Save our Health Service

March 4, 2009

A letter to the editor of the Irish Times, caught my attention the other day as it’s topic was the health service. I was very pleased to find that it’s content confirmed my views about the abuse of out-patient clinic appointments in our public hospitals. The contributor proposed some ideas to solve this problem, measures which would also help to reduce waiting lists and raise funds for hospital services.

The letter was headed “DNA and Hospital Waiting Lists”

save-our-health-service“Madam, – Sheila Gorman (February 19th) notes that last year St James’ Hospital had almost 25,000 “DNAs”. As she explains, a “DNA” is someone who did not attend the hospital for their appointment. They did not call to cancel or postpone and so the hospital’s time was lost.

In my own area of Pembroke-Rathmines, St Vincent’s Hospital had 26,878 “DNAs” last year.

Assuming similar figures for hospitals across the country, waiting lists could be cut dramatically by appealing to those who have made medical appointments which they no longer require to cancel their appointment. This would also help to ensure that those most in need of medical attention get it sooner.

In the UK, NHS dentists request a £20 deposit from patients booking an appointment. This is later refunded or discounted from the bill. If the patient does not attend,and fails to cancel in time, the dentist keeps the £20. A similar scheme for our hospitals would either reduce waiting lists by hundreds of thousands or raise millions of euro to provide better services.

Could this be a simple way to improve our own health service for medics and patients alike?”

Source: The Irish Times online.

There are probably lots of reasons why so many public patients do not attend for hospital appointments but I would say prime amongst them, is a lack of respect for our inefficient health service. I’m all for making our present health service more efficient but only if it results in improved patient care. The sooner we get a system of universal health insurance in place, the better.

For anyone interested, world-famous cancer specialist, Professor John Crown will address a Public Meeting in Blanchardstown tomorrow evening. The meeting, hosted by Deputy Joan Burton of the Labour Party, will deal with issues relating to the future of Connolly Hospital, Blanchardstown and will facilitate questions by members of the public.

Where? St. Brigid’s Community Centre, Blanchardstown
When? Thursday 5th March 2009 at 8pm

Prof. Crown will address the meeting on the importance of introducing universal health insurance to put an end to our 2-tier health system.


Aychessee Sinking?

July 21, 2008

What’s that about? It took me a while before the penny dropped.

The “Aychessee” is a sinking ship according to Prof John Crown. “A suitable alternative needs to be launched before it sucks our health service and our economy down with it into Davy Jones’ Locker.”

You can read all about it here.

If you’re still confused as to what this is all about, it may be because you pronounce “H” as “Haych” in keeping with Irish ways.

Aychessee = HSE. Geddit?

It remains to be seen if Captain Harney and First Mate Drumm, will stay with the sinking ship.


So Dat’s Dat!

May 6, 2008

After ten years, ten months and ten days in office, Bertie’s finally gone! You cannot but wonder if Mary Harney will soon be following him. Brian Cowen, our Taoiseach-in-waiting, is due to receive his seal of office tomorrow and will announce his new cabinet shortly afterwards. Will he show Mary the door?

I had to laugh when reading about the HSE in the Sunday Indo yesterday. “A bloated system”. “HSE belt tightening is a fat lot of good”. “The HSE like everyone else needs to tighten the belt, to cut a little fat”. “The HSE will soon resemble a hippopotamus in bondage gear”. I”ll give you one guess as to what stimulates this sort of language from newspaper columnists. You’re right! Our present Minister for Health is no advert for healthy living and after three and a half years in the job, she’s definitely looking the worse for wear. Harney took on this role in September 2004 with promises to reform the health service. During her time in office, she is credited with achieving a reduction in A&E waiting times, putting a new cancer control programme in place, reducing operation waiting times and the introduction of hygiene audits.

A recent report provided by the HSE, showed that in the first two months of this year 44 per cent of patients in hospital emergency departments awaiting admission, had to wait longer than the official maximum target period of 12 hours. The report also revealed that the number of patients waiting more than 24 hours for admission increased by 57 per cent over the same period last year. The only thing that has improved is the HSE’s daily fiddling of the figures to make it look like there is a reduction in the numbers on trolleys.

As regards the cancer control programme, Mary Harney secured at enormous cost, the appointment of a top cancer specialist, Prof Tom Keane. His mission is to restructure cancer care in this country with the introduction of 8 new centres of excellence. According to John Crown, a medical oncologist, none of the four centres planned for Dublin will be comprehensive. “The plan is that colon cancer is treated in one place, lung cancer in some other place. That is not excellence in care. It is a system based on compromises which are in turn based on medical politics”. Under the new plan, there will be no centre of excellence located north of a line between Dublin and Galway. This system is already doomed to failure.

Waiting lists for operations have been reduced but at a huge cost. Surgeons and their operating teams in our public health system are frequently left twiddling their thumbs when their operating lists are cancelled because of the shortage of beds for elective admissions. Meanwhile the HSE is paying top dollars to the private hospitals via the National Treatment Private Fund (NTPF) to have public patients treated in the private system. This madness is Mary’s solution to the long waiting lists. Talk about false economy.

And finally the hygiene audits. Mary Harney promised back in 2005, to tackle health care associated infections (HCAI) and said that the target over the next three to five years would be to reduce hospital-acquired infections by 20 per cent and MRSA by 30 per cent. The numbers of patients becoming infected with MRSA fell only slightly last year. Newly released figures show there were 533 cases of bloodstream MRSA infection reported last year, compared with 588 in 2006, a reduction of less than 10 per cent. Overcrowding, poor cleaning, haphazard hand hygiene, infrastructural defects, and lack of infection-control staff particularly microbiologists, is favouring the spread of the hospital superbugs. Our Minister for Health is more interested in budget control than infection control and patients remain at serious risk of infection.

New official figures have shown that the HSE is now €95 million over budget for the first four months of the year. The HSE has drawn up a series of controversial proposals to claw back on the financial overrun. These include hospital bed closures, the curtailment of A&E services and new restrictions on the issuing of medical cards and drug-cost reimbursements. There is also a proposal to divert the €185 million earmarked for the development of services for the disabled, older people and those in palliative care. We ain’t seen nothing yet in terms of cutbacks and the impact this will have on patient care.

There is increasing unrest amongst those working in the health service and patients too, are fast losing patience. Mary Harney’s credibility has been badly damaged by a series of cock-ups and system failures during her tenure in office. The failure to get the new consultant’s contract up and running has been a major blow to her plans. Her promises to reform the health service, have not materialised. The question remains. Will Brian Cowen take the easy route and leave Mary Harney to continue to take the flak or will he have the courage to show her the door?


A Balancing Act

April 19, 2008

I listened with interest to Prof John Crown on the Late Late show last night as he outlined the failings within our health service. John Crown is a leading consultant oncologist working in the front line of the Irish health service and he doesn’t mince his words. He believes that the consultant’s contract as currently presented by the HSE, is a fiasco. He described it as an apartheid contract for an apartheid system of healthcare. Today, I heard that the Irish Hospital Consultant’s Association (IHCA) has accepted the HSE’s proposals and will be recommending the contract to it’s members in a ballot later this month. Meanwhile, the Irish Medical Organisation (IMO) is still refusing to come on board and has today requested third party mediation to resolve the problems. On one side, we have a government that insists on perpetuating a 2-tier system of healthcare despite the consensus of opinion which believes that a single tier health service is the way forward. On the other side, we have doctors who don’t like being put under the thumb by administrators who will decide their working hours. This contract has already been four years under discussion and I have to agree with Prof Crown, it has the potential to be a fiasco.

We have a health service in Ireland that offers a high standard of care but the care is not optimal. According to John Crown, this is due to ‘mal’ funding rather than underfunding. When the allocation of money from the HSE runs out, services are cutback at the expense of patient care. Treating patients costs money but It costs the system nothing to have patients on waiting lists. We have a health service run by civil servants instead of having a medical leadership structure in place. The policy of co-located hospitals as proposed by the Progressive Democrat (PD) health policy, is set to cause an even wider divide between the public and private systems. Each system will be differently funded, further adding to the complications. The concept of co-location ultimately means that services are duplicated in the one location. This is neither efficient nor cost effective . The co-located private hospitals already in existence, tend to be small and have sub-optimal expertise in place. As a holder of private health insurance, I can personally testify to this having once faced the decision of having to choose between standard of accommodation and standard of medical care. I was very unwell in A&E at the time and required admission for investigation. As I was known to be infected with MRSA , I required isolation facilities in order to be admitted to the hospital. There were single rooms available in the co-located private hospital but the physician under whose care I was to be admitted, worked only in the public hospital where no isolation facilities were available at that time. This dilemma typifies all that is wrong with the plans for co-location and the divisive nature of the consultant’s contract. I had no problem choosing medical expertise over comfort but I should never have had to make that choice. Why does healthcare have to so divisive? If you’re sick and in need of hospitalization, the type of care you receive shouldn’t be dictated by your ability to pay.

John Crown is in no doubt that the way forward for our health service is a single-tier, not for profit system of healthcare based on a universal system of social insurance. He makes no apology for speaking out about the deficiencies within our health service. As long as there continues to be vested interests and a burgeoning bureaucracy in control of our health service, the system is doomed to fail. The future of the consultant’s contract remains in the balance.


Be Angry

April 9, 2008

When I first saw the list of speakers lined-up to participate in the Health Debate, I couldn’t believe my luck. This was a prime opportunity to hear our Minister for Health endeavour to defend her tactics to privatise healthcare in this country at the cost of the public health service. As it turned out, she left in a bit of a hurry but I did, at least succeed in getting to have my say.

I arrived early in the front square of Trinity College Dublin (TCD) just as the State car drew up at the entrance to the Exam Hall. Mary Harney stepped out of the car wearing what can only be described as, velour pyjamas and with her entourage in tow, she proceeded up the length of the exam hall with me in hot pursuit. Her pyjamas proved to be an excellent decoy as nobody took a blind bit of notice of her and she was quickly escorted to a side room to await the arrival of the real stars of the night. The debate was ably chaired by Conor Gannon of TCD VdeP Society, who did a fine job introducing each of the speakers and keeping order throughout the debate. The motion put forward was: “This House believes that the Irish Health System Fails the Disadvantaged”. I’m delighted to be able to report the motion received unanimous support from the audience and Mary Harney and her band of loyal followers suffered a resounding defeat. Unfortunately, she didn’t stick around for long enough to hear the disquiet that flowed from those on the panel in support of the motion, and from the audience. She made a hasty retreat shortly after delivering her own contribution to the debate. We were told that she had been “called away by Cabinet business”. Yeah, right!

The debate was opened by Prof. Orla Hardiman who gave an impassioned speech about the faults within the health service. She urged the audience to “be angry, be very angry”. She is firmly in favour of an equitable healthcare system for all and her address received rapturous support. Mary Harney then got to her feet and declared that it is her intention to provide a health service based on medical need (as opposed to ability to pay) and insisted that huge progress has been made. We got reams of statistics about how the health service is helping us to live longer but in reality, it was a lacklustre performance. She was constantly interrupted by a heckler in the audience who persisted in shouting her down despite repeated requests to desist. While this heckler was clearly out of order, his intervention proved to be the only challenge to Mary Harney last night as she departed before any one else got the opportunity. Fergus O’Ferrall, speaking in favour of the motion, informed us that 90% of the €16 billion spent annually on the health service comes directly from our taxes. The other 10% of funding comes from the private health insurance market. He accused the HSE of mismanagement through under-provision and rationing of services. The next speaker, Dr. Sean Barrett who opposed the motion, almost won approval when he declared that this health service not only fails the disadvantaged, “it fails everyone”. However, he then proceeded to place the blame on productivity being too low, the fact that private medicine is practised in public hospitals, the high ratio of staff to number of beds, and a greedy medical profession. He made no mention of the Dept of Health or the HSE. Mary Harney scuttled out of the room at this point while she still had someone on side. Throughout the evening, those in support of the motion gave credit to the late Susie Long for using her own plight to highlight the failures within the service. The opposition put forward two further speakers, an ex-TCD student and member of the young Progressive Democrat party (Mary Harney is a PD ) and also a manager from the HSE who were both, it has to be said, less than convincing. We also heard from two further speakers in support of the motion. Audrey Deane, representing the St.Vincent de Paul Society, told the room that HSE managers are turning to the SVdeP to access help for those failed by the system. How bizarre is that? The final speaker in support of the motion was Prof John Crown who denounced the waiting lists caused by underfunding in the health service. He joked that if we had such a thing as an abortion clinic in this country, he was sure the waiting list would be 10 months. “That’s if you go privately, going publicly would take longer!” EU figures for waiting times, show Ireland coming 2nd last on the list. He accused the HSE of employing too many spin doctors, referring to the place as ‘Burassic Park’. John Crown wants to see the Bismarck model of healthcare implemented (a one tier, not-for-profit health service) or else he warned “we’re heading for a ‘Paris Hilton’ style of health care”.

The debate was then opened to the floor and speaker after speaker outlined their experience of the deficiencies within the service. I waited until the end of the night before taking to the floor and then, I let rip. I surprised myself by the depth of passion which flowed as I spoke about the chaos in the public health service, the squalor of the conditions endured by sick people and the scourge of MRSA in our hospitals. I outlined the madness of the recent HSE cutbacks, the continuing problems in A&E despite claims to the contrary and warned of the consequences to follow if Mary Harney’s continues to privatise healthcare in this country. I also spoke out in defence of those who have private health insurance. We tend to be blamed for contributing to the a 2-tier health system when in fact we feel forced to seek insurance as we know we cannot rely on the health service in times of need. I concluded by commending the hard work of those healthcare workers who strive to provide excellent care in difficult conditions and reminded the audience that we need to protect the good aspects of our health service from further government interference.

Following the resignation of our Taoiseach, Bertie Ahern, last week Mary Harney announced that she had no intention of running away from her post as Minister for Health. In response, I’d like to say to Mary “be afraid, be very afraid. Time and patience is fast running out.

UPDATE: I forgot to thank Grannymar for her support in helping me to highlight this debate. The chairman of the debate was delighted to have a full house for this annual event and was impressed to hear that the blogging community had given support.


You wanted more

April 5, 2008

Here is another opportunity to join the Health Debate.

Motion:This House Believes That The

Irish Health System Fails The Disadvantaged”

Tuesday 8th April 2008, Exam Hall, TCD @ 6pm

Speakers include:

Mary Harney (Minister for Health & Children)

Dr Sean Barrett (Lecturer in Economics, TCD)

Frank Mills (HSE)

Prof John Crown (Consultant Medical Oncologist, St Vincent’s Hospital)

Audrey Deane ( St Vincent de Paul Society)

Fergus O’Farrall (Adelaide Society)

Prof Orla Hardiman (Consultant Neurologist, Beaumont Hospital)

It’s a fantastic line-up of speakers. I intend to be there too!


A Force for Change

March 30, 2008

healthcarecrisis.jpg

If you’ve read this blog before you’ll know that I’m continually harping on about the crisis in the Irish health service. Put simply, the public health system in is melt-down. When the HSE was first set up, we were promised better services – we got patients on trolleys. We were promised better conditions for health staff – and we got a jobs freeze. We were promised value for money – we got mismanagement and dictat. Yesterday, I was given reason to believe that this health crisis will not end in catastrophe.

An estimated crowd of over 4,000 people turned out in Dublin to demand a better public health service. People travelled from all over the country to take part in the rally. It was the first time that patients, consultants, hospital staff, unions and patient pressure groups all came together to declare “Enough is Enough” and demand a decent public health service. The Irish Nurses Organisation (INO) and Irish Medical Organisation (IMO) gave their support. Eamonn Gilmore (leader of the Labour Party), James Reilly (Fine Gael health spokesman) and the Lord Mayor of Dublin all participated in the rally. The march was well-organised with the Gardaí providing an escort of outriders to facilitate movement of the large crowd through the city centre to Government buildings where the rally was addressed by speakers representing each of the groups.

ConorMacLiam, gave a very moving address to honour the wishes of his late wife, Susie Long. Susie’s untimely death last year was brought about by the direct failure of this government to provide an equitable health service for all. Conor claimed that as many as 5,000 people are dying each year as a result of cutbacks and delays in the health service. He also told us that the government has plans to privatise hospice care in this country. This government is determined to pursue against all advice, a policy of privatising the public health service and now we hear that it also plans to develop a 2-tier hospice service. How nauseating is that?

For me personally, there were many highlights to the day. I thoroughly enjoyed the camaraderie of the crowd as I walked alongside young and old, from all walks of life but all united in determination to fight for a better health service. They all had stories to tell of their travails with the health service. I was also encouraged to see two emminent hospital consultants join the rally and take to the stage to give their views on the health service. Prof. John Crown, a consultant oncologist, confirmed that we have been sold a ‘pup’ by this government in terms of healthcare and very soon when we enter a hospital it’ll be a case of “Turn Left” if you’ve health insurance and, “Turn Right” if you’ve not. Prof. Orla Hardiman, a consultant neurologist and spokeswoman for Doctors Alliance (a lobby group formed in 2007 that advocates for better public healthcare), warned that we should be careful to support and protect those elements of the public health service which work well in serving the sick. Otherwise, the government will use the constant whining from the public as further reason to privatise healthcare in this country. I thought this was an excellent point. There are lots of good aspects to our health service and we need to preserve and protect them from government interference.

Susie Long went public in the final year of her illness to highlight the inequities in the system. She turned her own personal tragedy into a force for positive change. She helped to motivate me and many others, to do more to highlight the failures within the health service. I was determined to be there yesterday to honour Susie’s memory and I can honestly say that for the first time in a long while, I felt the tide may be turning. Hopefully, this rally will prove to be the catalyst for change.


Enough is Enough

March 27, 2008
health-cut-backs.jpg

If you’re sick of our health service, or lack of one, here is your opportunity to campaign for better healthcare. A march and rally has been organised in Dublin to demonstrate public dissatisfaction with the health service. The time has come to show the Minister for Health that enough is enough!

An umbrella group of health unions and patient campaign groups are urging the public to come out in large numbers next Saturday 29th March, and support the march. The rally will assemble from 2.30pm at Parnell Square, Dublin where it will be addressed by speakers, before proceeding to Molesworth Street.

The following speakers will address the rally:

Prof. John Crown, Consultant Medical Oncologist

Conor MacLiam – husband of the late Susie Long

Representatives from the following groups will also contribute:

Doctors Alliance for Better Health Care

Irish Nurses Organisation (INO)

SIPTU

Health Services Action Group

Patients Together

MRSA and Families

Recent cutbacks in government spending have resulted in further suffering for Irish patients. Our government has failed miserably in it’s commitment to deliver an equitable health service based on need. The bureaucrats within the Dept of Health and the HSE should be shamed for the long litany of dysfunction within the health service. Patients have suffered for too long without the basic healthcare they deserve. It’s time for change.

Please support this march to show you care. I’ll be there – will you?


Health Service Exposed

September 25, 2007

I’ve long been a fan of Prof John Crown, Consultant Medical Oncologist, for the manner in which he speaks out to expose the faults in the Irish health system. John Crown does not mince his words – he says it as it is and in doing so has managed to rattle cages to shame the Department of Health into doing something about the disastrous health service in this country. He writes a regular column in the Sunday Independent which exposes the chinks and cracks in the system, and helps to paint a clearer picture of the problems involved. Last Sunday’s article was no exception where he likened the bureaucrats in the HSE (Health Service Executive) to the dinosaurs taking over in Jurassic Park, and named it ‘Burassic Park’.

In a week when the HSE announced a freeze on recruitment leading to health service cutbacks, they simultaneously announced a scheme of performance bonuses for senior HSE administrators. As John Crown so rightly pointed out, this clearly shows where the priorities of the HSE lie. This latest action by the HSE is a complete insult to those who are expected to continue to work in an already under-resourced and over-burdened health system. I personally feel very uncomfortable about the way in which our Minister for Health, Mary Harney, has reacted to the events that have happened at Barringtons Hospital recently concerning cancer care there. She is insisting that the Dept of Health has no authority over private hospitals and thus she says, it has no authority to take action to intervene. This does not bode well for the future of our health service which will have many more private hospitals coming on stream as the Minister insists on pressing ahead with the co-location debacle. Who will take responsibility when things go wrong in these private hospitals?

John Crown also clarified the problems involved in the stand-off that continues between the Dept of Health and the Irish Hospital Consultants Association (IHCA) over consultant contracts. To his credit, he actually criticised the consultants (his colleagues) for their increasingly unseemly row over private practice rights of their as yet, non-existent colleagues. He believes that the IHCA should concede the inevitable and accept that the new consultants will have to have new contracts which the Dept of Health will ultimately decide upon. He encouraged consultants instead to “channel their energies into the good fight, which is the fight for healthcare reform, universal health insurance and single-tier healthcare”. At last common sense has spoken!

Irish patients deserve equity of health care and a better healthcare service. We owe a great debt of gratitude to John Crown for the role that he plays as a doctor to advocate on behalf of all patients. He is a voice of reason in a world where common sense is sadly lacking. May he long continue to fight the good fight on our behalf.


Follow

Get every new post delivered to your Inbox.