My family's experience of A&E suggests the Irish health service is in better shape than the chattering class claims, writes SARAH CAREY
IF YOU torture statistics long enough they’ll tell you anything you want to hear. That’s why it’s worth paying attention to personal experience, especially when it’s in direct contrast to accepted truths.
I had just such an experience over the holidays. On St Stephen’s night, my six-year-old was clutching his arm screaming, berating the neglect of an interventionist God and promising dire revenge for the sibling who had – allegedly – shoved him off his chair. As the arm began to swell, we began to panic.
Surely there was no point going to an accident and emergency unit on a Saturday night over a holiday weekend in deepest winter? There’d be an all-night wait, no X-ray, overworked staff – and we’d probably catch MRSA. A medical friend suggested we head for Temple Street children’s hospital in Dublin.
So off we went, more in hope than expectation, arriving shortly after 9pm. By 11pm, he had been examined, treated for pain, X-rayed, a cast applied and an appointment made for the orthopaedic clinic on Tuesday morning.
As my husband prepared to leave for the appointment I suggested he bring sandwiches, because with all the ice-related limb breakages, there was bound to be a long wait. He rang at noon to report that the child had already been assessed, prepped and was en route to surgery. I stayed with him that night in the hospital.
Everywhere and everything was spotlessly clean. The equipment looked new. The staff were cheerful and diligent. Surgical teams and individual doctors were fussing over their patients. I was impressed and confused.
The whole experience was amazing. Where was the “Third World” service? Where was “Calcutta”? The trolleys? The dirt? When I started to think about it, I realised how much I’d been influenced by media reports. After all, I’d had both of my children through the public system and was delighted with the care. When my father had a heart attack a while back, he was treated publicly – and brilliantly. Two friends were admitted through A&E when they were seriously ill a few years ago and were treated so well they cancelled their VHI subscriptions.
So I rang around to check up on other people’s experiences. They fell into three categories.
Those who had never been near an A&E made every effort to discount my experience. They insisted it was a fluke and I shouldn’t consider writing about it. Praising the health service has made it on to the list of Things You Shouldn’t Say.
Those who had been through the system begged me to publish their gratitude. They said their emergency care was fantastic – X-rays at midnight on Christmas Eve for heaven’s sake – and that the hospitals had provided follow-up treatments for months, ensuring acute conditions were fully cured prior to discharge. Two mothers were mortified and impressed when social workers knocked on their doors after their children had been treated for injuries.
A third group had been through A&E and endured the long waits. The complaints focused on one or two specific hospitals – both cases were rural and involved minor injuries. One complained of a long wait in a private emergency department, but said at least the chairs were comfortable.
The main story was that in the major A&E centres, the system worked.
I’m not saying that Saturday night drunk-infested A&Es don’t exist, but that rather than having poor emergency care which is good in spots, it’s possible we have good emergency care which is bad in spots.
If so, why does A&E get uniformly bad press?
For the political right and left, negative stories of hospital care are essential material. The right needs people to believe in poor public care because it creates the political consensus to expand the private system. If half the country has private health insurance because they’re terrified of not being treated publicly, it strengthens the case to build private hospitals on public sites – a policy I believe is profoundly wrong.
Coincidentally, the left will always emphasise the bad stories because it legitimises demands for never-ending investment in State services. Naturally, the media doesn’t help because bad news is better than good.
Finally, groups like the Irish Nurses Organisation unintentionally undermine their own members by focusing solely on the negative aspects of their working conditions. The classic example is the “trolley-count”.
The INO counts in the morning, when it’s at a maximum. The HSE waits until the afternoon when patients have been processed. The INO isn’t lying – the people were on the trolleys – but the exercise intensifies the perception that A&E is a semi-permanent national disaster zone.
Instead, the major centres provide a model of how work practice reforms that are enthusiastically embraced by workers can create a fantastic service of which they and their patients should be proud.
If this same model of reform could be applied to black spots such as the criminally long waiting lists for chronic disorders at Temple Street, then we could all dump the private insurance.
Minister for Health Mary Harney claims she is trying to do for cancer care what has been done in AE, but faces “stakeholder” resistance – chiefly within the bureaucracy.
Perhaps if A&E’s successes were promoted as much as its occasional failures, it would inspire workers to push the necessary reform rather than use it as a bargaining chip in pay negotiations. It’s just a thought. And thanks to all at Temple Street.