Patients paying price for poor health system

[Posted: Wed 07/05/2008]

By Claire O'Reilly*

How many more scandals are going to happen? Recently, an elderly patient was on a trolley for over sixty hours following a heart attack in an A&E dept in one of our major hospitals. It was reported that she didn’t see a specialist for two days. We only know this because her family felt moved to speak about her plight on RTE News .

It took courage for this lady’s family to speak out about what was happening. Apparently a bed was later found and I hope the patient makes a good recovery. It will happen however, despite our health service, not because of it.

Today I feel ashamed to have been part of the nursing profession. I spent a horrendous night last year in A&E because of complications following an angiogram. I didn’t have a choice. I was brought to the hospital in an ambulance.

It was during the nurses' strike which I had fully supported. Nothing that happened to me in A&E that night was as a direct or indirect result of the nurses' strike. But I was left with a question for nurses everywhere.

Why did they you not go on strike a long time ago when they were asked to carry out your professional duties in the conditions in which you are being asked to work? How can you have allowed the dignity of the patients, which was such a priority when I trained, to have been eroded to the extent that it has?

I understand that it probably happened slowly and subtly. But surely at some stage you must have noticed? I know nurses were not instrumental in bringing about these conditions, but following that night in A&E, I couldn’t help but feel that you were partly complicit by not speaking out and taking action.

I felt dehumanised by my experience that night and I am well able to speak up for myself. But I have made a decision that I will never of my own volition return to an A&E dept.

I believe that Mary Harney and Brendan Drumm are not heartless people, but they both appear to have developed an arrogance that prevents them from listening to anybody else’s point of view.

I believe they both have a vision for an excellent health service for the future. But the problem for them is that people keep getting sick and upsetting their plans because they need treatment today.

They won’t wait to get sick until their ‘excellent’ health service is in place. If the service could be closed down as one could a factory, and reforms could be made while no service was needed or provided, then they could have a grand reopening with the centres of excellence etc. up and running.

The problem is that a service is still needed while the reforms are taking place. This is what Mary Harney, Brendan Drumm and the entire HSE appear to have lost sight of.

To maintain an acceptable service while introducing the reforms will probably cost more initially as the two run concurrently but savings may be made in the long term.

When the large psychiatric hospitals were being shut down and mental health services were being transferred to the community a few years ago, it was pointed out that the initial outlay would be greater but ultimately the savings could be made.

This is what should have happened if both services had run concurrently to maintain optimum care for those accessing the service.

But this didn’t happen and the promises that the money from the sale of the lands etc would be ploughed back into specific services for mental health were not kept.

How many times have we heard recently of a lack of services for children and young people with mental health problems? And we have much anecdotal evidence of people falling through the cracks in the so-called reformed community psychiatric services.

Is money allocated for services being siphoned off to be used elsewhere? Is there too much money in management? How can this top-heavy bureaucracy be allowed to continue? Practically all of the expensive reports done following recent scandals put forward “system failure” as the cause of the scandals.

But a system can only be as good as the person/people who are operating it. All systems are put in place by humans who are paid to do a particular job. If a system fails it is because somebody didn’t do their job properly.

How can there be no accountability? How can this scandalous situation be allowed to continue? Somebody must be held accountable.

Incidentally, can we be told what part of Brendan Drumm’s job merited his bonus of €80,000? The implication of his and probably some of his colleagues getting a bonus is that some part of the HSE is working successfully.

Is this 'system success'? And if it is, how can the people responsible for it be identified and rewarded, but those responsible for 'system failure' cannot be found, named or held accountable?

Anytime Mary Harney or Brendan Drumm or anybody from the HSE is interviewed they talk about the COST, the millions, if not billions that are being spent on the health service; an unprecedented amount of money.

Yet we have appalling overcrowding in A&Es, we have the breast cancer misdiagnoses, we have cutbacks and staffing embargos, we have respite care for the elderly being discontinued; we have a report of the appointment of a consultant for a palliative care service needing the signature of 46 managers in the HSE (Prime Time Tuesday April 15 2008), we have MRSA, we have patients dying with Clostridium Difficile in Ennis ('they died with the infection, not from it', said the HSE defensively).

People have a fear of being hospitalised. I have a fear of being hospitalised.  The list of scandals is seemingly endless. And how many others have not yet or may never make the headlines?

So while Mary Harney and Brendan Drumm and their cohorts constantly talk about COST, do they not see who is paying the PRICE?

The price is being paid at present by those lying on trolleys in A&Es, by the people who were misdiagnosed, by the elderly people and their carers who will no longer have respite care, by the people dying in inappropriate hospital beds because there are not enough palliative care beds available, by patients who have to travel long distances because of the closure of local hospitals and local A&E units, by people who are on long waiting lists for diagnostic tests (remember the late Susie Long and her family),by the people who died in Ennis and their families. 

I could go on and on. This price is too high. This price will continue to be paid by the sick children of Ireland and their families if the decision to build the new children’s hospital on the Mater site is not reversed. How can that site be acceptable given the traffic problems that currently exist in that area?

Add the few thousand staff cars and a couple of cars per patient in the new hospital and gridlock doesn’t even come close to describing what will happen on the roads. Lives will be lost because of delays in reaching the hospital. Will this be another 'system failure' for which nobody will be held accountable?

I know reforms are necessary. Everybody knows reforms are necessary. But look at the breakdown in relationship between the HSE and practically all the health care sectors. If I have problems with all the significant relationships in my life, it is MY behaviour I need to look at.

Stop blaming everybody else. Listen to Fin Breathnach, John Crown, Orla Hardiman, Paula Gilvarry. Their words have all featured recently in the media and on the irishhealth.com website. They all work at the coalface and spoke or wrote in what I can only call a sane way about the health service. But is anybody listening?

Who will shout 'stop'?  When will the price paid by patients take priority over the cost? We live in a democracy. The money for the health service comes from the people through taxation. It is our money. Mary Harney and Brendan Drumm have been charged with appropriate spending of this money.

What they are doing is not working. The cost of a health service is the amount of money needed to provide a proper service to all the people who need it. Nobody chooses to get sick. If the amount of money in the budget doesn’t meet this cost then change it.

This doesn’t necessarily mean spend more, but please look at the top heaviness of the HSE. How can 11 administrative bodies merged into one with no redundancies be cost-effective? Stop asking the most vulnerable to pay the price. And please don’t ask any more patients to pay the ultimate price.

*Claire O'Reilly is a former nurse.

Jane(SPK69199)  Posted: 08/05/2008 15:56

The response as usual to poor levels of service is blamed on government and money. It might be more useful, however, to look at the way medicine has developed and how society has adopted the use of "quick fix medicine" - pharmaceutical products and surgical intervention as the accepted norm. This passive adoption has meant that we have acquired an apathy about the management of our own health, we have voted in a government who continues to restrict the financial resources available to the Health Service while continuing to invest heavily in pharmacy and acute care when what we should be doing is looking at the reasons that people are in hospital and addressing this. Obesity: this is not the fault of the health service. This is the fault of a government who fails to make legislation to disadvantage manufacturers of poor quality, high fat, high sugar foods. This is the fault of individuals failing to take responsibility for their own health and that of their children. High Blood Pressure: while there are several underlying medical conditions that lead to high blood pressure, the major cause of onset is poor lifestyle/exercise and stress and yet in most cases the first port of call, even for quite moderate elevations, for any GP when a patient presents to their surgery is to medicate. These medications are expensive and can have dangerous side effects. Often second and third medicines have to be prescribed to control the side effects of the first. In the past two weeks I have come across two patients, one suffered Atrial Fibrilliation and near heart failure with a heart rate of 35, the other appeared to show early signs of interstitial lung disease. Both patients quickly recovered from their symptoms when their Blood Pressure medication was removed. High Cholesterol: Up to recent times 7 was reckoned to be reasonable level of cholesterol, however, research funded and executed by drug companies has successfully lead to the introduction of lower levels as acceptable norms. Once again statins and other cholesterol lowering drugs have side effects. Often medication is prescribed without full investigation of the causes of increased cholesterol and without resource to other methods. In this way the cost of the health service is being unnecessarily inflated by the doctors operating within it. What is needed is a radical overhaul of the Health Service and those operating it and a focus on lifestyle intervention. Only this focus will result in a reduction in the number of people ending up in acute care and emergency care situations, so ensuring that we are in a position to fund an adequate level of Healthcare for all. What is required is an inter-service approach spanning education, sport, social services and health. One cannot simplify the situation and lay the blame at the feet of the Minister for Health and Professor Drum. The problem is systemic and will require time, commitment and patience from all to resolve.

Steph  Posted: 08/05/2008 17:10

I salute Claire O'Reilly for taking this stance. I salute her both as a patient and as a health professional for making her voice heard. She has made some very valid points and asked important questions. I admire her for admitting to feeling ashamed to be a part of a health service that lets it's patient's down. I would like to propose that the nurses would get huge support from the public if they were to strike about hospital conditions rather than pay rises. As Claire says, it's time to shout STOP! Everyone is paying the price for the shambles in our health service and with further cutbacks planned, it's going to get much worse - for EVERYONE! I agree with Jane (above). Government policies and budgets can only do so much. We need to look at taking preventative measures rather than playing the blame game. Patients too have a role to play. I am a patient and I'm not afraid to speak out about the faults as I see them in the health service. I write a blog (The Biopsy Report) to highlight the inadequacies in the system. I took part in the recent Health Rally in Dublin and I also contributed to the Health Debate in TCD last month. We as patients need to stand up and be heard and with our new Taoiseach now installed, the time is right. I've already paid the price for the failures within our health service. I am an MRSA statistic. Are you prepared to pay the price?

CATHY  Posted: 08/05/2008 21:01

It is not just the patients that are frustrated, doctors cannot work under restrictive conditions.In spite of the fact that old equipment in departments were highlighted, HSE has not visited hospitals around the country to check system problems nor did any effort to solve them. Doctors, especially junior doctors spend most of their "clinical" telephoning CENTRES OF EXCELLENCE for transfer of patients, the problem is going to get worse, as no new staff are employed, new bulidings have become white elephants, huge waste of money. Wonder where all the money goes?-- HSE managers who don't have a clue regarding health service.HSE are always claiming that we are moving forward, do we see any movement? Without money and staff patient's lives cannot be saved, it is not just cancer centres we need quick and speedy access to radiology,neurology, ENT, orthopaedic, cardiology. With so many restrictions, people's lives are at risk. Time to act is now .

Eve  Posted: 09/05/2008 10:58

Claire is to be commended for her article - which should be published in every paper in the country.

brandy  Posted: 09/05/2008 15:50

Claire, Thank you for an excellent article. Many, many posters would surely agree that Mary Harney and Prof. Drumm must indeed be arrogant. The genesis of this arrogance comes from their 'remove' from the real world. I've stated ad nauseam that most ordinary people like the wonderful Susie Long and many others, suffer because they (and those in charge should be reminded daily of this) are not wealthy enough to afford the speedy health-care that Harney, Drumm et al can afford (thanks to the captive tax-payer) ! You are perfectly correct to wonder why...if there is a system failure....no one is held accountable. Yet huge wages and bonuses can (and will) be doled out ! 'The fault - is not in our stars, but in ourselves that we are underlings' !! Sadly, the Irish will put up with anything. I've said before that the government's waste of multi-millions...on bureaucracy, useless quangos and the super-abundance of so-called public representatives (again, why 166 T.D.s ?) needs to be halted. The only people who can do that are the electorate. Unfortunately, voters are only too easily mislead by political craft and spin. The political/wasteful nepotism is set to continue. I fear the 2 tier Health-service will only get worse....there is no end in sight and the vision for the future that Mary Harney might profess publicly...is from her vantage point on top of Mount Olympus...far removed from mere mortals like ourselves.

cam  Posted: 10/05/2008 16:03

I would strongly agree with Claire`s excellent article. To Eve, I would like to say that I am a friend of Claire`s and she DID in fact offer this article to the Irish Times who declined to publish it. Shame is`nt it?

Eve  Posted: 13/05/2008 09:55

I didn't realise that. Thank you cam. Shame indeed. And I think it should also be pinned to the desk of Minister Harney. However, in relation to Jane's post. In so many cases medication or surgery is the answer because despite our best intentions, there is only so much that lifestyle changes like diet and exercise can do altho lets be honest - medication and surgery is hardly "quick". I agree that there is a certain level of apathy but addressing this requires: time - in a time poor society, education and money - which is in short enough supply in the health service as it is. The reasons that people are in hospital is not and never will be solely down to lifestyle. Diet and exercise cannot fix car accidents, broken bones or congenital disorders. Furthermore, other reasons why people are in hospital are - a lack of adequate GP services at weekend and evenings and a lack of step down beds in the community care facilities for long term care patients, usually elderly. (referred to as 'bed-blockers') With a cholesterol level of 7 + and other markers or heart disease, lifestyle interventions are useful after the level has been lowered, in order to keep it low but in order to lower it, many GPs will decide that medication is warranted - to prevent the condition worsening and leading to other health problems Therefore to say that only lifestyle changes will result in a reduction in the number of people ending up in acute care and emergency & a&e is vast simplification. While money is being spent on lifestyle intervention to assist in or prevent some conditions, the health service still needs to maintain an adequate level of funding for all other conditions as well as those for whom diet and exercise education would be inadequate to address their health problems. I agree tho, what is required is an inter-service approach spanning education, childcare, social & family services and the problem will require time, commitment and patience to resolve.

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