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.

It’s not rocket science

Everyone has heard of the hospital superbug MRSA and many have a view on how to stop it. MRSA is a serious problem in Ireland. A new report released this week has found that MRSA is costing Irish hospitals more than €23 million every year. Ireland ranks fourth in Europe for MRSA bloodstream infection rates with only Portugal, Greece and Italy ahead. Much of the media coverage on reducing the incidence of MRSA tends to concentrate on hospital cleaning and poor hygiene. This latest report addresses the whole story about MRSA.

The MRSA in Ireland: Addressing the Issues report, was conducted by a multidisciplinary advisory group including microbiologists, hospital pharmacists and patient advocates, and sponsored by healthcare firm Pfizer. The report found that the cost of dealing with healthcare associated infections (HCAI) totalled €233.75 million a year, with the MRSA cost representing 10 per cent of the overall figure. The main factor contributing to the cost is the increased length of stay by patients in hospital. Patients with MRSA spend, on average, 2.5 times longer in hospital.

Commenting on the report, Dr Edmond Smyth, Consultant microbiologist at Beaumont Hospital and chairman of the MRSA group, said that we need to “improve patient staff ratios; have laboratories on hospital sites that provide rapid diagnosis for MRSA and other infections; be able to isolate patients; ensure that doctors and nurses and healthcare workers generally wash their hands before and after any contact with a patient; ensure that we use antibiotics appropriately; discharge patients home earlier.”

“It’s the simple things,” Dr Smyth says. “There’s no rocket science here, we just need to do all these simple things at the same time.”

It may not be rocket science but at a time when the health service is facing over €1 billion in cutbacks and with the present economic downturn, I can’t really see all this happening, can you?

Cartoon by Chris Slane

Information source: TV3 News and The Irish Times.

At the Front Line

A draft document from the Department of Health has been circulated around HSE managers warning of further job losses in the nursing sector. Staff nurse levels will be cut by 700 this year as part of a move to optimise resources. The Irish Nurses Organisation (INO) has claimed that these further cutbacks will have an unsafe impact on frontline services and that patient care will be compromised. The HSE  is defending the proposal and continues to insist that frontline services will be maintained. I wonder what the VAD nurses would have made of today’s working conditions at the front line?

The British Red Cross Society formed the Voluntary Aid Detachment (VAD) in 1909 to provide auxiliary medical service in the event of war. While it was mostly men who fought on the front lines during the First World War, some women also worked close to European battlefields as nurses. These graduate nurses and members of the Voluntary Aid Detachment – a corps of semi-trained nurses – worked in war hospitals, drove ambulances, and served as cooks, clerks, and maids. Most women who volunteered with this unit were not professional nurses. They attended classes in first aid, home nursing, and hygiene with the St. John Ambulance Association for between three and six months and also volunteered in hospitals, making beds, taking temperatures, and performing other duties. Open-air drills also taught VADs to build and cook on camp fires, pitch hospital tents, and care for wounded soldiers.

The work was physically and emotionally taxing. Nurses worked long hours in crowded and chaotic hospitals treating severely wounded soldiers from the front lines. They slept on bunks, ate rations, and went without the usual comforts from home. Although the work was stressful and sometimes traumatic, it also produced a sense of satisfaction in many nurses by allowing them to make significant and public contributions to the war effort.

Image courtesy of the British Red Cross Museum and Archives.

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.

Let’s Get Talking!

I wrote a post the other day to highlight the continuing scandal of the unacceptable waiting times in our health service, pointing out that it’s ‘Time for Change’.  The response was a deafening silence bar one comment from an ardent Aussie blogger, Baino, who has the balls and the ability to speak out about injustice whenever she sees it. I know that people are probably sick of listening to me harping on about healthcare problems  but I happen to believe that if you don’t make your voice heard, the scandalous state of our health service will continue unabated. People tend to say nothing until/unless it affects their own lives. Trouble is, by then it’s probably too late.

The point I’m really trying to make is that it’s time we had a proper debate on the way forward for the health service. There seems to be almost universal agreement that our Minister for Health, Mary Harney is going in the wrong direction in her attempts to reform the health service yet no one is shouting STOP! The only people who seem to approve of Harney’s measures, are her buddies in cabinet and the muppets in the HSE and we all know why that is. It’s openly acknowledged that the health portfolio is a bum job and that Harney is the only one willing to tackle it but she’s made a balls of the job and it’s time someone tackled her. Harney’s policies are clearly not working but because no-one else wants the job, she’s allowed to continue. It’s patently obvious that she needs pointing in a new direction but to achieve this, we have to first agree on the best way forward.

For starters, the HSE needs to be disbanded. It’s a bureaucratic nightmare that is soaking up funds intended for frontline services and Harney should have got rid of it years ago. We should instead, utilise the brains of the top entrepreneurs in this country to motivate a change in direction. We need more consultation with those who work at the frontline of healthcare, to help devise tangible ways to solve the problems. Our health service has a fantastic wealth of expertise but it’s being thwarted at every turn by cutbacks and morale has reached an all-time low. It’s time to take the politics out of healthcare and to put back the pride in our health service.

I firmly believe that it’s not too late to stop the rot but this won’t happen unless people put their heads together to turn the situation around. The only way to get the health service back on track is if everyone pulls together to make it happen. I urge you to make your voice heard but please don’t wait until it’s too late!

Thanks Baino for stimulating me to shout a bit louder today.

Make Your Voice Heard

Last week the Government caused uproar by announcing plans to scrap the automatic entitlement to a medical card for all over-70’s. Having lulled the elderly into a false sense of security that they would be entitled to free healthcare until the end of their days, they are now trying to claw back on this commitment. There is no denying that this country is facing a serious economic downturn and that harsh cutbacks are required to sustain public finances but this callous plan to target the elderly, is despicable.

Enough has already been said about the bungled campaign to introduce a ‘means test’ for the over-70’s medical card. I have never felt so angry and frustrated by the gross incompetence shown by our Government in their handling of this issue. They are guilty of causing great fear and anguish to those most vulnerable in our society. The comments made over the weekend by our Minister for Health, Mary Harney and our Taoiseach, Brian Cowen have done nothing to allay the fears of the elderly. Now the Government is floundering around trying to find a way out of the controversy created. Our health service is no longer alone in it’s descent into chaos.

A public rally has been organised outside the Dáil at lunchtime on Wednesday to protest against this Government’s attempt to mug the elderly. If you too have been outraged by this medical card débâcle, I would urge you to show solidarity with the elderly and support this protest.

Assemble @ 1pm on Wednesday 22 October in Kildare Street, outside the Dáil.

Salmonella Agony

The latest figures for the recent outbreak of salmonella agona show that some 132 people have now been infected with the bug and it’s already spread to 5 countries within the European Union. The genetic fingerprint of the microbe has been linked to a particular production line at Dawn Farm Foods in Naas, Co. Kildare. The company has decided to close the entire plant for a week and has contracted the expertise of Limerick company OMC Scientific, to decontaminate the entire production facility. How times have changed.

Many years ago when holidaying in Connemara, our holiday plans came to an abrupt end when the friends who’d been staying with us, had to return home following the sudden death of a relative. Our little holiday cottage felt very empty with just my husband, myself and our young son rattling around in it so to cheer ourselves up, we decided to treat ourselves to lunch in a local hotel. Later that evening, I became violently ill with nausea, vomiting and diarrhoea which continued relentlessly all night. I still felt very unwell the following day so we decided to give up on the holiday and return home. I shall never forget that 6-hour car journey with awful nausea, every mile was agony. My husband and son luckily were unaffected and sang songs together all the way home to help pass the time. As far as I can remember, I recovered within a few days but a week or so later, I again became increasingly nauseated until the whole unpleasant episode started all over again.  I consulted my doctor who prescribed medication to ease the symptoms. This pattern repeated itself every few weeks until eventually about two months later and two stone lighter, I was admitted to hospital for investigation and treatment. This is when it emerged that I had a dangerous form of infective diarrhoea and the bacteria was linked back to the piece of chicken I’d eaten for lunch on that fateful day in Connemara. My infection was officially notified to the Food Safety Authority and that was the last I ever heard of the sorry tale. I’ve often wondered since how many other poor souls suffered the same fate after eating food from that kitchen and I have to admit, I still to this day shudder whenever I pass by the doors of that hotel.

The HSE is presently in talks with OMC Scientific to consider using it’s technology in Irish hospitals, to reduce the incidence of hospital-acquired infections (HCAI’s) such as MRSA and clostridium difficile. OMC’s bio-decontamination service is already used in a number of British, French and American hospitals. A study published in the Journal of Hospital Infection found that this technology is 66 times more effective than manual cleaning in removing hospitals superbugs. It’s estimated it would cost the HSE about €14 million a year to cover all 52 acute hospitals in the country but this would lead to a reduction in the prevalence of superbugs which is thought to cost the HSE about €200 million a year. Now there’s a cutback worth considering!

Tighten your Belt

Well, it’s finally happened. The economic downturn is upon us, our public finances are under severe pressure and major cutbacks in healthcare spending are anticipated. Our already ailing health service is set to suffer even further and it almost goes without saying that patient care will be compromised.

Brendan Drumm, the HSE chief, believes that in the present economic environment, the health service could face five years without any extra funding. He also believes that there is no reason why the standard of health service provision should suffer as a consequence. Our Minister for Health, Mary Harney has warned that hospitals must operate within budget and must do so without impacting on patient care. We’re told that the way our hospitals are being run is both ineffective and inefficient. I turned on the news last night to hear that hospitals across the country are facing a scaling back of services with staff cuts and ward closures. One hospital has already accused the HSE of gross neglect of patients and claims that the cutbacks are being done at the expense of patients. A spokesperson for the HSE insisted that patient care will not be compromised by the cutbacks. Who do they think they’re fooling?

My biggest fear is that patient’s lives will be put at risk by these further cutbacks in spending. There is already a serious problem in our hospitals with the level of healthcare associated infections (HCAI’s) such as MRSA and Clostridium difficile. 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. There is also growing public disquiet. We are constantly promised that improvements are “planned” or “under way” but how can this be so when cutbacks in basic front-line services are being simultaneously requested. This is not the time to talk about cutbacks and the necessity of hospitals staying within budgets. The HSE has lost sight of the needs of the patients. It increasingly prioritises bureaucracy and finance rather than health, with numbers and budgets taking precedence over real people and care.

We are once again being asked to tighten our belts. Brendan Drumm says that it is the duty of everybody, including the health service, to use taxpayers’ money more effectively. This is all very well and good but could someone please explain why this situation has arisen after a whole decade of unprecedented economic growth? Is there any Government accountability left in the area of healthcare?

UPDATE: In case anyone ever thinks I’m exaggerating about the state of our health service, have a look at this post which can also be found over at Irish Election. It details the experience of bringing a child to A&E and is a classic example of how the system is failing to provide emergency care. This post completely mirrors my thoughts.

Your Wealth is your Health

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

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.