Still, no cure for ongoing hospital ills



One thing that strikes me about the current screaming headlines over the crisis in the Health Service is that there is absolutely nothing new about this. The situation in our hospitals has been dysfunctional for years, particularly chaotic in emergency departments with long, distressful waits on trolleys before patients are admitted.

Being admitted to hospital via an emergency department can be horrific, as I found given my experiences a couple of years ago.  There was the agonising worry of bringing in a seriously ill husband for attention combined with the anxiety of not knowing what on earth was going to happen in this terra – should be terror – incognita.

The waiting area the hospital was crowded with people in every kind of predicament: from writhing in unexplained agony to having fallen off a bicycle, all queueing on chairs for hours before being assessed by the triage system. Once inside the hospital it was like a war zone, crammed with beds and trollies bearing patients waiting attention from overstretched medical personnel. Once in there it didn’t take long to realise that the doctors, nurses and orderlies working there under extreme pressure in difficult circumstances were absolutely heroic.

Nor did it take long to realise either that, God help any patients, especially those unable to communicate effectively if they didn’t have someone to advocate for them and ask for simple things like water, bedpan or some form of food as hours passed. Asking about the possibility of a bed, where the wait ran to days rather than hours, was like asking for a miracle at Knock,  never mind getting information on a prognosis or any procedure required.   At one point, if I hadn’t been there, my husband would have been be left forgotten in a wheelchair in a corridor for hours waiting to return to emergency after a procedure.

Insufficient beds and lack of staff get blamed frequently for the current crisis. Having more of both means throwing more money at the problem and I am not sure that would resolve the crisis. In the weeks  visiting my husband as he recovered from a stroke (only tragically to be diagnosed with terminal lung cancer) poor management in the system became glaringly obvious.

And who manages the public health system?  The HSE, a 100,000 strong inflated team with nearly four dozen different divisions, some with names like The National Quality Improvement Team or The Patient Safety Programme which sound as though they should be tasked with solving the crisis.

Causes of some of the bed bottlenecks were obvious. Beds were occupied by patients who simply should not have been there and there were many ways beds could have been freed up if the HSE had been running things efficiently. There were patients who could have been released to step-down nursing home facilities, patients in need of home care, supposing home care had been available through – guess who? – the HSE and patients who couldn’t return home and should have been placed in care homes.

Every day there were patients waiting for hours, sometimes into the afternoon to be discharged from hospital, taking up those precious beds, surely a situation which could have been managed better. Nursing staff often came from agencies, an expensive way to recruit staff since agency fees have to be paid on top of wages. And those were just the kind of problems any visitor could see, without any analysis of the deeper malaise in the system.

My insights are from four years ago. Since then the situation in the health service has worsened and the numbers employed in the HSE have swelled. The problems which I could see are still unresolved and quoted as being part of the bed scarcity problem as over-crowding reaches record levels. Hundreds of consultant roles are unfilled, with a 44% increase in the number of doctors emigrating to Australia Now, nurses are threatening to strike over intolerable conditions.

And the new dawn of promised Slainte Care hasn’t materialised.

Rather than any acceptance of responsibility or attempt to reform the system, already overstretched medical staff have been asked to work weekends to resolve the worsening crisis exacerbated by winter virus, flu and Covid.  We have been told to stay away from hospitals and emergency departments.

No problem there: the latest poll reveals that 72% of us would only attend A&E if their life depended on it.

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