‘Cos you deserve better

Have you noticed the sudden upsurge in radio and TV ads for private healthcare? Frankly, they sicken me.  “Because you deserve better” quotes one ad for a state-of-the-art private hospital. Because who exactly deserves better? Answer: Those who can afford private health insurance. But what about those who can’t, I ask? Don’t they deserve better too?

I hold private health insurance and I make no apology for it. I’ve a complex medical condition which requires regular medical supervision. Unfortunately, I cannot rely on our public health service to provide the care needed. Our health system has been so stripped of services that ‘public’ patients face long delays in accessing out-patient appointments and treatment. Privately insured patients can access care faster by paying for it. Such is the inequity of a 2-tier health service. Emergency care is different, it’s provided on the basis of need only. The delay in the public system, is putting people’s lives at risk. Remember Susie Long? I’m not prepared to risk my health because of our government’s failure to provide an equitable health service for all. I therefore see my health insurance as a priority, not a luxury. I choose to do without other non-necessities in life so as to afford the health insurance. I’m lucky to have that choice. Many don’t.

In these difficult times of recession, many people are struggling to maintain a roof over their heads/to afford enough food to feed the family. The advertisements for private healthcare appear very inappropriate in the circumstances. Of course, the real reason why these companies are advertising, has nothing to do with your welfare or mine. They are desperately trying to survive too.

Our Minister for Health has gone terribly quiet!

Held To Ransom

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.

Dear Mary

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 look forward to hearing from you.

Steph @ The Biopsy Report

Finger on the Pulse

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.

Source: Irish Times online

Battling On

I turned on the news this evening to hear that 909 patients around the country are waiting to have a colonoscopy and some of those people have been waiting for more than two years. In December, our Minister for Health told the HSE to comply with a target of access to a colonoscopy within four weeks of being referred by a doctor. I had a private consultation with a gastroenterologist this afternoon and have been booked for an urgent colonoscopy next Monday morning. This sadly, is the difference between public and private health care.

Unfortunately, the antibiotic I’ve been on for the past 8 days (Vancomycin), has failed to bring a nasty colitis under control. After almost six weeks of worsening symptoms, I’m in real need of help. While this means having to go through a dreaded colonoscopy again, right now that seems like a doddle compared to my present circumstances. The diagnosis is most likely to be an antibiotic-associated colitis caused by the ongoing treatment for the chronic infection in my head. However, biopsies are required to confirm this and also to rule-out other possible causes, such as Crohn’s Disease.

While queueing to see the doctor today,  I received a call from another doctor’s office. The surgeon in the UK has requested a CT scan of my skull before I travel to Nottingham for a review consultation. My surgeon in Ireland has organised the scan for tomorrow and I will travel to the UK in a couple of week’s time to receive the verdict. It’s certainly been all go today.

The reason I’m able to access prompt medical care for my health problems, is simply because I hold private health insurance. The policy is a huge burden on our family budget each year but I cannot afford to be without it. The delay in accessing investigations in our public health service, is costing lives. It seems that little has changed since the untimely death of Susie Long who succeeded in highlighting the inequities in the system. The Irish Cancer Society has described the waiting times as unacceptable. I’d describe the situation as scandalous and it’s time the HSE was held accountable.

RTE News Bulletin

Get It Right

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.

Patient Empowerment

The public, armed with useful non-jargon information, is rightly demanding a say in how healthcare is organised and delivered. Historically the patient has been expected to follow blindly the doctor’s advice with little input or participation in his/her treatment. The ability of patients to act as consumers and therefore participate in their own treatment has been severely hampered by medical secrecy and arrogance. The patient, on the whole, was not seen as having the training or intellect to understand complex medical issues and was therefore treated as a passenger and not a participant in their treatment. This lack of participation by the patient was caused in large part by a lack of appropriate information on which to make informed decisions.

The almost universal access to the internet has turned a bright light into what had been relatively dark corners. Patients, armed with useful non-jargon information, are becoming consumers of healthcare. They are insisting on doctors being measured, the publishing of meaningful outcome data, and access to healthcare based on their needs and not services based around what the health workers want.

Patients need to have a platform from which to make informed decisions and demand that they are participants and not passengers in their treatment. They can begin to measure around data points that are meaningful to them the quality of the treatment they receive and, most importantly, begin to shape the health service from a patient’s and not an employee perspective.

In France, (where the health system frequently ranks at the top of the World Health Organisation’s best providers) 40 per cent of health provision is supplied by the private sector. The French enjoy choice, clean hospitals and friendly staff, not to mention some of the highest quality outcomes in the world. France has embraced an agnostic system where providers are chosen and survive based on ability and quality of outcomes and not idealism.

For too long, patients have been allowed to suffer while high-level discussions take place around the politics of health.  France and others have proven that the discussion must centre around the patient and their needs. Most importantly, the patient must be at the centre of that debate and not be kept on its periphery.

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The above is the opinion of Ken Anderson, former commercial director general, Department of Health, UK. He is singing my song. The best and the most efficient health systems in other countries are based on universal provision where the money follows the patient. With further health cuts promised in the present economic downturn, we have never been more in need of new leadership and a new direction for our health service.

Source: Irish Times online.

Time For Action

Here’s a follow-up to my recent post  ‘Did Not Attend‘ and the comments it generated. A new study has found there is a high rate of non-attendance by patients at hospital appointments and these ‘no-shows’ are placing a significant drain on time and resources. Now, there’s a surprise!

PATIENTS WHO do not attend their hospital appointments are a serious drain on time and resources, according to studies conducted by the medical profession.

Figures produced for two of Dublin’s biggest hospitals show that almost 25,000 did not attend appointments at St James’s Hospital last year and and the figure for St Vincent’s Hospital was almost 27,000.

A report in Britain estimates that those who do not attend (known as DNAs), cost the NHS almost €1 billion a year. No equivalent figures are available here, but the most comprehensive study carried out in the Republic to date, by Beaumont Hospital’s dermatology department, has indicated the extent of the problem.

More than one-third (36.5 per cent) of all patients did not attend their appointments in January and February last year, according to research carried out by consultant dermatologist Dr Gillian Murphy and by student doctors Hafsah Sazli and Sheena Gendeh.

An examination of other departments in the hospital indicate that the DNA rate at the dermatology department was not exceptionally high. “My students looked to see if it was disease specific and it wasn’t,” said Dr Murphy.

According to the research, 26 per cent gave not receiving their appointments as the most common reason why they did not attend. A further 22 per cent forgot their appointments, 17 per cent gave medical reasons such as a cold or diarrhoea and 12 per cent claimed they had cancelled but their names had not been taken off the list.

Other factors were wrong addresses, patient cancellations, a mistaken appointment date and work commitments. Emergencies such as a family bereavement, a broken down car or a cancelled babysitter accounted for only about 3 per cent of DNAs.

Appointments are more frequently broken by the elderly, mostly above 80 years of age, and patients with a record of previously broken appointments are more inclined to be serial absentees.

Dr Murphy said DNAs were not only a waste of hospital time, but also increased the burden on GPs whose workload was automatically doubled if they had to re-refer a patient for a hospital appointment.

Beaumont Hospital estimates that there are an average of 13-16 DNAs at the dermatology department alone on every day the clinic opens. It takes one-two hours a day to deal with the non- attendee administration.

“For all the additional work that is done in processing that information about those people, you could actually employ another secretary,” Dr Murphy said.

Luckily, modern technology offers two obvious and very cost-efficient solutions. Text messaging has been used with some success in the UK and e-mail could also be used as a back up.

Trials of a system called Managed Appointment Reminder Service (MARS) sends out a text message reminder to all patients’ nominated mobile phone at an agreed date ahead of the appointment. It has proved to be extremely successful in bringing down rates of DNAs.

Not only is it beneficial to the patient, but it also cuts down enormously on administration costs if a reply service can be updated automatically. Getting through to the relevant department can be a major problem for patients wishing to cancel.

The fundamental problem with text message, however, is that elderly people, who are more likely to miss appointments, tend not to use it.

However, Beaumont is examining if it would be possible for an elderly person to give the mobile phone number of a relative who then calls to remind that person of their appointment. Not only does it ensure that more appointments are kept, it facilitates cancellation of appointments by people who cannot keep their appointment. This in turn allows those appointments to be reallocated to others awaiting appointments.

Dr Murphy said more research needed to be done to ascertain why less than half of all patients receive their appointments in the first place, a figure which the hospital has found to be very puzzling.

However, she also said that patients must take responsibility for their own treatment and especially the nearly third of all patients who forget about their appointments or claim that they have cancelled but there is no record of such a cancellation.

“If people were more careful about their appointments, took them more seriously and were given a timely reminder closer to the date, the situation would improve.”

Source: The Irish Times Healthplus

It seems that The Biopsy Report and it’s merry band of commenters are a way ahead of the posse. We didn’t need the results of any study to know how to tackle the serious drain on hospital resources. Our health service is awash with reports that have never been acted upon. We don’t need any more reports, we need action!

Did Not Attend

I recently wrote a post about ways to save our health service. One of the issues I spoke about was the problem of patients not turning up for out-patient appointments. I proposed that the high DNA (did not attend) figures in our hospitals were due to a lack of respect for our inefficient health service. The first comment I received in response suggested that the problem was most likely caused by patients not receiving notification of their appointments in time. I now have reason to believe that Ian is absolutely right.

It’s been 5 weeks since I last had an out-patient appointment with my surgeon. I was advised and given a prescription lasting two months. This new treatment failed within a couple of weeks so I was seen by my GP. He mentioned that he’d had a letter from the hospital detailing my treatment and saying that I would be reviewed again in 3 weeks. This was the first I’d heard about any review appointment so I joked with my GP that it was only the stuff of routine dictation and meant nothing. However when I became ill again 10 days later, my GP decided to phone the hospital himself to see if he could get an appointment. He was told that my name was already on the list for the next out-patient clinic in two weeks time (the surgeon was away in the interim) and that I would be notified by post. Again we laughed at the absurdity of a system that forgets to inform the patient.

I’ve still heard nothing and as the appointment is scheduled for tomorrow, I phoned the hospital today to query the appointment. It was confirmed that I was on the list for the morning but no explanation could be given as to why I’d not been notified. The fact is that had I not become ill since I last attended the hospital, I would never have known that an appointment had been made for my return. Through no fault of my own, I would have been registered tomorrow as a ‘DNA’  and my appointment which could have benefited another patient, would have been wasted.

Our health service is being bled to death by administration costs and it seems that patients no longer matter. What ever happened to the concept of patient-centred care?

Fighting MRSA

Hospital cleaners may one day use ionic liquids to clean wards. Scientists at the Queen’s University, Belfast have come up with a new way to kill off bacteria, including the hospital superbug MRSA. In this era of finite resources in our health service, any development which declares war on the superbugs, is to be welcomed.

Many types of bacteria, such as MRSA, exist in colonies that stick to the surfaces of materials. The colonies often form coatings, known as ‘biofilms’, that protect them from antiseptics, disinfectants, and antibiotics. Ionic liquids are up to 250 times better at killing ‘difficult to treat’ biofilms. Ionic liquids are essentially salts which are liquid at around room temperature. The liquid can be sprayed onto a surface where it will kill any existing bacteria. Significantly, the liquid doesn’t evaporate so once it is on a surface, no bacteria can withstand the treatment. It continues to destroy any bacteria that arrive subsequently provided the ionic liquid has not been wiped off. The liquid has low toxicity but has not yet been tested for use in human treatments.

The development was carried out by eight researchers from the Queen’s University Ionic Liquid Laboratories (QUILL) centre, supported by a grant from Invest NI. The research has been published in the journal, Green Chemistry. The Queen’s University group plans to introduce commercial products based on the technology, and is also studying possible uses with humans, eg as hand washes.

The prevalence of superbugs in Irish hospitals is thought to cost the HSE about €200 million a year. Poor cleaning, overcrowding, inadequate facilities, lack of infection control staff, poor management and a lack of accountability have all contributed to unacceptable levels of infection and death within our health system. Almost every year, we hear of a new breakthrough in the war against the superbugs. It remains to be seen if ionic liquids will become the weapon of choice.

Source:  The Irish Times and BBC News Channel (NI).