoking to the equation and it becomes a 70% causal factor. Last night’s debate raised many philosophical as well as practical arguments. Should people who adopt risky lifestyle behaviours like smoking or abusing alcohol, be given the same access to healthcare as people who adopt healthy lifestyles? Is equity of healthcare, a fundamental right for everyone? Should people be judged by their lifestyle choices? How do we define which patients are worthy of treatment? Should our limited resources be put into educating people to change their behaviour? Who decides on these huge moral issues?
The debate was opened to questions from the floor giving the audience an opportunity for engagement before the final show of hands was taken. The motion was overwhelmingly carried in favour of equal access to healthcare for all patients regardless of lifestyle choice.
I voted against the motion and for good reason. I happen to believe that hard decisions need to be taken to stop the drain put on hospital resources through risky lifestyle behaviours. Look at the problems in A&E with the drunks and drug addicts. Are you happy that they get the same priority of treatment as the genuinely sick and the elderly? Instead of waiting to treat the problems caused by unhealthy lifestyle choices, healthcare resources could be allocated to educating people to take responsibility for their lives. I also believe that people with serious illness are being denying optimum treatment by our failure to prioritise treatment on the basis of genuine need. The poor survival rate in this country for cystic fibrosis sufferers, is the direct result of a system that refuses to make decisions. The cervical screening programme is another example of the failure to prioritise. It was rolled out last year, 21 years after the government first agreed on the need for such a programme. It’s time people woke-up to the fact that patient’s lives are being lost through lack of government leadership. Our health service is rudderless and it remains to be seen if Captain Harney and her First Mate Drumm, will stay with the sinking ship.
The next debate in the series takes place in Cork in UCC, on 29/04/09 and will discuss the hot topic of co-located hospitals. This issue has already generated much discussion nationally so it should be a lively debate.
A recent letter to the editor of of the Irish Times pointed to an accusation once made by the wife of a former US ambassador to Ireland who said that the Irish had “no sense of outrage”. This accusation is highly applicable to us as a nation when it comes to our toleration of a health service that is failing us. It seems that it’s not until we are confronted head-on with the failures within the service, that we wake-up to how inhumane and inefficient the system really is.
The letter continued…
“My recent experience of the A&E system was in the company of my elderly mother. A&E is like the Red Cow Roundabout. You need to go to an entirely different place but the ’system’ dictates that everyone must first ‘congregate’ in A&E, regardless of whether they are an accident or emergency case, in order to get eventually – if they are lucky – to where they need to be in hospital.
My mother had a GP’s letter recommending her immediate admission to Mayo General Hospital. Yet for two days, in severe pain, she was forced to run the gauntlet of gross duplication (her medical details alone were demanded and written down by seven different people in A&E), lack of treatment, lack of privacy, lack of communication, lack of care, inadequate toilet facilities and a total lack of dignity. My mother died suddenly and unexpectedly a mere 32 hours after her ordeal in A&E.”
This person’s experience prompted her to ask some very valid questions…
“Is it not time to call time on the HSE as it is presently devised? Remove decisions on medical treatment and care from accountants and form-fillers to medical staff. Return the hospital management to the matrons and clinical staff who have the training to determine patients’ needs. Or, like the banking system, is the present system that governs the HSE all about money and greed — the same disease that has wrecked our economy — with the patient’s clinical care merely an appendage?”
The late Susie Long advocated on behalf of all patients to bring about change in the system which had failed her. Susie turned her own personal tragedy into a force for positive change. She succeeded in waking the Irish nation out of it’s stupor of indifference and toleration. Surely we owe it to her memory to unite to become a force for change and to continue her fight for proper reform of our health service? It’s time for the Irish nation to stand up and be counted and to prove that it does indeed possess a sense of outrage.
A young woman with purple hair styled into a punk rocker Mohawk and sporting a variety of tattoos, arrived in the A&E department.
It was quickly determined that the patient had acute appendicitis, so she was scheduled for immediate surgery.
When she was on the operating table, the staff noticed that her pubic hair had been dyed green, and above it was a tattoo that read, ‘Keep off the grass’.
Once the surgery was completed, the surgeon wrote a short note on the patient’s dressing, which said, ‘Sorry, had to mow the lawn’.
On a more serious note…
The Brain Doctors is scheduled for tomorrow night. This is a fascinating, no-holds barred glimpse into the world of neurosurgery.
Posted by Steph 
Posted by Steph 
Posted by Steph 
The debate was opened to questions from the floor giving the audience an opportunity for engagement before the final show of hands was taken. The motion was overwhelmingly carried in favour of equal access to healthcare for all patients regardless of lifestyle choice.
