Patients are a nuisance

Whatever savings and cutbacks are having to be made in these harsher economic times, curtailments in the treatment of sick children are not something that most of us are prepared to tolerate. As the HSE continues to push for efficiencies in the public system, many children in this country are being denied treatment and more and more problems are arising in terms of patient care.

Our hospital system is breaking down as the basics simply aren’t happening. The embargo on staff recruitment has resulted in operating lists (elective surgery) being cancelled without warning, out-patient appointments being cancelled and phones not being answered in many departments. Frontline staff are fed-up and disillusioned and many of the consultants are no longer advocating for their patients. The bottom line is… patients are suffering and it seems that even sick children, don’t count anymore.

If you think I’m exaggerating, have a listen to this interview with Professor Michael O’Keeffe, Consultant Ophthalmic Surgeon in Temple Street Hospital (a children’s hospital in Dublin). Thankfully, he’s not afraid to speak out.

Interview Credit:  ‘Today with Pat Kenny’ on RTE Radio 1.

Photo: Steph’s theatre gown, captured on mobile phone.

Chapter 27

This being the start of a new year, my surgeon had a new senior registrar in tow at his out-patient clinic yesterday. Having outlined my extensive medical and surgical history, the consultant summed up by saying that a book could be written about my case. Four different surgeons have operated on my head at this stage and at least four more have been consulted, in an effort to solve the problem of chronic infection. Just recently, I found an old file at home which contained a detailed record of all the surgery I’ve had over the years. I was amazed to find that on my head alone, I’ve undergone a staggering 26 operations under general anaesthetic. I knew it was a lot but I’d lost count years ago as I’ve been through many day procedures and other operations as well. Yesterday’s consultation concluded with the surgeon suggesting, not for the first time, that I should write a book about my experiences. Right now, a new chapter has already begun.

My last trip to the operating theatre 2 weeks ago, was for a ‘drill-out’ of a small area of recurring bone infection in my head. The exposed bone was treated with an antibiotic medication and I was discharged home the following day. Once I’d recovered from the effects of the anaesthetic, my head felt good and I was confident that the treatment had been successful. However, a week later my symptoms gradually returned and my hopes were shattered once more. An uncharacteristic despondency descended over me as we entered the New Year.

On examination in the outpatient clinic yesterday, the surgeon confirmed that the infection has recurred in the bone. I was concerned that he would opt to refer me back to the specialist unit in the UK but to my relief, he decided to proceed there and then with some further work on my head. While the treatment was unpleasant (without anaesthetic), it certainly wasn’t unbearable and I have been asked to return in 2 week’s time for another session. If this treatment fails, then I will definitely have to return to Nottingham for further assessment. The story continues.

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.

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

Home Again

My good friend Bendy Girl, who is also an EDS‘er, asked me to bring back some photos of my holiday. Thankfully, she didn’t specify that I had to take the pictures myself. I didn’t. All credit is due to my husband, Jaimie, who has me spoilt with his beautiful, professional photographs. We have just spent three fantastic days together in Connemara in the West of Ireland. I hope you enjoy these shots.

This was the view from my ‘hotel’ last night.

And the lovely view from my bedroom window.

My hotel for the night, with broadband connection.

A salmon jumping on the river at Ballynahinch Castle.

Galway hooker in Roundstone Bay.

Herbaceous border in restored Victorian gardens at Kylemore Abbey.

Cut turf drying out on Roundstone Bog.

Sea Holly growing on a Connemara beach.

We’ve had some very good times over the years camping in this location, especially when our children were young. On this occasion however, we only spent the last night of our holiday in a tent. The rest of the time we ‘cheated’ by staying in the luxury of the Ardagh Hotel, just outside Clifden on the Ballyconneely Road. This is a place we’ve also come to love in recent years as our bones grow older and wearier. Our two night stay this weekend included a 5-course gourmet dinner plus two superb breakfasts and the price was €149 per person sharing. To put this into perspective, it costs me at least €150 each time I have to see a specialist. I’ll leave you to guess which one leaves me feeling better.

I hope these pictures are enough to make Bendy Girl happy too!

All I want is…

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?

So Dat’s Dat!

After ten years, ten months and ten days in office, Bertie’s finally gone! You cannot but wonder if Mary Harney will soon be following him. Brian Cowen, our Taoiseach-in-waiting, is due to receive his seal of office tomorrow and will announce his new cabinet shortly afterwards. Will he show Mary the door?

I had to laugh when reading about the HSE in the Sunday Indo yesterday. “A bloated system”. “HSE belt tightening is a fat lot of good”. “The HSE like everyone else needs to tighten the belt, to cut a little fat”. “The HSE will soon resemble a hippopotamus in bondage gear”. I”ll give you one guess as to what stimulates this sort of language from newspaper columnists. You’re right! Our present Minister for Health is no advert for healthy living and after three and a half years in the job, she’s definitely looking the worse for wear. Harney took on this role in September 2004 with promises to reform the health service. During her time in office, she is credited with achieving a reduction in A&E waiting times, putting a new cancer control programme in place, reducing operation waiting times and the introduction of hygiene audits.

A recent report provided by the HSE, showed that in the first two months of this year 44 per cent of patients in hospital emergency departments awaiting admission, had to wait longer than the official maximum target period of 12 hours. The report also revealed that the number of patients waiting more than 24 hours for admission increased by 57 per cent over the same period last year. The only thing that has improved is the HSE’s daily fiddling of the figures to make it look like there is a reduction in the numbers on trolleys.

As regards the cancer control programme, Mary Harney secured at enormous cost, the appointment of a top cancer specialist, Prof Tom Keane. His mission is to restructure cancer care in this country with the introduction of 8 new centres of excellence. According to John Crown, a medical oncologist, none of the four centres planned for Dublin will be comprehensive. “The plan is that colon cancer is treated in one place, lung cancer in some other place. That is not excellence in care. It is a system based on compromises which are in turn based on medical politics”. Under the new plan, there will be no centre of excellence located north of a line between Dublin and Galway. This system is already doomed to failure.

Waiting lists for operations have been reduced but at a huge cost. Surgeons and their operating teams in our public health system are frequently left twiddling their thumbs when their operating lists are cancelled because of the shortage of beds for elective admissions. Meanwhile the HSE is paying top dollars to the private hospitals via the National Treatment Private Fund (NTPF) to have public patients treated in the private system. This madness is Mary’s solution to the long waiting lists. Talk about false economy.

And finally the hygiene audits. Mary Harney promised back in 2005, to tackle health care associated infections (HCAI) and said that the target over the next three to five years would be to reduce hospital-acquired infections by 20 per cent and MRSA by 30 per cent. The numbers of patients becoming infected with MRSA fell only slightly last year. Newly released figures show there were 533 cases of bloodstream MRSA infection reported last year, compared with 588 in 2006, a reduction of less than 10 per cent. Overcrowding, poor cleaning, haphazard hand hygiene, infrastructural defects, and lack of infection-control staff particularly microbiologists, is favouring the spread of the hospital superbugs. Our Minister for Health is more interested in budget control than infection control and patients remain at serious risk of infection.

New official figures have shown that the HSE is now €95 million over budget for the first four months of the year. The HSE has drawn up a series of controversial proposals to claw back on the financial overrun. These include hospital bed closures, the curtailment of A&E services and new restrictions on the issuing of medical cards and drug-cost reimbursements. There is also a proposal to divert the €185 million earmarked for the development of services for the disabled, older people and those in palliative care. We ain’t seen nothing yet in terms of cutbacks and the impact this will have on patient care.

There is increasing unrest amongst those working in the health service and patients too, are fast losing patience. Mary Harney’s credibility has been badly damaged by a series of cock-ups and system failures during her tenure in office. The failure to get the new consultant’s contract up and running has been a major blow to her plans. Her promises to reform the health service, have not materialised. The question remains. Will Brian Cowen take the easy route and leave Mary Harney to continue to take the flak or will he have the courage to show her the door?

A Balancing Act

I listened with interest to Prof John Crown on the Late Late show last night as he outlined the failings within our health service. John Crown is a leading consultant oncologist working in the front line of the Irish health service and he doesn’t mince his words. He believes that the consultant’s contract as currently presented by the HSE, is a fiasco. He described it as an apartheid contract for an apartheid system of healthcare. Today, I heard that the Irish Hospital Consultant’s Association (IHCA) has accepted the HSE’s proposals and will be recommending the contract to it’s members in a ballot later this month. Meanwhile, the Irish Medical Organisation (IMO) is still refusing to come on board and has today requested third party mediation to resolve the problems. On one side, we have a government that insists on perpetuating a 2-tier system of healthcare despite the consensus of opinion which believes that a single tier health service is the way forward. On the other side, we have doctors who don’t like being put under the thumb by administrators who will decide their working hours. This contract has already been four years under discussion and I have to agree with Prof Crown, it has the potential to be a fiasco.

We have a health service in Ireland that offers a high standard of care but the care is not optimal. According to John Crown, this is due to ‘mal’ funding rather than underfunding. When the allocation of money from the HSE runs out, services are cutback at the expense of patient care. Treating patients costs money but It costs the system nothing to have patients on waiting lists. We have a health service run by civil servants instead of having a medical leadership structure in place. The policy of co-located hospitals as proposed by the Progressive Democrat (PD) health policy, is set to cause an even wider divide between the public and private systems. Each system will be differently funded, further adding to the complications. The concept of co-location ultimately means that services are duplicated in the one location. This is neither efficient nor cost effective . The co-located private hospitals already in existence, tend to be small and have sub-optimal expertise in place. As a holder of private health insurance, I can personally testify to this having once faced the decision of having to choose between standard of accommodation and standard of medical care. I was very unwell in A&E at the time and required admission for investigation. As I was known to be infected with MRSA , I required isolation facilities in order to be admitted to the hospital. There were single rooms available in the co-located private hospital but the physician under whose care I was to be admitted, worked only in the public hospital where no isolation facilities were available at that time. This dilemma typifies all that is wrong with the plans for co-location and the divisive nature of the consultant’s contract. I had no problem choosing medical expertise over comfort but I should never have had to make that choice. Why does healthcare have to so divisive? If you’re sick and in need of hospitalization, the type of care you receive shouldn’t be dictated by your ability to pay.

John Crown is in no doubt that the way forward for our health service is a single-tier, not for profit system of healthcare based on a universal system of social insurance. He makes no apology for speaking out about the deficiencies within our health service. As long as there continues to be vested interests and a burgeoning bureaucracy in control of our health service, the system is doomed to fail. The future of the consultant’s contract remains in the balance.

A Force for Change

If you’ve read this blog before you’ll know that I’m continually harping on about the crisis in the Irish health service. Put simply, the public health system in is melt-down. When the HSE was first set up, we were promised better services – we got patients on trolleys. We were promised better conditions for health staff – and we got a jobs freeze. We were promised value for money – we got mismanagement and dictat. Yesterday, I was given reason to believe that this health crisis will not end in catastrophe.

An estimated crowd of over 4,000 people turned out in Dublin to demand a better public health service. People travelled from all over the country to take part in the rally. It was the first time that patients, consultants, hospital staff, unions and patient pressure groups all came together to declare “Enough is Enough” and demand a decent public health service. The Irish Nurses Organisation (INO) and Irish Medical Organisation (IMO) gave their support. Eamonn Gilmore (leader of the Labour Party), James Reilly (Fine Gael health spokesman) and the Lord Mayor of Dublin all participated in the rally. The march was well-organised with the Gardaí providing an escort of outriders to facilitate movement of the large crowd through the city centre to Government buildings where the rally was addressed by speakers representing each of the groups.

ConorMacLiam, gave a very moving address to honour the wishes of his late wife, Susie Long. Susie’s untimely death last year was brought about by the direct failure of this government to provide an equitable health service for all. Conor claimed that as many as 5,000 people are dying each year as a result of cutbacks and delays in the health service. He also told us that the government has plans to privatise hospice care in this country. This government is determined to pursue against all advice, a policy of privatising the public health service and now we hear that it also plans to develop a 2-tier hospice service. How nauseating is that?

For me personally, there were many highlights to the day. I thoroughly enjoyed the camaraderie of the crowd as I walked alongside young and old, from all walks of life but all united in determination to fight for a better health service. They all had stories to tell of their travails with the health service. I was also encouraged to see two emminent hospital consultants join the rally and take to the stage to give their views on the health service. Prof. John Crown, a consultant oncologist, confirmed that we have been sold a ‘pup’ by this government in terms of healthcare and very soon when we enter a hospital it’ll be a case of “Turn Left” if you’ve health insurance and, “Turn Right” if you’ve not. Prof. Orla Hardiman, a consultant neurologist and spokeswoman for Doctors Alliance (a lobby group formed in 2007 that advocates for better public healthcare), warned that we should be careful to support and protect those elements of the public health service which work well in serving the sick. Otherwise, the government will use the constant whining from the public as further reason to privatise healthcare in this country. I thought this was an excellent point. There are lots of good aspects to our health service and we need to preserve and protect them from government interference.

Susie Long went public in the final year of her illness to highlight the inequities in the system. She turned her own personal tragedy into a force for positive change. She helped to motivate me and many others, to do more to highlight the failures within the health service. I was determined to be there yesterday to honour Susie’s memory and I can honestly say that for the first time in a long while, I felt the tide may be turning. Hopefully, this rally will prove to be the catalyst for change.

A Long Time Waiting

I listened to a radio interview today where it was stated that nothing has changed in A&E despite the Department of Health’s insistence that patients no longer have to wait long hours on a trolley for admission to hospital. My blood is still boiling.

Dr James Binchy of the Irish Association for Emergency Medicine, which represents A&E consultants, stated that Irish patients are dying unnecessarily due to delays and overcrowding in A&E. Many A&E departments continue to be unfit for purpose despite a damming report last year. Dr Binchy talked about feeling despondent when he arrives into work each day to face a backlog of patients still waiting for admission from the day before. He described how he endeavours to avoid eye contact with these patients, such is his despair at the conditions they must endure while they await a hospital bed. I’ve personally observed this avoidance tactic in A&E and I know exactly what it feels like from the patient’s perspective.

A year ago, my elderly father was rushed to hospital by cardiac ambulance from the nursing home where he resides in full-time care. He suffers from acute short-term memory loss and needs constance reassurance as to his whereabouts. Thankfully, his collapse was not as serious as first suspected but in order to ascertain this, he had to spend three days and nights on a hospital trolley in the busy A&E department of a large general hospital. He was thoroughly investigated and monitored but his surroundings caused him great anxiety and he became hugely confused during his stay. He was eventually discharged back to the nursing home, not because he was well but because they could no longer care for him in such an acute hospital setting. Luckily, my father is physically none the worse for this experience but to this day, he remains traumatised from having felt so lost in that A&E environment. He still phones me regularly to report “I’m in hospital for the night in case anyone is looking for me”. It’s sad and it sickens me to think of all the elderly people who are suffering this sort of abuse because of our third world hospital system.

Little or nothing has changed despite the urgent recommendations of the task force set up in 2006 after our Minister for Health, Mary Harney declared A&E overcrowding a “national emergency”. Dr Binchy makes the point that the delays in A&E are due to the backlog caused by a shortage of beds in the public system. He quantified this with figures which show that no patient in the hospital where he practices, had to wait overnight on a trolley for admission during the Christmas period. This is simply because elective admissions had been cancelled over Christmas thereby temporarily alleviating the bed shortage crisis.

And the moral of this story is? If you’re going to get sick and need emergency care, make sure you do it during a festive period unless you’re willing and able to rough it out in A&E.