Heart Beat: Come here to me now. Did you hear the latest? The mandarins of the Health Service Executive (HSE) have run out of money and instead of going back to the Government and taxpayers for more, they are going to institute some readjustments (cutbacks, to you and me).
In anatomical terms, I wondered how much flesh you can pare from a skeleton, but these are mighty men or they wouldn't all be getting these bonuses.
An operating theatre closed here, endoscopies reduced there, only essential day care and emergency surgery, and outpatient clinic reduction somewhere else; these are just samples of projected cuts across the State. The HSE's Prof Brendan Drumm defends this on grounds that the system is not efficient and that there are patients in acute hospital beds who should not be there. We all know that but where are these unfortunate people to go?
A simultaneous embargo on recruitment and overtime is also in force. This, one would think to those not bereft of all reason, must restrict patient treatment. Now for two gems; firstly the HSE says "these are not cutbacks, but an attempt to realign activity levels with this year's 'service plan'". So it's service plans rather than patient need that dictate how we look after the nation's sick.
Secondly, the Minister for Trolleys has insisted that no patients will suffer. That simply beggars belief. I have written before that healthcare is not merely a commodity. It encompasses caring, compassion and concern for the welfare of our fellows. It is not and should never be the sole prerogative of the bean counters.
This regressive trait was further emphasised by the allocation of new consultant posts in the so-called 100+ initiative. As almost any doctor or nurse could tell you, the hospitals that needed help the most, did not get it. This is simply unjust and leaves caring behind, in the search for "efficiency". Everything is reduced to money, that most heartless of values. It breeds indifference in our society and indifference suffers others' pain lightly.
Geoffrey Studdert Kennedy, aka "Woodbine Willy", English- born graduate of Trinity College Dublin, parson, poet, war hero, and humanitarian, wrote of such indifference:
"When Jesus came to Birmingham, they simply passed him by
They never hurt a hair of Him, they only let Him die
For men had grown more tender and they would not give
Him pain
They only just passed down the street, and left Him in the rain."
All the great religions and indeed enlightened humanism have as a primary charge the love and care of our fellow men. How is it that we forget so easily?
If I am beginning to sound like some sort of Christian fundamentalist or crypto socialist, I can assure you that I am neither. I do not denigrate either in their sincerely held belief. I believe that putting money before concern in medicine is simply wrong and that the present direction and thrust of our health service needs urgent reappraisal.
On a related matter, the certification of hospitals is a topical issue once again. Concerns were expressed about cancer care in a particular hospital, care which is now under review. Appeals are made, which should be supported by all right-thinking persons, that certain hospital standards must be met.
The Health Information and Quality Authority (HIQA), while bearing such responsibility in the public sector, has no such remit in the private sector. Dr Tracey Cooper, HIQA director, feels that they should have. I agree with her. Why should the 50 per cent plus of the population with private health insurance be excluded from such quality assurance?
It has been cogently argued by Prof Niall O'Higgins and others that a certain volume of surgery is required for best outcomes in breast surgery. It applies to other forms of cancer surgery, heart surgery, neurosurgery, organ transplantation and other disciplines as well. All of these require multidisciplinary team skills, not merely the expertise of the surgeon, fundamental as that is. In my own discipline, it is worldwide opinion that no institution performing fewer than 100-150 open-heart operations per annum should be accredited. Similar norms exist in other specialities, both medical and surgical.
We talk glibly of audit and peer review in the public sector but we are told that "legal reasons" may inhibit such safeguards in the private system. This is intolerable. Every patient entering a treatment facility in this State has the right to know that its standards have been inspected and found to be satisfactory. I am not suggesting a draconian system of inspection here, merely the application of common sense. Yet it would appear that it is in the transfer from regulated public medicine to unsupervised private institutions that the bean counters of Government and the HSE look for the salvation of the health service. They could not be more mistaken and such delusion will affect every man, woman and child in this country.
Maurice Neligan is a cardiac surgeon.