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?

group insurance

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.

9 Responses to Held To Ransom

  1. Baino says:

    Hmm interesting postulation but I don’t know whether that happens here or not. It doesn’t makesense that a consultant would have a vested interest in keeping a private patient in hospital unless they were on the hospital payroll. Here they seem to send people home to early.

  2. Steph says:

    Baino – The fact is that some (a minority of) consultants get to play God on the wards and nobody opposes them. I found it hard to believe what I witnessed in terms of delayed discharges. This would never happen in the private sector as the health insurance companies allocate cover for a fixed number of days only, after which a patient costs the hospital money. This ensures efficient treatment and rapid throughput of patients. In the public sector, many patients occupy beds for weeks on end for the reasons I suspect above.

  3. Lily says:

    I know there is alot wrong with the US health system for US citizens, but I was amazed at the sheer efficiency of the hospital process, when Tommy had surgery there. Into hospital at 6am on the morning of surgery, (eleven hours of surgery, completed by two separate teams, one for each leg, meaning only six hours under anaesthetic), discharged four days later.

    And it was a wonderful caring experience.

  4. annb says:

    You may have hit the nail on the head here but what about the Hippocratic oath? Are these consultants not harming those left languishing in A&E?

    I have to say my experience in children’s hospitals has been very different – I see consultants in there at all hours day and night, they work very much as team players.

    I hope posts like this on the state of service mean that you are feeling better!

  5. Steph says:

    Lily – I know Tommy had youth on his side but that sounds like amazingly efficient healthcare. It’s always nice to hear of good experiences.

    If Tommy’s operation had actually been available in Ireland, I hate to think how many weeks it would have taken in hospital, to achieve the same outcome.

    I’ve said all along that I couldn’t fault my care in the public hospital. However, the conditions were far from ideal and a minority of the consultants were in no hurry to discharge their patients.

  6. Steph says:

    Ann – You slipped in there while I was busy elsewhere. Have a look at my last comment on Catch-22.

    As regards, the behaviour of some of the consultants… it was a struggle to desist from asking them how they could justify their decisions when we all know about the chaos in A&E. These same consultants were the ones who only put in an appearance on the ward about once a week! Their manner made me so mad, I had to write that post. It’s makes a change from me looking for sympathy anyhow.

  7. annb says:

    You of all people could hardly be accused of looking for sympathy!

    I think there needs to be a complete power shift in attitude along the whole chain of command within the health service. There are a lot of people in there who have no interest in the health of patients or quality of service. Those who do care, get burned out trying to overcompensate. It is deeply frustrating. God bless your sense of humour – without it you would be in deep water!

  8. knipex says:

    Steph

    Funnily enough I was thinking something similar last week with a family member but and after talking to the consultant and the NCHD’s I came up with a different conclusion.

    A number of Irish consultants will oppose any change because of the very fact that it is change.

    There has been a significant change medical opinion over the last few years with the belief now being that if someone can go home and assuming they can get the required level of care at home then they are better off at home.

    Historically things were different and patients were kept in hospital for far longer periods of stay.

    Some consultants have simply not changed to match the current thinking.

    A few years back the HSE tried to change this by issuing a policy of discharging patients as soon as they were fit. Then even reviewed certain surgical procedures and issued guidelines as to expected length of stay (a surgery performed using modern minimal invasive procedures required vastly shorter recovery times that older techniques etc). Other consultants are refusing to change simply to snub their noses at the HSE due to what they would consider the HSE sticking their nose in.

    Most consultants fortunately will send patients home as soon as they are fit enough but similarly there are a minority who tend to try and push patients into going home too early.

    While it would be great of rules could be put in place all patients are different so we depend on doctors to make the decision based on the individual patient and their situation.

    But you are correct a minority of consultants are holding the entire health-care system to ransom.

  9. Steph says:

    Knipex – Great to hear from you again. You make an excellent point, as always.

    I would agree that some consultants are resisting change imposed by the HSE. However, the cases I saw of delayed discharge, did not fit this description. I got the distinct impression that the consultants in question were delaying discharge to save on time/paperwork and the patients involved , weren’t arguing.

    Patients are guided by their doctor’s advice so you it’s up to the docs to judge when the time is right. You might say “well, who am I to judge about delayed discharge”? I can assure you that the cases I witnessed, did NOT need to be in hospital. Remember also that unless recovering/undergoing treatment, hospitals are not healthy places to be!

    I also agree that some consultants are sending their patients home too early due to the pressure of HSE guidelines, to the cost of the patient in terms of recovery time.

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