Is it just us or is our health service crap?

  • Niall Hunter, Editor

For your consideration (as they used to say on the 'Twilight Zone'), this article will present you with some vignettes from our health system. (Note for slow learners - italics used there for a reason).

This is the same system that those running it and working in it frequently tell those of us who don't appreciate the nuances of such matters, (journalists for example) that the system is of a 'high quality, generally speaking'.

Oh, yes, and 'research has shown, you know, that patients are by and large satisfied with the care they get, in spite of cutbacks etc'. Oh yeah, and 'rising patient expectations.' Let's not forget those things.

Oh, and 'our results (ie whether or not we kill or injure too many people unnecessarily) compare well internationally'. (Note - have yet to see such published results nationally on whether the number of people who unexpectedly die or get damaged in hospitals every day is more or less near accepted norms. So we'll take your word for it Professor.)

Seem to remember something, though, about litigation/data protection risks if such comparative results on clinical performance were published etc, etc m'lud.

And let's not forget the great and the good and the bow-tied who tell us (and have occasionally told me after some desultory protestations on my part, notebook and pen quivering in sweaty hand, desperately trying to suppress innate self-loathing), that when something goes seriously wrong, it is a...(trumpets sound and angels sing) 'rare event.'

'And the system, my good man, (what's your degree in, by the way?...oh...) is becoming more transparent. It's only a matter of time before we have official hospital league tables and comparative results between hospitals for surgery and other treatments.' (Only joking, said developments will occur over still-warm deceased corpse etc, but we have to say that - it sounds good - and don't you just hate those 'bureaucrats' in HIQA? Oh, did I mention this is a 'learning process' for everyone?')

Well, for the unnecessarily dead, damaged, misdiagnosed or traumatised patients, they've had all the learning they need.

They and their relatives usually have a pretty good idea (often manifesting itself as a sick feeling in the pit of their stomachs - difficult to transmit sometimes to hospital staff), when they know, amid all the hustle and bustle and occasional filth, that things are going wrong, or that nobody seems to be doing anything right.

So basically like, (as the uneducated are wont to say) a perusal of letters from some 'coalface' staff in the Irish Times over the past week seems to tell all of us who have ever been or had a relative left waiting in distress for hours or days on a trolley; or shoved into an overcrowded ward; or shifted from bed to bed; or left like an emotional wet rag having spent a largely fruitless week advocating on behalf of someone in hospital and coming up against something a little harder than a brick wall (a brass neck, perhaps?);or have had to endure plain pig ignorant rudeness while the patient is in a vulnerable state...or...or...

Well, what the bereaved, the damaged, the misdiagnosed, the traumatised are essentially being told by some people in the health system is they shouldn't really be complaining that much.

Oh it's all coming out now, we know what his hidden agenda is (BTW, is it a sign of incipient madness when you start doing both sides of the argument?)

And don't get me started (oh,!) about our 'rich man/poor man' hop, skippin' and a-queue jumpin' unequal access health system, with the ideal of better private healthcare being unashamedly flogged to the highest bidder like the last turkey in the shop on Christmas Eve.

And don't worry, universally high cost health insurance for all is on the way.

And as for free GP care for all. Excuse us while we fetch our vuvuzelas to hoot with derision. Even one of the junior health ministers (the one who replaced your one who resigned) admits that that was pretty much all, er...a fib. Flame resistant pants anyone?

But one must exercise don't want to sound like one of those hysterical harpies who want a safer maternity service.

Anyway, what the 'powers' that be' (don't you love that phrase? Powers that be what?) in healthcare will tell us is:

A. Our system generally works and doctors and other health workers are great, of debate, and, er goodnight, oh thanks, mine's a G&T...

B. Safety lapses are rare, so we don't need too many safety precautions. Such as...(sigh):

* Following up properly on blood tests/x-rays;

* Reading x-rays/patient files properly;

* Telling patients and their relatives what's wrong;

* Telling your colleagues on the same treatment team in the same hospital how a patient is progressing or otherwise;

* Giving discharged patients proper advice on post-hospital self-care/lifestyle etc;

* Drawing up early warning systems for rapidly deteriorating patients;

* Washing one's hands after examining a patient (and no, it's not a threat to your clinical independence to be told to use some liquid handwash occasionally);

* Providing a patient with edible, nutritious food;

* Cleaning the odd toilet, or blood off the floor;

* Or, heaven help us, listening to a patient.

You know, all that type of nitpicking stuff that can be so aggravating for some of our healthcare staff.

'By the way, let us be the first (you're not, but go ahead anyway) to offer our condolences to the family of...'

C. If in doubt re B, see A.

D. Oh yes...and stop complaining...and see A.

To which all the average, uneducated, unsophisticated user of and payer for our far from perfect system can say is 'I know he's a Hindu, and with the deepest respect to his religion, but thank God Praveen Halappanavar did complain.'

And so to patients' stories. The letters in the Times previously referred to were in response (...couldn't help but notice...has been brought to my attention by butler on sliver platter with breakfast kedgeree...mnaw! collegiality! etc) to an article by Ann Marie Hourihane.

The article suggested that our health service is, well...often, em,... sometimes, er, in fact a lot of the time...well...crap.

How crap is it?

Well, judge for yourself. Like the shares in those dodgy investment ads, craposity levels can rise or fall:

Every week's Rate My Hospital service gets around 50-60 ratings and comments from patients and their relatives about their recent experience of the hospital system. Here are comments about some patients'/relatives' recent experiences:

Mayo General Hospital:

"The staff in elderly care were terrible. Really bad attitudes. Especially one staff member who came in one day to find my mother (who is paralysed on the right hand side from a stroke) sitting slumped to one side on a standard armchair in tears. I asked if she could lie in bed again as she is unable to sit up and she was freezing and the staff member refused. Eventually a lovely nurse came in an ignored this staff member's request and put my mother back into bed thankfully. It was so unprofessional. I could not believe what I was witnessing. My mother has been ill for two years now and I could write a book on some of the things I have seen. I have documented most of them. On another occasion a student nurse changed my mother, I thought she was a nurses' aid. I offered to give her a hand. I had to take over as she hadn't a clue and she asked me "was it okay to leave the soiled sheets on the bed"! I constantly had to check to see if the correct medication had been administered. Two years ago my mother had a stroke. She was subsequently sent to Galway for an angiogram. I was advised not to go with her as there was no need, as it was a 'simple procedure'. During the angiogram she suffered a severe stroke. I was then called to get the immediate family up to Galway immediately. We had to sign for the anti clotting drug. This could have been given in the early stages if a family member had been allowed accompany her. I found out months later from a nurse that my mother had been very distressed that morning leaving for Galway and yet none of them called the family. From what I have seen there are extremely poor management skills. I do realise staffing numbers have been cut but some of them seem to use this as an excuse."


Cork University Maternity Hospital:

I had my son in early 2011 and still can't talk about it without crying. Horrifying experience for me, my husband and my family...The verbal abuse my husband and I received would not be believed. It certainly wasn't the heart warming experience that having your first baby should be. I could not wait to leave. Awful, disgusting, unprofessional, staff from start to finish. Just awful.....its upsetting to even think about it.


Our Lady of Lourdes, Drogheda:

"My daughter had broken three bones in her foot and we had to wait three hours before she was seen. She was then sent for an x-ray where we had to wait another 30 minutes. We then returned to the clinic before being seen 30 minutes after. The doctor was no help at all, they just sent her to get a cast on her foot and told us to come back in six weeks. Six weeks passed and we returned again for the same carry on all over again. This time we had to wait four hours before being seen. This is absolutely disgraceful. There were people in terrible pain and they were not being seen to at all. Something seriously needs to be done about this massive wait at the clinic."

Tallaght Hospital:

Male ward toilets were so bad they made me feel sick. There was no way I was having a shower on the ward. No soap in the dispenser throughout my stay, I felt so dirty. Food on the ward was so bad, it was only lukewarm and tasteless. I have never seen food look so bad. I lived on sandwiches from the shop. The food in canteen wasn't much better. I don't know how very long-term patients don't die of hunger, it is that bad.

Kerry General Hospital:

My family's experience in KGH was on of the worst experiences of our lives. From the minute my grandfather was admitted into A&E he was treated as an inconvenience more than anything else. This 91 year old private (not that it should matter) patient was then left on a trolley for nine hours before being admitted to a ward. Having received NO diagnosis, rather than him having a 'slight infection' the previous night, we returned the next morning to hear that he had a serious illness and hours left to live. Luckily (or maybe unluckily as it transpired) my grandfather was a fighter, and survived another five weeks. During this time he was diagnosed and re-diagnosed about eight different times and his age was mentioned more than his actual name. Many of the staff were indifferent and downright rude towards the man and clearly seemed to resent us keeping vigils by his bedside...There were of course the odd exceptions namely Dr Cashe in A&E, Dr Billy the house doctor and Dr Sheehan. The student nurses were also a Godsend, showing more care and consideration than any of their seniors could manage. Fr Spillane was also fantastic. Overall, it was a horrific experience, and should I ever get sick myself I'd prefer to take my chances in the parking lot....I suspect I'd have a greater chance of survival out there.

You can find thousands more Rate My Hospital patient stories here.

Click here too, for thousands of testimonials to how considerately and professionally people can be treated by individual staff in hospitals.

It should be emphasised that we are not singling out particular hospitals in the comments above - all the above hospitals, like every hospital in the county, have had both very positive and very negative comments and ratings posted on Rate My Hospital.

It appears that quality of care can vary considerably between and within hospitals. Why this should be the case, however, is perhaps something that needs 'looking into'.

Unfortunately, to date, there is little sign of the health authorities providing the public with transparent audit results on clinical outcomes within and between hospitals for various procedures and treatments.

Potential legal difficulties? Advice to Government/HSE - tell anyone who objects to transparency to get lost, or at least challenge their legal objections. The public has a right to know.

The HSE, or whatever replaces it, has a duty to tell the public how its hospitals rate in terms of quality and safety, taking into account obvious factors like complexity of surgery, patient volume, age etc when publishing results and comparisons.

Bland safety assurances following the latest 'clinical incident' atrocity or reciting surveys which show that two-thirds of patients are generallty satisfied with their care will no longer do. There are a lot of dissatisfied patients out there, and even those who are generally satisfied will have caveats about aspects of their care.

Let's not forget that, extrapolating international statistics to this country, there are estimated to be 160,000 patients, or 4% of hospital admissions, damaged or affected adversely in some way by hospital treatment in Ireland.

EU-wide research in 2010 found that 20% of those surveyed in Ireland said they or a family member had experienced an adverse event in healthcare.

Rate My Hospital is still, six years after its launch, the only hospital rating system available to the public. This is not mere self-hype - it is fact, and indeed a severe indictment of the fact that our health authorities have yet to provide such a guide to the safety and quality of our system.

It is compiled by the people who use the system they pay for. Every day, these people take the time to rate a hospital under different headings and, if necessary, provide an account of their experience. Given the traumatic nature of some people's experiences, this is not often an easy thing to do.

It is not a 'cranks' forum', and this can be testified to by the fact that over 7,000 service users have gone to the trouble of posting very positive comments about health staff attitudes and skills. Nor is it a commerical venture - it's not sponsored by anyone.

In many respects, Rate My Hospital is the only currently available accurate narrative of our healthcare system, free of management spin, hidden agendas, political point-scoring or industrial relations mumbo jumbo. In many cases, it is the story of what is seriously wrong with this system.

Over six years or so, it has amassed 25,000 ratings and 15,000 comments. Some comments, it must be said, praise staff and hospitals to the heavens, and rightly so. Others are to put it mildly, highly critical of what is sometimes an unnecessarily hellish experience.

Oh yes, and here comes the caveat to all this negativity (Note - caveat not a type of necktie):

Many, many, many people are treated very well every day in our health system. They are cared for and cured successfully by kind, professional, good quality staff...usually, but not always.

Yes, and not wanting to disrespect (or indeed patronise) highly professional health staff, but should we be excessively grateful for this? Should we use it as a fig-leaf to cover bad practice, systemic ineptitude, sins of omission or commission, lack of communication/transparency?

How much longer can we continue to accept assurances that generally speaking, our health system works in spite of everything? And then read the latest medical scandal report and wonder why a patient has to die or get damaged unnecessarily before anything is done about implementing basic healthcare practices and precautions?

It is only when we stop being extremely grateful that most people do the jobs they are paid to do reasonably well most of the time, and when our health authorities and political leaders decide to tell us the full story when things go wrong, and lose the their congenital instinct not to blame people occasionally, that 'the system' will change for the better.

If you're in doubt, ask Praveen Halappanavar or any other victims of 'adverse events'.



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