HEART BEAT:The figures in an 'improving' system that don't stack up
“O wad some Power the giftie gie us
To see oursels as ithers see us!
It wad frae monie a blunder free us
An’ foolish notion”
To a Louse
(Robbie Burns, 1786)
BURNS’S POEM on observing the creature crawling on a lady’s hat came to mind recently. I heard Minister for Health Mary Harney talking about the situation in AE departments in the State and I read impressions of progress in the health service given by the retiring chief executive Prof Brendan Drumm, and the retiring chairman of the HSE board, Liam Downey. Not for the first time it struck me how detached from reality such august personages can become.
On July 6th there were 331 patients on trolleys in hospitals across the State. In 2005 Mary Harney told us that AE overcrowding was a national emergency. She said she would resolve the problems within six months. She didn’t.
In an interview on RTÉ's Prime Timeon June 17th this year, when pressed about the continuing, indeed escalating problems in these units, she claimed that the situation was improving. Furthermore she stated that the problems were largely confined to six hospitals in which there were internal problems. There was nobody facing her in studio to give the lie to this self-serving nonsense.
However, the president of the Irish Association of Emergency Medicine appeared on screen to refute her assertions. He said he was supported by 90 per cent of his colleagues in stating that the service was getting worse.
At this point I would ask you to bear in mind that these figures refer to a day in mid-summer; a time when pressure on such units is usually at its lowest. On this day in Dublin, St Vincent’s had 23, the Mater 32, Beaumont 29, Tallaght 26 and James Connolly Hospital, Blanchardstown had 22 patients on trolleys.
Outside the capital, Naas had 11, Mullingar 10, Cavan 21 and Our Lady of Lourdes in Drogheda had 10. Cork University Hospital had 28 and the Mercy Hospital, also in Cork, had 11. In the west, University Hospital Galway had 22 and Mayo General had 12, Sligo General had nine. Waterford had nine and Wexford General had 27 such patients. These statistics are compiled by nurses of the Irish Nurses and Midwives Organisation (INMO) and are collected at 9am each day.
Administration collects trolley figures at midday, akin to measuring rush hour traffic at midnight.
At times of extreme stress it could be possible that there might be as many as five or six patients so situated in some hospitals. That generous assessment is exceeded by no less than 18 of the acute hospitals across the State. Almost all of the “centres of excellence” are included in this catalogue of failure.
The Minister lauded a plan in Limerick to move admitted patients quickly from the emergency department to the wards. Indeed the Limerick department had “only” seven patients on trolleys on that day. Perhaps there was not space behind the doors or in the centre of wards or, God forbid, in corridors, to accommodate the luckless seven.
Let me give you an opinion on this and similar plans.
Overcrowding wards just to square figures in A&E departments is no solution. It is dangerous “out of sight, out of mind” delusion. It renders the orderly planned working of a hospital impossible and leaves patients exposed to potentially lethal infections. Can we plausibly suggest that the answer to our A&E problems is to overwhelm the wards and expose our patients to such danger? On this day there are 1,300 beds closed across the State, we are 1,000 nurses below complement and there are increasing vacancies for NCHDs.
The outgoing chairman of the HSE board tells us that progress was being made despite the resistance of vested interests. Apart from the usual suspects, doctors, nurses and everyone who works in the system, he included patient advocacy groups. Maybe they didn’t tell yourself and your board at the outset that the HSE has only one purpose. That is to deliver the best possible service to Irish patients and to enable their carers to look after them. But no; apparently we’re all out of step but our Johnnies.
mneligan@irishtimes.com