Catch It. Bin It. Kill It.

August 24, 2009

A new health warning has been issued in Ireland. Public information leaflets and posters have been distributed to ports and airports. You have an important role to play in stopping the agenda of privatisation and for-profit medicine. Stop the spread of this pandemic disease now.

Radical health reform, in terms of creating a universal system of healthcare which offers equality and accessibility, is one of the greatest challenges facing Ireland today. Play your part.

Stop the spread of privatisation.

Podcast credit to PoliticalThicko and You Tube.


Health Access

March 26, 2009

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?

diet-shakeThe 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.


Missing In Action

January 15, 2009

minister-for-health

Have you noticed that our Minister for Health, Mary Harney has been ominously quiet of late? What’s going on at the Department of Health? Leadership has been notably absent despite the spiralling chaos in our health service.

This is what Senator Fitzgerald, Fine Gael Senate Leader and Spokesperson on Health, has to say about Harney’s silence…

Silence from Health Minister as co-location big idea looks increasingly shaky

“In 2005 Minister Mary Harney announced her co-location big idea claiming it would deliver 1,000 extra beds ‘in the fastest and most cost-effective way in the next five years.’ Almost four years later, not a single brick has been laid and not a single bed opened.”

“Recent media reports revealed that six Beacon head office staff have been let go and senior management have agreed to pay reviews. Considering this group has won three of the tenders for co-located hospitals, it’s financial condition is pivotal to the project. Together with the lack of bank credit for developers, the whole project has to look increasingly shaky. The HSE’s own service plan for 2009 notes that projects will only be progressed to completion phase ‘subject to satisfactory banking arrangements’. The current crisis in banking does not bode well for the co-location project yet the Minister has had nothing to say on the subject.”

“Whilst co-location remains uncertain the reality for patients is that 500 existing public beds are currently closed and the Minister has rubberstamped a HSE plan to remove 600 more. The Minister is actively reducing capacity, not increasing it and the HSE are seeking a further €900 million in cutbacks for 2009. The result is her big idea is terrible news for patients meaning less isolation facilities to stop the spread of MRSA, more overcrowding in A&E, more cancelled operations and longer waiting lists.”

“The crisis in the health service continues unabated in the first two weeks of 2009 but the Minister for Health is missing in action. Many of the ongoing problems began long before the present financial crisis but while responsibility rests with this Government, leadership is absent. In December, the Minister signed off on the closure of 600 more acute beds and the slashing of €900 million from the health budget before riding off into the sunset. Instead she should be telling us how she intends to deliver long-promised reform, beginning with tackling waste and inefficiency in the back room rather than constantly hitting the front line and hurting patients.”

Well-said! Senator Fitzgerald. My thoughts exactly.

Source: Fine Gael website – Latest News 12/13 Jan ’09

UPDATE: Sara Burke, journalist and health policy analyst, may be able to solve the Mystery of the Missing Minister for us. She believes that there is currently a stand-off going on between the HSE and the Minister. You can read Sara’s excellent analysis here.

Source:  Irish Times online 29/12/08.


Why, Oh Why?

July 2, 2008

I accompanied my elderly mother to a high-tech private hospital yesterday for a check-up with a specialist. While she received nothing but the best of care, I couldn’t help but feel very uncomfortable with the whole experience. The gap between the public service and the private sector seems to be ever widening and I really fear for the future of our health service if privatisation continues to be seen as the way forward.

My mother is a long-term resident in the dementia unit of a large public nursing home. She is severely physically disabled and suffers from an unusual form of dementia. When she was admitted to the nursing home some years ago, I was told that she would no longer require health insurance as all care is fully covered by the public health system. Knowing what I do about the state of our health service, I ignored this advice and opted to maintain my mother’s basic insurance cover. Every citizen in this state is entitled to a bed in a public hospital but the reality is, only the very sickest patients and accident victims succeed in getting a bed when they need it. Otherwise, the waiting lists for specialist appointments, out-patient services and elective admissions, are atrocious. I wanted to keep her insurance as a safety valve in case we ever needed to access specialist intervention for her.

As things turned out, my mother developed a nasty auto-immune condition recently and required urgent specialist attention. The nearest appointment we could get for her at the local public hospital involved a four-month wait. A private appointment was available at the Beacon Hospital for the following day so naturally I gave the go-ahead to proceed with this appointment. Her insurance policy covers out-patient expenses incurred for investigations carried out in a private hospital but it offers little or no help with appointment charges. Frankly, I didn’t care how much it all cost as long as my mother got the urgent help she needed. As it transpired, she required day surgery and her insurance thankfully covered this expense so the charges for her appointments pale into insignificance by comparison. She will have to be carefully monitored until her condition settles.

The Beacon Hospital is quite literally a beacon of the private healthcare market. It’s quiet and efficient but it’s also ‘over the top’ in luxury and exudes wealth out of every corner. The leather armchairs were so huge in the waiting area where we checked-in yesterday that it was almost impossible to manoeuvre a wheelchair. The sight of my poor mother slumped in her wheelchair could not have been more incongruous with the exclusive surroundings we found ourselves in. Her world in the nursing home is very far removed from this plush hospital environment and I felt sick just thinking about how inequitable the whole health system has become. Why are we forced to access care in ‘over the top’ facilities like this when all that’s needed is a basic health service that works efficiently? Why does there have to be such a contrast between public and private care? I hasten to add that my mother was treated with the utmost respect at the Beacon and I’m very grateful for the treatment she’s received there. However, she’s also treated with the utmost respect at the nursing home but her surroundings there leave a lot to be desired. Why does it have to be so different? Why can’t we have a public health service that treats all citizens and especially it’s oldest ones, with the dignity they deserve?

The Beacon Medical Group has won the tenders to build three of the co-located hospitals that are due to be built on public hospital sites (Beaumont Hospital, Cork University Hospital and Limerick Regional Hospital). If what I saw at the Beacon Hospital yesterday is what our Minister for Health envisages as the way forward for our health service, then I despair. When are people going to wake-up to what’s happening to healthcare in this country, and shout STOP?


Your Wealth is your Health

June 1, 2008

Having recently reviewed my annual subscription for private health insurance, I considered reducing my level of cover in an effort to reduce the cost. However, having watched the second programme in the 3-part series Surgeons I’ve decided against making any changes. Our Minister for Health is determined to implement new changes in the Consultants’ contract of employment, to meet the needs of our health service. Has anyone ever heard her mention the needs of the patient? Her continuing plans to reform the health service by encouraging privatisation, makes private health insurance cover seem all the more important. And that’s exactly what the Department of Health wants!

The programme featured the work of two neurosurgeons, Donncha O’Brien and Ciarán Bolger in Beaumont Hospital. It was riveting stuff offering a unique insight into the lives of the doctors and patients featured whilst at the same time revealing the workings of a public hospital. Ciarán Bolger certainly doesn’t mince his words about the public health service. “The system is shite!” he says.

The HSE aims to employ 1,500 new consultants many of whom will be limited by the new consultant’s contract, to working in public practice only. There will also be strict monitoring of private practice. At the moment, public patients gain because they have access to the top specialists but this could soon become the preserve of private patients if the HSE continues to dictate to the consultants. Ciarán Bolger believes that a lot of the consultants will vote with their feet and go into the private sector so that we’ll end-up with an exacerbation of the 2-tier system. He believes that many of the existing highly trained consultants presently working in the public health service but who are also running a limited private practice, will opt to work fully in private practice. He says “WW3 would break out if nurses were told they couldn’t do agency work, or teachers couldn’t give grinds, or Gardaí couldn’t do bouncer work for night clubs”. He considers the new consultants’ contracts to mean that “you’re signing over a profession to be controlled by an organisation that can’t organise anything at the moment.” He says that it doesn’t matter how many consultants the HSE employ as it’s not going to make any difference if they don’t have places to work. “We need more beds, more resources, more surgeons, less administrators, and less people telling us how to do our job.” The proliferation in the development of private hospitals around the country at the same time as services in our public hospitals are being cutback, is no coincidence. Private health insurance is rapidly becoming a must.

The title of this post is a hard pill to swallow. It’s particularly offensive to those who cannot afford to ‘buy’ their healthcare. Our government wants to privatise healthcare in Ireland at the expense of the public health service. They want to scare as many people as possible into taking out private health insurance so that they can relinquish their duty of care. Healthcare in this country, is fast becoming a lottery. If you’re not in (insured), you can’t win!

This week’s ‘Surgeons’ programme, the final week in the series, looks at two revolutionary and radical surgeries being performed on children: cochlear implant surgery and limb-lengthening surgery. If the rest of the series is anything to go by, it promises to be excellent.

Thursday June 5th on RTE 1 @ 10.15pm


All I want is…

May 26, 2008

It’s reached that time of year again when big money has to be found to renew my health insurance policy. I freely admit that this has proved to be a good investment over the years as I have a complicated medical history which has resulted in higher than average expenses. I’m happy to pay out good money for health insurance but I would much prefer to contribute to a scheme that funds an efficiently-run single tier, not-for-profit health service rather than contribute to what is fast becoming an apartheid approach to healthcare in Ireland.

The Irish health service is set to be radically privatised over coming years. Tax incentives introduced by our government, are leading to the rapid development of private hospitals throughout the state. Some of these hospitals will be co-located on publicly owned land thus duplicating the need for highly trained staff in the one location. Privately insured patients will soon have every luxury imaginable available to them while public patients will continue to suffer in our poorly funded health service. Furthermore, the revised contract of employment for hospital consultants is set to complicate the system even more. Some of the consultants will be allowed to work with public patients only, others can opt to engage in limited private practice on the public hospital campus or in the co-located hospitals while a third type will work in the public system but will also treat patients outside the public hospital campus. It strikes me that this system of healthcare will benefit the consultants and the private insurance companies but does little to improve conditions for public patients. It’s no harm to bear in mind that every citizen in this state is entitled to a bed in a public hospital but with the chaos in existence, more than 50 percent of the population have opted to take-out private health insurance. With the escalation of private hospitals, it’s inevitable that a sharp increase in premiums will follow and more and more people will be forced to drop their private insurance. If the underfunded public sector cannot cope with it’s present burden, how on earth is it going to cope with a further influx from the private sector?

Patients shouldn’t have to negotiate a minefield of options when choosing health insurance. I don’t want to be forced to buy into a 2-tier health system where the type of care offered depends on the type of insurance held. When I become ill, all I want is to be guaranteed a bed in a clean, efficiently-run hospital which will provide good care when it’s needed. Public patients are presently being denied this basic right. I’m prepared to pay for this right but I believe that it should be available to everyone via a universal system of health insurance. What’s good enough for one, should be good enough for all. When I’m sick, I don’t want or need an á la carte menu. I want doctors who will treat me because I am ill, not because of the insurance I hold or because they can make a fast buck by offering me a bed in a high tech facility. The present plans for the reform of our health service are totally absurd. Is it really too much to ask for some common sense to be applied before it’s too late?


The Health Debate

February 22, 2008

Well, actually it was more of a discussion than a debate and even though I didn’t succeed in getting to have my say, I’m glad I tuned in to Your Call on Newstalk106 yesterday. As was predicted, both our Minister for Health and the CEO of the HSE, declined the invitation to take part in a live debate on the health service. Not one to be easily dissuaded, Brenda Power went right ahead and chaired a lively discussion with a panel of experts which included a well-known retired cardiac surgeon, a GP, a health economist and Newstalk’s own economics editor plus contributions from various phone-in callers. While the opinions of the panel differed at times, everyone was in agreement that morale within the health service is at an all-time low.

The following is a brief synopsis of the opinions expressed during the programme: “We do not have a health service – we have a dysfunctional, immoral state system. Services are not joined-up and are hampered by a dysfunctional transport system. The health service is a black hole with €15 billion spent on it last year and further massive cutbacks in health spending are inevitable. The GP’s have not been consulted on hospital development plans and funding has been pulled from GP training schemes and out-patient services. Management problems within hospitals are directly affecting vital services such as cleaning. The prevalence of MRSA and other superbugs, has caused a widespread fear amongst patients of going into hospital. Over 52% of the population take out health insurance because of the rationing in the system. The National Treatment Purchase Fund (NTPF) is ‘like a finger in the dyke’ and is not cost-effective. The NTPF pays more than private health insurance schemes to secure treatment for public patients in private hospitals and in the process, is denying access to patients who pay for top health plans. Emergency departments (A&E) are unfit for purpose. Bed capacity is a big issue and few are in agreement with the HSE’s opinion that more beds are not needed. Rehabilitation facilities are almost non-existent throughout the country. Psychiatry has been badly neglected as a service. The plans for co-located hospitals are a joke. It is immoral to have one standard of care for public patients and another (better one) for private patients. Focus should be put on the public service but there is no incentive in place at the moment. Numerous reports have been produced on the health service but they have not been acted upon. The hallmark of quality service is ‘morale’ and the present ethos within the health service is one of low trust, low morale and no sense of direction.”

So, while nothing particularly new or startling came out of this discussion, it did provide a good overview of the problems that exist. The bureaucrats within the Dept of Health and the HSE should hang their heads in shame at this long litany of dysfunction. Patients have suffered for too long without the basic healthcare they deserve. The general consensus of opinion from the panel was that trust has broken down and a change of mindset is needed if a way forward is to be found. Many feel that our Minister for Health should resign as the level of confrontation has become too great for co-operation. Progress will only become possible if the powers-that-be learn to engage with the people on the ground, and listen to their views. We can only hope this process started yesterday.


Public or Private?

February 15, 2008

Do you have private health insurance? I do, as does over 50% of the Irish population. I have no problem in admitting that it offers a welcome safety valve in an otherwise chaotic system of healthcare. I can think of lots of other useful things to do with the money I spend on health insurance but I choose to make healthcare my priority. It’s not a decision I take lightly. I firmly believe that the way forward for our health service is a system of universal health insurance, funding a single tier health delivery model which promotes equity of health care. However as our health service is in such complete disarray, I feel I’ve no other option other than to continue to invest in health insurance. I’ve certainly had reason to be thankful for it over the years though it has proved at times, to be a bit of a double edged sword.

In late 2004, I was told that I needed some complex surgery carried out to arrest a chronic frontal sinus infection. I was under the care of a consultant surgeon who operated a private practice as well as a public service contract. With my health insurance policy, I’m fully covered for surgery in a private hospital with accommodation in a single room. However, my choice of doctors and hospitals is limited as I have a complicated medical history. On this occasion I was informed that the surgery would have to be carried out in a large public hospital where the necessary back-up facilities would be available. I was duly given a date for surgery and booked for post-op recovery in a high dependency ward. Two days before the operation, the hospital phoned to ask me to report immediately for admission. I initially protested at the stupidity of taking up a bed for two days pre-op but was told that a bed could not otherwise be guaranteed. I had no option but to agree to this crazy plan. By the time I had my overnight bag packed, the hospital phoned again to say that the bed was no longer available due to an admission from casualty. This process was repeated several times over the following two days until eventually, my surgery was cancelled due to the failure to secure a bed. The surgeon was furious as an operating theatre and a surgical team had been booked solely for my lengthy operation and it all went to waste that day. Frustrated by the restrictions imposed, the surgeon suggested that a stop-gap procedure be carried out in a small private hospital. I was duly admitted the following week and underwent some relatively minor surgery. However, this action also backfired as the surgery was unsuccessful and within months I had to return to discuss the bigger operation. The surgeon again insisted that the surgery should be carried out in the large teaching hospital and in order to secure a bed, he put special arrangements in place to allow me to be transferred to the nearby private co-located hospital, to recuperate. This was only possible because I had health insurance. It should not have been necessary.

I duly checked into the co-located hospital early on the morning of my operation and within hours, was whisked away to the operating theatre in the main hospital where I remained for the rest of the day. When I next came to, I was back in the private hospital in a shared room with three other women. I now had a sophisticated stent in my skull to facilitate drainage and a surgical wound over my right eye. I received good post-operative care and was discharged home feeling extremely lucky that all had gone so smoothly. About two weeks later, my post-operative pain began to worsen and I developed severe swelling around both eyes. I was asked to report to the busy A&E department in the main hospital where I was assessed and admitted. My health insurance again secured a bed for me in the private hospital and I happily settled into a 5-bedded room, secure in the knowledge that I was lucky to have a bed at all. Three days later, it was discovered that my surgical wound was infected with MRSA and thus began a lonely journey which continues to this day. The following week while I was longingly gazing out of the window of my isolation room, I spotted a woman I recognised in the car park. I’d shared a room with her in the private hospital a month previously, immediately following my operation. I waved frantically to attract her attention and she came over to chat to me through the open window. That’s when I learnt that her problem had turned out to be an MRSA infection and that’s when the penny dropped!

The airwaves are constantly buzzing these days with sad stories about the failures within the public health service but private hospitals are not the answer to the problem. They are selective and only serve to perpetuate the upstairs downstairs model of healthcare in this country. They do no offer A&E services which means that all patients requiring emergency treatment must be processed through the chaotic system in the public hospitals, regardless of their insurance status. Those with complex medical/surgical conditions generally cannot be treated in private hospitals because the medical back-up there is too limited. And anyone who takes out health insurance in the belief that they’ll be entitled to a single room, is in for a big shock if they are hospitalised. There is a huge shortage of isolation facilities across the country and single rooms quite rightly, have been prioritised for infectious patients and those who are dying. Our public health service is expected to provide all these service yet it’s on it’s knees through years of neglect and inadequate funding from the Government. Unfortunately, our Minister for Health continues to believe that the way forward is to promote the present unsatisfactory public/private mixture of healthcare by encouraging the development of co-located private hospitals. You have to question the wisdom of backing a policy that further perpetuates inequity of healthcare. We have a booming economy in Ireland but our health service is failing the most vulnerable people in our society. This is not about public versus private healthcare, it’s about saving lives.


Money Talks

February 1, 2008

I listened with interest yesterday to an interview on Newstalk radio about in-patient services for acute psychiatric patients. This interest soon turned to outrage when I heard about the latest insult inflicted on psychiatric care in this country.

St. Ita’s Hospital in Portrane, Co Dublin was built in 1902 to cater for long-stay patients with intellectual disability. It is also the centre for acute psychiatric in-patient care in Dublin north. These facilities have been massively ignored by successive governments over the years and allowed to deteriorate to the point of neglect. It is no coincidence that the complex is on prime development land. Negotiations were started with the Dept of Health as long as 20 years ago, to agree a plan to move the acute psychiatric unit to a new purpose built facility in the grounds of Beaumont Hospital in Dublin. Dr. Richard Blennerhassett, clinical director at St. Ita’s has personally been fighting this battle to improve services since he took up his post in 1998. Agreement was finally reached, the plans were drawn-up and planning permission was obtained for this unit to proceed. It has recently emerged that the plot of land allocated for psychiatric services at Beaumont Hospital has been re-allocated to the building of a new co-located private hospital on the site. St. Ita’s now has to return to the drawing board to start the process all over again.

Frankly, I think this matter stinks. Yet again some of the most vulnerable members of our society are being disadvantaged in favour of private (for profit) health care. Our Minister for Health is insistent on driving forward a 2-tier health system in this country while the public health service continues to crumble. The concept of building co-located hospitals on the grounds of public ones is a recent one. The plans to move services out of St. Ita’s have been on the agenda at the Dept of Health for over 20 years. I’ll let you draw your own conclusions.


The Minister’s off her trolley

January 9, 2008

Today we hear that the number of patients waiting on trolleys for admission to hospital around the country has reached similar levels to last year when the Minister for Health announced a national crisis in A&E. And the HSE is still trotting out excuses.

Has anyone else noticed that there’s been an ominous silence from Mary Harney since Christmas. What ever happened to the consultant’s contract which she insisted would be signed and sealed by Christmas? Where are the 2,000 extra beds promised for the public hospitals to alleviate the problems in A&E. Have you heard anything recently about the plans to develop a system of co-located hospitals to move private patients out of public beds? The HSE wheeled out a spokesman this evening to defend the inaction of the organisation. He was full of excuses as to why the problems are ongoing – even the winter vomiting bug was blamed. “It’s been difficult to find agency nurses to work in A&E”. “Home-care packages are coming on stream to enable old people to manage better in their own homes”. “Step-down beds will be available in a ‘few weeks’ for patients categorised as ‘delayed discharges’. This will release beds for acute patients”. All measures to relieve the crisis are always in the future. What about now?

Well, frankly Mr. HSE I’m not one bit impressed as we’ve heard it all before. A whole 365 days has gone past, very little has changed and today 365 patients are lying on trolleys awaiting beds. The backlog in A&E is a symptom of the failure in the whole hospital system. More beds are urgently needed and the HSE has no immediate plan in place to alleviate the shortage. Working conditions in A&E are so horrendous due to the overcrowding that only the most dedicated, or the most desperate, will work there. Is it any wonder that agency nurses are difficult to find? Why are we still waiting for the funding for home-care packages to happen? The recent Department of Health cutbacks in spending have curtailed any efforts to get this system up and running. There are long-stay beds available in nursing homes around the country but the HSE hasn’t put out to tender to secure these as step-down beds for the ‘bed blockers’ in our acute hospitals. Thousands of bed days are being lost in acute hospitals because of the failure to free-up beds. Improved primary care such as GP services, would greatly relieve the burden on our hospitals but again this invaluable resource is being ignored by the HSE.

It’s becoming patently obviously that the Minister for Health has lost the plot. Even the dogs in the street know that the HSE is failing to steer the health service in the right direction. It’s like a ship without a rudder… if only it would sink.