HEART BEAT:'Centres of excellence' lack resources to fulfil their roles
" How my achievements mock me"
– Shakespeare, Troilus and Cressida
THERE WERE 411 patients on trolleys in hospitals around the State one night last week. That’s some achievement. It’s only September. They are on trolleys, chairs and floors because the facilities to treat them do not exist. They have been shut or downgraded. “Centres of Excellence” have neither the capacity nor the finances to fulfil their postulated roles. We face the grim reality that the monies required to give a passable, let alone a “world class”, service to our people are no longer there.
We are now being subjected to a series of nauseating valedictories from those quitting the struggle. They alone perceive how things have altered for the better. They are self and mutually congratulatory on what they have achieved. They are either blind or indifferent or both to the perception by ordinary people of the validity of their claims, the little folk who suffer from their efforts. These exalted people somehow know best.
Everybody understands that every saving is essential in these troubled times. Value for money is not alone a virtue, it is a necessity. It simply cannot be achieved without consultation and input from those who run the service on the front line. Too long have we endured the desk-bound generals.
The object of the service is to deliver appropriate treatment and care, within a reasonable time frame, to the sick. The numbers and presentation of such patients must dictate the services required. It is risible to hear that region X or unit Y exceeded its service plan. What does this Minister and her hordes of satraps propose to do with such patients who fall ill, beyond the centrally-dictated capacity? Shoot them perhaps?
We know that there cannot be a hospital at every crossroads. Medical and nursing personnel accept that rationalisation is desirable. However, such reorganisation must be preceded by the access to the better facilities promised. It is simply immoral to close local services, which have served their communities well, and then dispatch the unfortunate patients to trolleys and outpatient lists in some resource- starved “centre of excellence”.
The mantra that this is being done for “patient safety” is manifestly untrue. Such concerns appear to be relevant only to hospitals destined for reconfiguration, ie closure. These concerns are not manifested in the overcrowded “centres of excellence” and, most scandalously, they do not seem to occur in Ireland’s burgeoning private hospital sector.
This latter sector is propped up by another perceived “success” of the health service, the National Treatment Purchase Fund (NTPF), which trumpets its success in removing patients from shamefully-long waiting lists. These same lists are inexorably growing again. Without the input of the NTPF, many of the private hospitals would not be viable.
The NTPF was the “finger in the dyke” response to system failure and it would be niggardly to deny that many patients benefited from its existence. Now we need a different integrated approach where all hospitals, large and small, public and private, have a defined role in a system where standards and quality mean something and are not used merely as spades to bury some local hospitals that this unaccountable bureaucracy has mandated for closure.
As stated earlier, there were 411 patients on trolleys in hospitals around the State one night last week. There are 1,350 beds closed in the public hospital system. This is in a State with one of the lowest bed numbers per 1,000 population in the OECD.
You cannot do all surgery as day surgery; you cannot conduct all medical investigations on a day-case basis. This is because we have a scattered population with difficulty of access. You cannot supplant all hospital care with primary community care, even if this latter was fully developed.
Such under-achievement mocks you, Minister, and the legions that insulate you from reality – the HSE, Hiqa, the Department of Health and all your personal staff, advisers and junior ministers. You might ponder such achievements as you opened extra floors in the Blackrock Clinic. Did you think of Louth, Monaghan, Navan, Nenagh, Ennis and those other insignificant hospitals whose obsequies are now being arranged?
mneligan@irishtimes.ie