Heart Beat: Big fleas have little fleas, Upon their backs to bite 'em, Little fleas have smaller fleas, And so, ad infinitum. Sometimes ascribed to Bertrand Russell but in reality far older, dating back to at least the early 18th century, the above quatrain is applicable in many fields. What led me to thoughts along these lines was the appreciation that an industry had been steadily evolving around school exams, writes Maurice Neligan.
Many years ago the principals in examinations were the students and the teachers, with family playing a support role. Now the little fleas have proliferated ad infinitum. We have experts of every description telling the students how to take the exams, how to sleep, exercise, eat before the big day; how to pray, weep and run for your life when the results are out.
A life after exams is postulated and all possible avenues explored for those whose achievements sadly do not match their expectations. Doubtless some of this is useful, especially the latter. Much of it is not and as fleas betoken parasites, one is led to the uncharitable conclusion that this is what some of these experts, advisers, call them what you will, really are. Make the schools better places with good facilities for the students, pay the teachers appropriately and spare us the meaningless frills of pedantic commentary around the edge.
This takes me back to student hospital days and my wandering pathway, and to the realisation that in the provision of medical care, the smaller fleas have proliferated to such a degree as to militate against the delivery of patient care. In short we have a plague with no treatments, let alone cures, in sight. We also have a total unwillingness on the part of those responsible to face their responsibilities.
I have been all sorts of flea, little, big and now, I hope, a persistent irritant until things start to improve. This is a recurrent theme I realise but the application of resources to realities and not to shadows should be the business of Government. There is no substitute for knowledge and experience and if those leading the way lack both, disaster is inevitable and it is upon us now.
There are innumerable examples of sheer disorganisation. We have a state-of-the-art orthopaedic unit newly commissioned in Castlebar, lying idle because the funds necessary for its opening have not been allocated. Down the road in Galway we have a state-of-the-art private hospital due to open apparently with the blessing of the Taoiseach, and looking for patients from the National Treatment Purchase Fund. This hospital also intends to perform cardiac surgery, as does University Hospital Galway two miles away.
By any criterion you care to use, there simply is not an adequate volume of patients for both. So what happens? Do the public and private sectors talk to each other? Is there any overall planning? Is there any regional planning? Is there any planning at all?
Does nobody see the absurdities and contradictions in all of this development without assessment of patient requirement. It should be easy to know how many hips, knees, hearts a region requires? I could continue with examples of units being built but not staffed, of services being downgraded in the public sector while private facilities develop without hindrance, and with generous tax incentives for the developers.
We need regulation in private hospital development and the assurance that staff are equivalently qualified to those who work in the public sector. At present, there is but a tenuous connection between the public and private systems, usually provided by doctors who work in both. There is no integrated plan. Recently Mark Moran, chief executive of the truly excellent Mater Private Hospital, voiced this concern about the relationship between public and private hospitals, and the parts each could play in the scheme of things, if there was a scheme. I wish!
I had intended to talk about the much vaunted National Treatment Purchase Fund. I don't vaunt it at all, and I think that its very existence proves the failure of our public hospital system. I will return to this very important subject.