Be Angry

When I first saw the list of speakers lined-up to participate in the Health Debate, I couldn’t believe my luck. This was a prime opportunity to hear our Minister for Health endeavour to defend her tactics to privatise healthcare in this country at the cost of the public health service. As it turned out, she left in a bit of a hurry but I did, at least succeed in getting to have my say.

I arrived early in the front square of Trinity College Dublin (TCD) just as the State car drew up at the entrance to the Exam Hall. Mary Harney stepped out of the car wearing what can only be described as, velour pyjamas and with her entourage in tow, she proceeded up the length of the exam hall with me in hot pursuit. Her pyjamas proved to be an excellent decoy as nobody took a blind bit of notice of her and she was quickly escorted to a side room to await the arrival of the real stars of the night. The debate was ably chaired by Conor Gannon of TCD VdeP Society, who did a fine job introducing each of the speakers and keeping order throughout the debate. The motion put forward was: “This House believes that the Irish Health System Fails the Disadvantaged”. I’m delighted to be able to report the motion received unanimous support from the audience and Mary Harney and her band of loyal followers suffered a resounding defeat. Unfortunately, she didn’t stick around for long enough to hear the disquiet that flowed from those on the panel in support of the motion, and from the audience. She made a hasty retreat shortly after delivering her own contribution to the debate. We were told that she had been “called away by Cabinet business”. Yeah, right!

The debate was opened by Prof. Orla Hardiman who gave an impassioned speech about the faults within the health service. She urged the audience to “be angry, be very angry”. She is firmly in favour of an equitable healthcare system for all and her address received rapturous support. Mary Harney then got to her feet and declared that it is her intention to provide a health service based on medical need (as opposed to ability to pay) and insisted that huge progress has been made. We got reams of statistics about how the health service is helping us to live longer but in reality, it was a lacklustre performance. She was constantly interrupted by a heckler in the audience who persisted in shouting her down despite repeated requests to desist. While this heckler was clearly out of order, his intervention proved to be the only challenge to Mary Harney last night as she departed before any one else got the opportunity. Fergus O’Ferrall, speaking in favour of the motion, informed us that 90% of the €16 billion spent annually on the health service comes directly from our taxes. The other 10% of funding comes from the private health insurance market. He accused the HSE of mismanagement through under-provision and rationing of services. The next speaker, Dr. Sean Barrett who opposed the motion, almost won approval when he declared that this health service not only fails the disadvantaged, “it fails everyone”. However, he then proceeded to place the blame on productivity being too low, the fact that private medicine is practised in public hospitals, the high ratio of staff to number of beds, and a greedy medical profession. He made no mention of the Dept of Health or the HSE. Mary Harney scuttled out of the room at this point while she still had someone on side. Throughout the evening, those in support of the motion gave credit to the late Susie Long for using her own plight to highlight the failures within the service. The opposition put forward two further speakers, an ex-TCD student and member of the young Progressive Democrat party (Mary Harney is a PD ) and also a manager from the HSE who were both, it has to be said, less than convincing. We also heard from two further speakers in support of the motion. Audrey Deane, representing the St.Vincent de Paul Society, told the room that HSE managers are turning to the SVdeP to access help for those failed by the system. How bizarre is that? The final speaker in support of the motion was Prof John Crown who denounced the waiting lists caused by underfunding in the health service. He joked that if we had such a thing as an abortion clinic in this country, he was sure the waiting list would be 10 months. “That’s if you go privately, going publicly would take longer!” EU figures for waiting times, show Ireland coming 2nd last on the list. He accused the HSE of employing too many spin doctors, referring to the place as ‘Burassic Park’. John Crown wants to see the Bismarck model of healthcare implemented (a one tier, not-for-profit health service) or else he warned “we’re heading for a ‘Paris Hilton’ style of health care”.

The debate was then opened to the floor and speaker after speaker outlined their experience of the deficiencies within the service. I waited until the end of the night before taking to the floor and then, I let rip. I surprised myself by the depth of passion which flowed as I spoke about the chaos in the public health service, the squalor of the conditions endured by sick people and the scourge of MRSA in our hospitals. I outlined the madness of the recent HSE cutbacks, the continuing problems in A&E despite claims to the contrary and warned of the consequences to follow if Mary Harney’s continues to privatise healthcare in this country. I also spoke out in defence of those who have private health insurance. We tend to be blamed for contributing to the a 2-tier health system when in fact we feel forced to seek insurance as we know we cannot rely on the health service in times of need. I concluded by commending the hard work of those healthcare workers who strive to provide excellent care in difficult conditions and reminded the audience that we need to protect the good aspects of our health service from further government interference.

Following the resignation of our Taoiseach, Bertie Ahern, last week Mary Harney announced that she had no intention of running away from her post as Minister for Health. In response, I’d like to say to Mary “be afraid, be very afraid. Time and patience is fast running out.

UPDATE: I forgot to thank Grannymar for her support in helping me to highlight this debate. The chairman of the debate was delighted to have a full house for this annual event and was impressed to hear that the blogging community had given support.

19 Responses to Be Angry

  1. Steph says:

    Thanks! GM

    Blogging is what’s helped me to find my voice. I could never have done what I did last night without all the support and encouragement received through this blog. And anyway, I was only following the good example set by you with your wonderful speech at the IBA night πŸ˜€

    While my knees were knocking, my voice thankfully remained strong and the words simply flowed. It felt real good πŸ˜€

  2. Grannymar says:

    Well done Steph for standing up and being counted. There is nobody better placed than you to speak for those without a voice. Day and daily you deal with the shortcomings of the HSE.

    No need to thank me, I was only following your lead and spreading the word you gave us.

  3. Steph says:

    Ian, thanks!

    I would have been very disappointed if she’d sent a press release as then I’d have missed that apparition in pyjamas πŸ˜€

    The public health service will be in tatters if we have to wait until the next election (2011) to get rid of Harney. The general consensus of opinion doing the rounds is that Brian Cowen will dump her when he does his cabinet re-shuffle in May. This way he can be seen to copper fasten his place in history with radical reform of the health service. Then again as you say, she makes a good shield to take the flak and I can’t imagine too many people queueing up to take her place!

  4. Ian says:

    Steph,

    I’m not surprised that Ms Harney was shepherded – I would have half expected she would have issued her speech as a press release, as though it represented the spirit of the meeting.

    I think Brian Cowen will continue Bertie’s policy of keeping her in place and to take all the opprobrium and then dump her at the opportune moment. Her seat is very vulnerable anyway, so she would probably not last beyond a general election.

  5. Grannymar says:

    Steph the knees were not knocking, they were clapping you! πŸ˜€

    When you believe in and know your subject it is easier to speak in public. Do you fancy a career in Politics πŸ˜‰

  6. Baino says:

    Wow Steph, takes courage and conviction to do that and you seem to have both. Shame she didn’t stay for ‘question time’ I’d have thought she could at least have fielded some criticism.

  7. Steph says:

    GM πŸ˜† No politics for me – I’ve no velour pyjamas πŸ˜‰

    Baino – I didn’t mean it to sound like I was looking for a pat on the back though as you can probably tell, I’m feeling quite proud of myself for having spoken out on a subject I passionately care about. Thanks anyhow! πŸ˜€

    As regards Harney, like Ian, I’m not in the least bit surprised.

  8. Ian says:

    2011, Steph?

    It’s only a year since the last election, they could continue until 2012. However, I think if Cowen saw a surge of support and polls showing FF in the mid 40s, he would go for a snap election in the name of seeking a new mandate.

  9. laura says:

    well done Steph. John Crown knows what he is talking about

  10. Knipex says:

    Errrr I would probably be in the huge minority here but I have to back a lot of what Dr. Sean Barrett said.

    Public perception seems to be that the entire problem rests on the shoulders of the HSE and Department of Health while the nursing and medical staff are heroes who answer to a calling. Managers and administrators and frowned upon and medical and nursing staff can do no wrong.

    Unfortunately that is just not true and there are a few things that the Irish public have not been told.

    Irish Nurses are not under paid by international standards indeed they are among the highest paid in the world and much better paid than their UK counter parts. This is based on OECD figures not HSE figures or department of health figures. Pay scales are published on the INO website but do not include the last increase that was received under social partnership.

    To listen to the press you would believe that in Ireland we have a vast shortage of nurses with less nurses per patient that anywhere else in the developed world. In fact we have over twice the number of nurses per bed than is the case in the NHS and and when compared to France and Germany we still have vastly more nurses per patient. Again these are OECD figures and they look at Whole Time Equivalent nurses so they take into account part time nurses, job sharing etc.

    I am not saying that there is not a shortage of nurses in certain areas and in certain hospitals (that would be just crazy) but over all in Irish hospitals we have very high levels of nursing staff. The problem is how these are deployed and while it would be very easy to blame the HSE for this the nursing unions have ensured that the terms and conditions of Irish Nurses are the best in the world and makes it very difficult if not impossible to redeploy nurses from one area to another.

    The inefficiencies in all levels of the HSE from management to porters and cleaners is amazing and due to the public service unions getting these people contracts that makes it impossible to fire people for incompetence, adjust working hours, change working practices etc there needs to be a massive change in culture in ALL levels in the HSE.

    Medical staff that refuse to work shift, consultants who call 215K mickey mouse money, all there are symptoms of an underlying problem where the patient is now secondary to looking after yourself.

    There are some wonderful hardworking nurses and doctors working int eh Irish health service and like wise there are some that are lazy and incompetent. It is the same for administrators, some are hard working people who go out fo their way to try and improve things while at all times being frustrated by unions and even their own colleagues while others are incompetent paper pushers. The current system means that they both get rewarded the same with pay linked to length of service rather than ability or work ethic things will never change. We need fundamental reform of the health sector at all levels.

  11. Steph says:

    Laura – Cheers and thanks! John Crown is good at using humour to get a point across. I watched his body language while Harney was talking and it was hilarious! As could be predicted, she didn’t stick around to hear him talk (intentional snub) and he got his own back by referring to the ‘fatwa’ placed on him by the Dept of Health when he first returned to Ireland from New York in 1999/2000. Incidentally, he commented that he was only the 4th consultant oncologist to be employed in the country at the time. I wonder how many are in place these days?

    Knipex – I’m delighted you’ve raised these points because…

    1. I agree totally with you. The problems within the health service are much more complicated than we are led to believe. Mary Harney has focussed most of her energy on tacking the issues above, causing a lot of alienation in the process while the problems within the HSE continue to escalate out of her control. The IHCA, IMO and INO met their match when they met Harney and the stand-off continues!

    2. I felt that Dr. Sean Barrett made a valuable contribution to the debate and made much more of an impact than Harney, in opposing the motion.

    Sean Barrett quoted that there are 1.2 beds per doctor in the Irish healthcare system, and 1/2 a bed per nurse i.e too high a ratio of staff to beds. He also criticised the restrictions placed on the numbers in medical training in Ireland and commented that the 35 hour week being sought, will further add to the problems. He was the only member of the opposition panel to bring some balance to the debate.

    3. I wondered if anyone would pick up on his points, so fair dues to you, Knipex for spotting them and adding fuel to the debate! πŸ˜€

  12. Bendy Girl says:

    Steph it sounds like you made a very important contribution to an excellent debate, good for you! As for the velour pj’s, what a bizarre choice of outfit!! BG

  13. Steph says:

    Thanks! BG

    While the PJ’s provided good cover for her, velour doesn’t hang well on some πŸ˜‰

  14. Ellie says:

    Unfortunately what we have in Ireland is underutilised nurses. They do not do the tasks they have trained so hard to do. They study Physiology, Anatomy, Biochemistry, etc, in college and when they are qualified, are not ALLOWED to do an ECG! Or put in an IV line. Or take bloods. They are not in a lot of places allowed to give first dose IV meds-how fecking stupid and redundant is that. They are kept down, making beds, emptying bedpans, and wiping bums, when health care auxiliaries and care assistants should be performing these tasks, leaving nurses to to the jobs they train for. It is no coincidence that the most satisfied nurses are often working in A&E, ICU etc, as there they are allowed to use their knowledge and apply it to their work, rather than work as overqualified maidservants.
    I work in NZ at the moment, and you don’t catch nurses sitting there feeding patients while having a million things to do. There are HCAs dedicated to the room that oversee feeding, report to the nurses food and fluid intake, and the nurses work out fluid balance, nutritional requirements etc, and refer to a dietitian or contact a medic if appropriate. Nurses at home cannot even refer to physio or social work etc, a doctor has to sign off and fill out the form. Yet the nurse knows as well as the doctor, often better, whether referral to an allied health professional is warranted. So why are they not allowed to refer to them?
    We have placed nurses in a position in Ireland where they are undervalued and overprotected simultaneously. Their knowledge and expertise is not valued enough to allow them to administer certain IV infusions, to perform ECGs, to site IV lines, to take bloods, all practical skills that they would be performing if they were in the US, or UK, or Oz or NZ. This has a knock on effect, they have to call a doctor to do these things, who has to leave A&E, or OPD or the ward round etc etc, and hence slows everything down further, leaving everyone chasing their tails.
    We should be valuing our nurses valuable skills by using them, and hiring more care assistants for the tasks such as feeding, changing, washing and bedmaking etc. This would speed up the whole health service, and increase job satisfaction for the nurses. But the HSE no doubt does not want to spend money on lots of HCAs and care assistants.

  15. Steph says:

    Well-said! Ellie

    I agree wholeheartedly with you. As a patient, I’ve met some fantastic nurses who are highly professional and know full-well the needs of their patients but are frustrated by the limitations of their job. I’ve watched these nurses gain the confidence of their patients only to have to hand them over to an often less-than-competent junior doctor to perform some menial task which the nurse could have done IF THEY WERE ALLOWED. I think there is a problem in Ireland with the perception of nursing. Nursing has changed radically in recent years but the system has failed to adapt in conjunction with this. The general public can’t be expected to know the difference between a nurse and a HC assistant and this adds to the confusion of how nurses are perceived. The nursing profession would benefit greatly from a PR campaign to spell out their role and improve their image. I would also add that many of our most highly skilled nurses are leaving the public hospital system to work in private hospitals where they are allowed to utilise their knowledge and skills. Many thousands of nurses (and junior docs) are leaving the country once they’ve completed their basic training as they feel so frustrated by the limitations imposed on them by our dysfunctional system of healthcare.

  16. Ellie says:

    As a junior doc who once was “less than competent” I might add that the only way to become competent is by doing, and unfortunately at the start, you’re not going to be that good at any of these things unless you gain the practical experience. This unfortunately requires honing your IV skills on “patient patients” who are usually much nicer about it all than I think I’d be if I was sick and some day 1 intern asked me “Can I practice sticking needles in you?”
    Problem is, at the moment, we are the only ones competent in these practical but simple tasks as we are the only ones doing them, for the most part. It’s true, “if you don’t use it, you lose it”. Yet we were not the only ones trained to do this stuff. It must be so so frustrating for them.
    When I first started over here I was working at a more junior level than I am qualified for as that was where the shortage was. I called up the Radiologist out of hours to ask for a CTPA for a patient that was highly suspicious for pulmonary embolism. I finished outlining my case, and at the end, in a highly dissatisfied voice, he said “Have you discussed this with your registrar?”
    I said “yes”, as my reg knew me and told me on acute nights to just do whatever I think needs doing and let her know afterwards.
    Then he says “And has she seen this patient?”.
    GRRRR!
    “no”, I admitted, “she hasn’t”. Then I outlined my case a bit more definitively, and he did agree to do it. But I felt so annoyed-I KNEW she needed the scan, I had made as good a case for it as anyone could, and simply because the protocol is there to have the reg order these things and no-one else, I was about to not be able to do what I needed to. If this is how the nurses feel everytime they have to bleep some NCHD to come and do an ECG or site a cannula they know needs doing and could do themselves, then I sympathise whoelheartedly. It is a crap feeling. Thankfully I’m now in a position where I can order what needs to be ordered without all this, but I think it is not so easy for the nurses as that. Something should be done from higher up to recognise their skills and implement them into their job while redistributing the cleaning and bedmaking to HCAs. We are short of ward nurses, we should be utilising the ones we have appropriately. Maybe then so many of them won’t leave.

  17. Ellie says:

    By the way Knipex, shiftwork is a great idea-but not the way the HSE wants us to do it, treating weekends as part of your normal week, doing 12-15 days back to back.
    Here in NZ weekends are still not the norm, though we are on shiftwork of sorts. Every 6th weekend at the moment, I do 8:00-23:00 Sat and Sun, and then a normal week the week after. It’s still a bit much to be honest, we’re wrecked tired after it as it ‘s 12 days straight with two fairly long acute days at the weekend. But it’s a lot better than what we were doing back home. There is an agreement between managment and the union here though that at LEAST every second weekend is free for us, and that is in the worst case. It works really well, as the people who were on Friday long day come in on Saturday and see the last night’s admissions, while the weekend people continue with acute admissions. The HSE from what I had heard had proposed all kind of antisocial rubbish, working Wed-Wed and other anencephalic nonsense.
    “So you’re a health professional eh? Well, you shouldn’t have had that pesky family and made those friends and gotten that hobby. You should be more dedicated to your job than that. Thinking you were gonna have a life…how silly”.
    Why, oh why don’t they look to other systems that work instead of people who have never even worked a day in a hospital dictating how said hospital works????
    Australia’s health policies are made by DOCTORS. Their hospitals are run by clinical directors who are DOCTORS. And they have the best patient outcomes and the best working conditions for staff in the whole world. Are the Irish too proud to admit their’s is failing and try to emulate more organised examples? What is wrong at home at all!!

  18. Ellie says:

    sorry, that should read “theirs” not “their’s”. My grammar!

  19. Steph says:

    Thanks again, Ellie

    I hear your anger πŸ˜‰

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