Irish hospitals are heading for disaster mere months down the line unless we change course now, writes IMT Editor Terence Cosgrave
Back in the day, my mother used to tell a story about a priest’s housekeeper. The story was about how the priest would always have to ask to get a job done.
He would say: “Have you set the table with the good china for the bishop?” And the answer would be: “I was just about to Father.”
“Did you feed the cat Mary?”
“I was just going to do that now Father.”
And so on. And so on. Until…
“Did you wash all the pages in the books in the library?”
“I was just going to do that now Father.”
The point of the story is obvious, and I won’t labour it here. But we need to talk about the winter, and this seems as good a place as any to start.
As a mere plebian in the world of Irish medicine, and, as has often been pointed out, I am no expert in the intricacies of our health system. But it doesn’t take much intelligence to forecast that if we are having capacity problems in August, we are likely to have much bigger problems in January.
I have a feeling that by the time January rolls around, we are likely to hear many excuses and explanations for the chaos that is almost certainly bound to ensue – very much like the priest’s housekeeper we will react then. We will also hear promises to make it better in the future, and a commitment to ensure that the disaster of January 2023 doesn’t happen again.
It will be too late then for the patients affected, but the HSE will say, nobody could see this coming. They will say they expected a bit of overcrowding, but not at this level. No-one could have foreseen that.
I could rant and rail about this (that is the standard journalistic response) and refer in January to my foresight and my prescience in August – but I would be simply doing what everybody else has been doing – refusing to take responsibility and hoping against hope things will not be as bad as we guess it will be.
Instead, I have asked myself what I can do – what any person can do to prevent the winter months from becoming a disaster that will cost lives? It’s obvious to most that this winter we will see a bad situation getting worse.
A few weeks ago, I talked about the need for new ideas in terms of our approach as a nation to the vexed subject of healthcare. It’s plain to see that governments in general see no need to fund the service in a way that doctors or nurses would – or even at a level patients would.
The problem is that patients either die or get better, and when they do, their focus moves on to other things. Doctors and nurses and the whole range of healthcare professionals are stuck with the system, and when they say the system isn’t working, isn’t funded to the proper level, it’s always interpreted as ‘money for medics’.
For as long as I have been working as a medical journalist this has been the case, and for some, this is just how the system works. Everyone shouts for ‘more’ and after the publicans, the landlords, the ‘poor’, the people who get up early in the morning, the teachers and everyone else gets their share, we get around to the sick – who usually get a good bit, but never enough.
There’s a supreme logic in this. The sick will soon be dead, and in time, their relatives will move on from their grief. The rich, in any case, will get moved out of the emergency room into a ‘ward’ that is not actually a ward but nonetheless is somewhat better than a corridor. “You don’t have to worry,” as a relative of mine was told recently while attending the emergency room, “you have VHI and the hospital loves that because they can charge you.”
This is not the way it should be, but the government (and nowadays the HSE) have always played the ‘Divide and Conquer’ game much better than doctors.
We all know that Irish medicine is a diverse group of interests, each one united only in their disdain of the others.
General practice naturally wants more funding, but hospitals also need more funding. Doctors naturally want funding for patient services, but not at the expense of their own salaries or pensions. And this is reasonable, rational and right. There’s no point in robbing Peter to pay Paul. Neither is medicine a charity, nor should the highly-skilled people within it be expected to work for any less than the world market for medics dictates.
But the problems have continued because the profession(s) have never put the case as a whole. There has never been a united, concerted and urgent appeal by all of healthcare to urge the government to allocate money to address the current problems bubbling under the surface which will explode – if not this winter, then over the coming years.
There are staff shortages, getting worse. There are unacceptable waiting lists. There are fundraisers to keep patient support groups going. And in between all the requests and pleadings, there is ample room for politicians to say after the Budget that they did this or that but you can’t do everything.
‘Everything’ is precisely what everyone wants them to do. And it’s what should be done. But it will never happen without the whole of Irish medicine uniting around what’s possible, rather than hoping to outdo some other worthy cause in healthcare by snapping up their own funding.
We’re all being played. And the more that sectors of healthcare battle for their own corner, the longer this dysfunction will continue.
It would be great to see a joint submission from Irish medicine this autumn to the Minister for Finance – outlining what needs to be done, and the consequences of not doing it. There are huge problems building up for the future that need to be tackled now. Doing everything as we have been doing it is just going to lead to more brilliant hindsight next January, when the problem is already making itself obvious to all but the most myopic.
