Nothing Else Matters

While sitting with my Mum today at the nursing home, I spotted one of my favourites books on a nearby bookshelf.  It was a LARGE PRINT version of  “The Two of Us: My Life with John Thaw” written by Sheila Hancock. As my Mum was sound asleep in her wheelchair, I had time to flick through the book and was reminded of what a wonderful read it is. Inside the front cover, I came across a beautiful piece of writing which Sheila had borrowed as she felt that the sentiments expressed in it applied equally to her late husband. I have taken the liberty of reproducing it here as I was so taken with the words.

When Clare Venables was dying from cancer, her friend Peter Thompson wrote her this letter. ..

“My much-loved friend,

It matters to have trodden the earth proudly, not arrogantly, but on feet that aren’t afraid to stand their ground, and move quickly when the need arises. It matters that your eyes have been on the object always, aware of it’s drift but not caught up in it. It matters that we were young together, and that you never lost the instincts and intuitions of a pioneer. It matters that you have been brave when retreat would have been easier. It matters that, in many places and at many times, you have made a difference. Your laugh has mattered. Your love has mattered. Above all, it matters that you have been loved.

Nothing else matters.”

What a beautiful tribute! Now I can’t wait to enjoy my own copy of Sheila’s book all over again.

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?

Not given the chance

We are living in a world gone backwards. If there’s one thing about the Irish government that is guaranteed to make me angry and frustrated, it’s their callous disregard for the plight of cystic fibrosis (CF) patients in this country. Ireland has the highest incidence of CF in the world and to it’s shame, it can also claim to have the highest mortality rate and the lowest life expectancy for CF sufferers. Last week, a whole generation of CF patients was given a death sentence with the announcement that the funding for a dedicated cystic fibrosis unit, has been pulled. At the moment, CF patients must endure  appalling hospital conditions with a high risk of cross-infection, in order to get the treatment they need to stay alive. This government is reponsible for many failures within the health service but the scandal of CF care in this country, is beyond belief.

Here’s what Eithne Donnellan, Health Correspondent of the Irish Times, had to say on the subject..

HSE postpones promised new cystic fibrosis patients’ facility

A PROMISE by the Health Service Executive that a brand new building with state of the art accommodation for cystic fibrosis (CF) patients would be provided at Dublin’s St Vincent’s hospital by 2010 is not now going to be honoured, it has emerged.

The HSE has confirmed that funding for constructing the building which would have about 30 single rooms for CF patients will not be available “until 2011 at the earliest”.

Godfrey Fletcher, the chief executive of the Cystic Fibrosis Association of Ireland, said the news was a major slap in the face for patients who have long campaigned for better facilities.

CF patients are prone to picking up infections and as a result should be accommodated in single ensuite rooms. After an outcry over the lack of isolation facilities for CF patients at St Vincent’s, which is the national adult referral centre for the condition, in early 2008 the HSE came up with an interim solution. It said 14 single rooms would be provided while a new block at St Vincent’s with a total of 120 beds – about 30 of which would be for CF patients – was being built. It said it would be ready by 2010.

However, HSE replies to written questions from members of the Oireachtas Health Committee, distributed this week, show that not only has the new block been delayed, but only eight of the 14 single rooms as part of the interim solution have been delivered on.

“The HSE had intended in early 2008 that another area of the hospital could also be reconfigured to provide an additional six single rooms on an interim basis. It has not yet been possible to realise this proposal due to other pressures at the hospital which required the use of the intended area as a decant facility to enable other essential capital works,” the HSE said in its written reply. “Design work and preparation of tender documents continues in respect of the proposed new ward block . . . the HSE’s capital plan shows that capital for construction, however, would not be available until 2011 at the earliest,” it added.

Mr Fletcher said the eight single rooms provided last August were very welcome and already patients using them were recuperating much faster. But the news that there would not be money even to start the new block until 2011 had come as a great shock to his organisation, he said.

“We were under the impression that it was to be a quick-build contract to be completed by 2010.” The fact that it was not was very serious, particularly when all the promised interim beds had not even been provided, he said. He predicted his members would be “rioting on the streets” if the promised single rooms were not forthcoming.

The lack of isolation facilities at the hospital for CF patients was condemned in a 2005 report by UK consultant Dr Ronnie Pollock. It said the lack of segregation and isolation for CF patients was dangerous and there was a risk patients who picked up infections would sue. It noted that Ireland has the highest incidence of CF of all European countries and there were “also strong indications that outcomes in Ireland are worse”.

Source:  Irish Times online.

Orla Tinsley, a CF patient and campaigner, wrote in response to the latest government announcement…

Trading people’s lives for economic survival is sick and heartless

Source: Irish Times online

Our Government has failed miserably in it’s duty of care to these young citizens. Sadly, many of them will not live long enough to benefit from the dedicated unit when it is finally commissioned. When you consider the millions which have been spent on consultants’ reports which are left sitting on shelves in the HSE, it makes this scandal all the harder to swallow. Cystic fibrosis patients are fighters. They have to fight to breathe and to keep their food down and now they are fighting for a chance to live.  They don’t deserve to have that chance taken away.  It’s an absolute disgrace.

Last Friday, Joe Duffy, presenter of ‘Liveline’, dedicated his whole radio show to talking about the problems faced by CF patients.  You can listen back to the show on the link below. Be prepared to be moved.

Liveline – RTE Radio

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).

Health Access

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.

Don’t Be Alarmed

A middle-aged woman seemed sheepish as she visited her gynaecologist.

“Come now,” coaxed the doctor, “you’ve been seeing me for years! You can tell me anything.”

“But, this one is kind of strange,” she replied.

“You let me be the judge of that,” the doctor said.

“Well,” she explained, “yesterday morning I went to the bathroom and heard a plink-plink in the toilet. When I looked down, the water was full of coins.”

“I see,” said the doctor.

“That afternoon I went again and there were more coins in the bowl,” continued the woman.

“Uh-huh.”

You’ve got to tell me what’s wrong with me!” she pleaded, “I’m scared out of my wits!”

The gynaecologist put a comforting hand on her shoulder. “There, there, don’t be alarmed,” he said, “you’re simply going through the change.” 

Groan! The cartoon is better 😀

Meaningless Figures

Just when I think I’ve heard it all, they go and do it again. The HSE has today published performance ratings for 29 of it’s acute public hospitals. All 29 hospitals were given either a green, amber or red rating overall. What a load of balls! These ratings do not reflect clinical care nor do they equate to the misery and suffering experienced by patients countrywide. Instead of focussing resources where they are most needed, at the coalface of our health service, the HSE has instead compiled another meaningless set of figures examining service performance. Is the HSE ever going to prioritise patient care?

There are few who would disagree that the health system in Ireland is in need of radical change. The debate is in where the major problems lie and how they can be remedied. Today I listened to a riveting radio discussion between Fionnuala Duffy, Assistant National Director of Planning and Development for the HSE and Prof. Michael O’Keeffe, a well-respected hospital consultant, who works in both the public and the private sector

Prof. O’ Keeffe made mincemeat of the HSE’s policy of equating our hospitals in terms of efficiency and effectiveness. As he pointed out to the HSE representative, “I work in the system, you don’t”.  And therein lies the core of the problem of the mismanagement of our hospital system.

The HSE’s response?  “There is scope for improvement in efficiency. There are challenges”.

Have a listen to the discussion for yourself. It was hard to know whether to laugh or cry.

(Fast forward 25 mins)

Today with Pat Kenny

No Sense of Outrage

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.

Source:  Irish Times online.

D’Unbelievable

Yes, we’ve done it!

Ireland has won the Grand Slam, the Triple Crown and the Six Nations Championship.

After this, anything is possible. I see trees of green…

Mutiny in the Ranks

The Irish Nurses Organisation (INO) is escalating it’s campaign against the proposed spending cuts in the health service. It has launched a new website Stop Health Cutbacks to monitor the level of cutbacks proposed by the Health Service Executive (HSE). Hospital staff and members of the public are invited to post comments online on what their experience of cutbacks has been and to air their views on how the services could be improved. All material will be validated before publishing and patient confidentiality will be protected at all times. Liam Doran, General Secretary (INO), has stressed that the overriding aim of this initiative is to demonstrate in detail where the system is failing patients.

The non-consultant hospitals doctors (NCHD) are also up in arms with the latest decision by the HSE, to cut their overtime and allowances.

Six junior doctors have begun a High Court challenge, along with the Irish Medical Organisation (IMO), against the HSE. The IMO and the doctors claim that the HSE’s proposals are a breach of contract. They further claim that the proposed changes are impractical and will damage the functioning of the various departments in the hospitals where they work.

Next month’s emergency budget will radically affect healthcare in this country and it will be patients who bare the brunt of the further cutbacks. It is essential that everyone plays their part to ensure the highest possible standards of patient care in the difficult times ahead. Make your views known before it is too late.