Sir, – Elective surgery is in direct competition with acute (emergency) surgery for the limited resources available in the health service (“Surgery waiting lists: Emergency department patients will always win over elective patients”, News, October 21st).
The HSE have laudable plans to build three-day case hospitals in Dublin, Galway and Cork to cater for the majority of patients on waiting lists for procedures. Unfortunately our track record with building new hospitals does not inspire confidence that these badly needed facilities will be delivered soon.
To provide care for those on surgical waiting lists a hospital should have operating theatres, outpatient clinics and diagnostic facilities – CT, X-ray and MRI – a modern ICU, adequate bed stock, adequate parking for patients, visitors and staff and ideally the hospital should be readily accessible from the M50 and be served by multiple bus routes.
Fortunately the solution to this problem is available in a much shorter time frame than it would take to build the planned hospital in Dublin.
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Crumlin hospital meets nearly all the requirements (bigger beds will be needed). The operating theatres are some of the newest in the public system. The 25-bed ICU is state of the art. The new ward blocks and outpatient facilities have many years of use remaining. There is plenty of space available for redevelopment if the brave decision was made to use this expensive and valuable asset before it becomes a fallow, derelict building.
It will be available in two years when CHI Crumlin transfers all its activities to the new National Children’s Hospital site.
This solution could be an excellent interim option to help address the needs of this under-served patient population, in all surgical specialties, who otherwise will languish on interminable waiting lists for more time than is fair or necessary. – Yours, etc,
DAVID P MOORE,
MCh Orth, FRCSI
Ballsbridge,
Dublin 4.
Sir, – Systems thinking is an area of management science which analyses the confusing behaviour of complex human systems. Its principles help to explain the curious fact that, despite 20 years of increasing reliance on the National Treatment Purchase Fund, we have longer public hospital waiting lists than ever (“Donnelly claims significant progress made in reducing hospital waiting lists”, News, October 18th).
The Irish public hospital system can’t keep up with demand. We don’t have enough beds, or staff to oversee them. Urgent needs – things like strokes, falls and heart attacks – displace non-urgent, “elective” healthcare.
Elective care includes everything from surgery on a painful hip, to evaluation of a worrying mole, to assessment of a child who should be walking and talking by now. It initially appears sensible to contract a private provider to perform such work on the State’s behalf.
However, systems thinking tells us that the effects of short-term policy interventions into complex systems are non-linear, delayed and often the opposite of what was intended.
The NTPF is a perfect example of this.
Desperate for short-term improvements in waiting list figures, policymakers find the prospect of outsourcing to the private sector irresistible. Addressing deeper structural flaws in Ireland’s complex, two-tiered system will not, after all, achieve such rapid results.
Yet by repeatedly choosing to invest in the private medical sector rather than the public system, we merely embed our reliance on that sector.
We incentivise overworked staff to migrate to the private system, or even overseas. And we send an implicit message to citizens that – if they really need to get sorted – they had better take out private insurance.
Ireland remains the only nation in western Europe without universal healthcare. Our peculiar and unfair system has been described by the World Health Organisation as an “extreme outlier”.
Reform of such a complex system is difficult. It requires long-term strategy and clarity of vision, not short-term fixes. – Yours, etc,
Dr DOMHNALL
McGLACKEN-BYRNE,
University Maternity
Hospital,
Limerick.