Value for Money?

June 4, 2008

A new set of draft standards for infection prevention and control, has been published by the Health Information and Quality Authority (HIQA). HIQA was established in May 2007 as an independent Authority, with broad ranging functions and powers, reporting to the Minister for Health. It was set up to drive safety, quality, accountability and the best use of resources in our health and social care services. Our present health service is neither efficient nor cost effective, it swallows up vast sums of money with poor return. HIQA aims to correct this imbalance and deliver value for your money.

The new standards once finalised, will provide a national framework to improve the performance of healthcare settings in order to reduce healthcare associated infections (HCAI’s). These standards are a key component in ensuring quality and safety. As Eithne Donnellan reports in the Irish Times today, “the standards cover accountability, hand hygiene, reducing infection from medical instruments, surveillance of infections, having appropriate multidisciplinary infection-control teams in place which reflect the size and specialities of a facility, informing patients immediately of their infection status, and management of outbreaks“. HIQA now wishes to consult with interested parties and the general public before drawing up a final set of standards to be published later this year. Everyone has a right to have their view considered and submissions can be made online here to the Authority until the 18th July, 2008. HIQA envisages having the standards finalised and ready for ministerial approval by September.

I’m really pleased to see that the Department of Health is taking infection prevention and control extremely seriously but I’m not convinced that we’re getting value for money. You see, I’m aware that the HSE published an updated set of comprehensive guidelines back in 2005, called “A Strategy for the Control of Antimicrobial Resistance in Ireland ( SARI)” but these guidelines, which have a marked similarity to the new standards drawn up by HIQA, were never implemented. It was publicly acknowledged by the HSE at the time that the guidelines failed because of inadequate resources, sub-optimal infrastructure and a lack of access to relevant expertise locally. Has anything changed in the interim, I ask? Forgive me if I’m wrong, but it seems to me that there’s very little new about the report published yesterday other than the change of name. I’d love to know how much it’s cost to date. Meanwhile, the health service continues to struggle on with it’s inadequate resources and sub-optimal conditions. HIQA faces a hard task ahead.


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


Be Angry

April 9, 2008

When I first saw the list of speakers lined-up to participate in the Health Debate, I couldn’t believe my luck. This was a prime opportunity to hear our Minister for Health endeavour to defend her tactics to privatise healthcare in this country at the cost of the public health service. As it turned out, she left in a bit of a hurry but I did, at least succeed in getting to have my say.

I arrived early in the front square of Trinity College Dublin (TCD) just as the State car drew up at the entrance to the Exam Hall. Mary Harney stepped out of the car wearing what can only be described as, velour pyjamas and with her entourage in tow, she proceeded up the length of the exam hall with me in hot pursuit. Her pyjamas proved to be an excellent decoy as nobody took a blind bit of notice of her and she was quickly escorted to a side room to await the arrival of the real stars of the night. The debate was ably chaired by Conor Gannon of TCD VdeP Society, who did a fine job introducing each of the speakers and keeping order throughout the debate. The motion put forward was: “This House believes that the Irish Health System Fails the Disadvantaged”. I’m delighted to be able to report the motion received unanimous support from the audience and Mary Harney and her band of loyal followers suffered a resounding defeat. Unfortunately, she didn’t stick around for long enough to hear the disquiet that flowed from those on the panel in support of the motion, and from the audience. She made a hasty retreat shortly after delivering her own contribution to the debate. We were told that she had been “called away by Cabinet business”. Yeah, right!

The debate was opened by Prof. Orla Hardiman who gave an impassioned speech about the faults within the health service. She urged the audience to “be angry, be very angry”. She is firmly in favour of an equitable healthcare system for all and her address received rapturous support. Mary Harney then got to her feet and declared that it is her intention to provide a health service based on medical need (as opposed to ability to pay) and insisted that huge progress has been made. We got reams of statistics about how the health service is helping us to live longer but in reality, it was a lacklustre performance. She was constantly interrupted by a heckler in the audience who persisted in shouting her down despite repeated requests to desist. While this heckler was clearly out of order, his intervention proved to be the only challenge to Mary Harney last night as she departed before any one else got the opportunity. Fergus O’Ferrall, speaking in favour of the motion, informed us that 90% of the €16 billion spent annually on the health service comes directly from our taxes. The other 10% of funding comes from the private health insurance market. He accused the HSE of mismanagement through under-provision and rationing of services. The next speaker, Dr. Sean Barrett who opposed the motion, almost won approval when he declared that this health service not only fails the disadvantaged, “it fails everyone”. However, he then proceeded to place the blame on productivity being too low, the fact that private medicine is practised in public hospitals, the high ratio of staff to number of beds, and a greedy medical profession. He made no mention of the Dept of Health or the HSE. Mary Harney scuttled out of the room at this point while she still had someone on side. Throughout the evening, those in support of the motion gave credit to the late Susie Long for using her own plight to highlight the failures within the service. The opposition put forward two further speakers, an ex-TCD student and member of the young Progressive Democrat party (Mary Harney is a PD ) and also a manager from the HSE who were both, it has to be said, less than convincing. We also heard from two further speakers in support of the motion. Audrey Deane, representing the St.Vincent de Paul Society, told the room that HSE managers are turning to the SVdeP to access help for those failed by the system. How bizarre is that? The final speaker in support of the motion was Prof John Crown who denounced the waiting lists caused by underfunding in the health service. He joked that if we had such a thing as an abortion clinic in this country, he was sure the waiting list would be 10 months. “That’s if you go privately, going publicly would take longer!” EU figures for waiting times, show Ireland coming 2nd last on the list. He accused the HSE of employing too many spin doctors, referring to the place as ‘Burassic Park’. John Crown wants to see the Bismarck model of healthcare implemented (a one tier, not-for-profit health service) or else he warned “we’re heading for a ‘Paris Hilton’ style of health care”.

The debate was then opened to the floor and speaker after speaker outlined their experience of the deficiencies within the service. I waited until the end of the night before taking to the floor and then, I let rip. I surprised myself by the depth of passion which flowed as I spoke about the chaos in the public health service, the squalor of the conditions endured by sick people and the scourge of MRSA in our hospitals. I outlined the madness of the recent HSE cutbacks, the continuing problems in A&E despite claims to the contrary and warned of the consequences to follow if Mary Harney’s continues to privatise healthcare in this country. I also spoke out in defence of those who have private health insurance. We tend to be blamed for contributing to the a 2-tier health system when in fact we feel forced to seek insurance as we know we cannot rely on the health service in times of need. I concluded by commending the hard work of those healthcare workers who strive to provide excellent care in difficult conditions and reminded the audience that we need to protect the good aspects of our health service from further government interference.

Following the resignation of our Taoiseach, Bertie Ahern, last week Mary Harney announced that she had no intention of running away from her post as Minister for Health. In response, I’d like to say to Mary “be afraid, be very afraid. Time and patience is fast running out.

UPDATE: I forgot to thank Grannymar for her support in helping me to highlight this debate. The chairman of the debate was delighted to have a full house for this annual event and was impressed to hear that the blogging community had given support.


Enough is Enough

March 27, 2008
health-cut-backs.jpg

If you’re sick of our health service, or lack of one, here is your opportunity to campaign for better healthcare. A march and rally has been organised in Dublin to demonstrate public dissatisfaction with the health service. The time has come to show the Minister for Health that enough is enough!

An umbrella group of health unions and patient campaign groups are urging the public to come out in large numbers next Saturday 29th March, and support the march. The rally will assemble from 2.30pm at Parnell Square, Dublin where it will be addressed by speakers, before proceeding to Molesworth Street.

The following speakers will address the rally:

Prof. John Crown, Consultant Medical Oncologist

Conor MacLiam – husband of the late Susie Long

Representatives from the following groups will also contribute:

Doctors Alliance for Better Health Care

Irish Nurses Organisation (INO)

SIPTU

Health Services Action Group

Patients Together

MRSA and Families

Recent cutbacks in government spending have resulted in further suffering for Irish patients. Our government has failed miserably in it’s commitment to deliver an equitable health service based on need. The bureaucrats within the Dept of Health and the HSE should be shamed for the long litany of dysfunction within the health service. Patients have suffered for too long without the basic healthcare they deserve. It’s time for change.

Please support this march to show you care. I’ll be there – will you?


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.


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.