Health Service needs a specific body like the ERSI to determine priorities

We’ve all experienced the type of excuse that is insincere, meaningless and unhelpful. Sometimes, it comes by way of an apology. Sometimes, an accusation. “You never told me that petrol was flammable”, or perhaps, “I didn’t cheat on you. You stopped loving me first.”

Mr Putin and his band of evil killers sometimes won’t even go this far. After blasting a civilian community to pieces they might issue a statement stating that they were ‘aiming at a military installation’ or that the civilians were, in fact, heavily armed paramilitaries about to strike Moscow – or some such nonsense.

Sometimes, an apology is just a lie – sometimes it plays on ignorance. Back in the day of early computerisation, when you called the company or institution about your reservation/college place/life-saving operation, you were often told that the ‘computer’ had lost it. Nothing could be done. No person was to blame.

This movement of responsibility from actual person to machine was highly effective, because older people (at the time) had little knowledge of how computers work. They understood from their children that sometimes things that weren’t ‘saved’ disappeared forever. And so, the appointment that they might have made with this actual individual over the phone was now gone. As if that conversation had never taken place. As if the human involved in that conversation was now absolved of any responsibility.

We can be assured that both government and the Health Service Executive will be apologetic when things go wrong. That’s nice, but it’s also merely going through the expected motions. It’s the same mealy-mouthed apology as ‘the computer lost it’ because it ignores responsibility.

The Irish College of General Practitioners issued a statement today about the dire predictions for the future of general practice in Ireland – particularly rural Ireland. Around 700 GPs will retire in the next six years, and we need 300 GPs a year to replace them. At least 2,500 GPs will be needed to deal with existing demand in the next seven years. They’ll be incredibly lucky to reach that target.

And we all know that’s the tip of the iceberg. That’s with no major increases in population, changes in work practices etc. And let’s be honest, attracting GPs to Ireland – let alone rural Ireland – is not an easy task. These GPs need to backed up with General Practice Nurses, and have the facilities and equipment to do the job properly and appropriately for 2030.

But we don’t want to be sitting here in seven years saying we should have done this or that. We need to act now to prevent this. And to remember above all that the health service is not one thing or the other – it’s the combination of every service. We are also short – miserably short – of home carers. All these things, when they come together, lead to tragic neglect of our fellow citizens who deserve better.

This is why – in theory – it was a good idea to set up the HSE so that they would take a strategic view of healthcare, because politically, some healthcare investments would never work. It’s hard to get anyone in politics to spend money on things that will benefit people in 10 or 20 years – so it was supposed to be a huge advantage to have a more strategic, corporate approach.

Unfortunately, it’s impossible to predict accurately what will be needed most in five or 10 years. And the HSE is still under political pressure to deliver things now – and to ignore future planning. And then, there is the question of balance – who gets what? Can the rural gombeens be satisfied with a bit of telemedicine, and shure lookit we’ll bury them properly when they come to town?

The Health Inspection and Quality Assurance Authority issued a report today that described the conditions in the Emergency Department in University Hospital, Limerick. HIQA based its report on a surprise inspection on March 15 and it found that the dignity, privacy and confidentiality of patients was compromised.

Just let that sink in for a moment, and imagine it was your mother, child or loved one in that situation.

It also said: ‘the overcrowded and understaffed emergency department posed a significant risk to the provision of safe, quality, person-centred care, and to the health and welfare of people receiving care in the department’.

As the young people abbreviate WTF? WTAF? That’s just not acceptable. One patient was waiting 71 hours for treatment, and another waited five days for a bed. Demand for services exceeded demand by a large measure. There weren’t enough nurses. Surprise, surprise.

HIQA said it was not assured that Limerick had enacted measures to sufficiently manage overcrowding in the emergency department and the related patient safety risks posed by overcrowding. Neither were they happy that contingency measures to deal with the overcrowding had been taken by the hospital.

The Authority sought assurances that the hospital and the region would be effectively supported to enact ‘substantive’ measures to address capacity deficits – including in acute and community service configuration, capacity and resourcing implementation.

But will they? And if they don’t, will there be any punishment, pay cuts or sackings? The answer to that question is a resounding ‘No’. It would be nice if people got the health service they need, but if they don’t, well, they’re too sick to cause much trouble.

This is not to attack Limerick or its staff, whom, I’m certain, are doing the best they can. The fault, Cassius, lies in a higher pay grade.

It’s become obvious that while HIQA is doing an important job, we need a body with a wider remit to monitor health services generally. In the same way that we have economic bodies to help direct government spending on the economy, we need a governmental body to identify and call for spending in the healthcare sector in areas where it will do the most to redress the shortcomings of both institutions and regions.

It mightn’t be listened to, of course. Governments can often ignore the advice of their own bodies, but it would at least give us some indication of what should be done, and which political party is most interested in building a proper, well-staffed and efficient health service that delivers the essentials.

If we had a template for a better service, and we had parties signing up to that plan, we could hold someone to account. That would (hopefully) lead to a service that works for all. And that’s probably why such a thing will never happen.

But hope springs eternal.

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