Recently I was unfortunate enough to have to pay a visit to a Dublin Hospital emergency ward. I have read and heard all the stories about how horrific an experience staying in A&E can be but somewhere you always seem to wonder if it could really be that bad. It is.
Without any doubt I can honestly say that the conditions our Nurses and Doctors work in and the experience that sick members of the public are expected to go through is truly unbelievable. I was fortunate enough in that whilst in A&E I was in one of the Clinical Decision Units (CDU), a small little alcove of up to four beds to one corner of the A&E. But to walk through the rest of the area and to hear the sounds of a night in that environment quite honestly makes you afraid to get sick. I have no idea how the doctors and particularly the nurses cope with working in these conditions. When you see the bureaucracy involved and outright bizarre management decisions making their jobs even more difficult you would wonder why they don’t just pack up their stethoscopes and walk out the door.
I left the hospital with new found respect and admiration for the frontline staff, nurses and doctors. I couldn’t do a job in those conditions and I don’t know how they do. But I am grateful they can.
Before I go any further let me lay some things out in the open.
I am in my thirties and fortunate enough to have medical insurance to some degree. It’s not the highest policy but it is medical insurance. I was assigned to the CDU on my first night while they awaited a bed on a ward in the main hospital. Essentially I was admitted and under the care of the consultants as opposed to being caught in the in-between status of an A&E patient. Finally, whilst in a lot of pain I wasn’t in a situation where blood or other bodily fluids were flowing from my body, altogether far more distressing and embarrassing situations to be in when you are sharing your living space with complete strangers.
During the recent election, and indeed during the local elections before it and the general election before them and pretty much every other opportunity our elected officials have had to speak to the voters, health has always been a major issue. For the vast majority of the public there is a very simple, straightforward equation that governs a lot of what they do, UNHEALTHY OR ILL = I AM UNLIKELY TO BE HAPPY. Sounds simple doesn’t it?
So if people accept this then the logical conclusion is that they need to be healthy to have a chance of being happy. And if they are unfortunate enough to become ill then they like to have some degree of confidence that someone will look after them and try to get them back to health, and happiness.
But people do not have that confidence in the current health system. It is viewed an s a management heavy dinosaur that is preoccupied with costs and money and as a result views the patient’s condition as secondary. It is run as a business where the provision of care is a service. I am not saying that service provision cannot be run as a business but there are different priorities.
If I am selling computers I am focussed on getting as many units through the doors for the highest price possible. You cannot run a health service like that.
The health service needs to be concerned with the patient’s needs and try to make them as comfortable as possible and then as healthy as possible in as short a time as is prudent.
From my stay in hospital I can say this isn’t the case in the current system. It isn’t the nurses and doctors that are creating this. Nor is it the individual managerial and support worker. It’s the culture that has been allowed to develop over time and it urgently needs attention.
During my stay I witnessed the horrors of overcrowded emergency ward, where people are sitting on seats for days and sleeping on trolleys, three deep in a corridor for days on end. If it isn’t a breeding ground for spreading illness then I don’t know what is. People of all ages and sexes sharing the same close living environment and the only connection they had was the misfortune to be ill at the same time. The facilities aren’t there for the wards to cope with the levels of people involved. In that scenario it’s no wonder that people lose patience and in some cases tempers. That’s not excusing their behaviour or actions but it does go some way to understanding it. Everyone has a breaking point and it’s clear to see how some of these people had reached theirs. Despite all this the nurses and doctors did their upmost to fulfil their roles, but throughout it all there was a looming sense of frustration and annoyance, even anger that they are being forced to work in these conditions.
I understand that as a country we are broke. We are hurtling towards an abyss financially and as a result everything has to be cut back. But we need to focus on what is important (health & education for example) and not on what appears to be popular to our continental brethren in the markets. We have reached the stage whereby our politicians are taking the care their ill voters need and pawning it to pay off bankers and investors who took a risk and who are no longer prepared to accept that risks can sometimes go bad. It can’t come as a surprise to anyone as for the past couple of decades the most heard expression in Ireland is “investments can go down as well as up”.
Yet we have sectors of our community who are prepared to place everything on black and then suffer sudden colour blindness when it rolls a red. They want to bet it all on the toss of coin. So long as the coin has two heads and no tails. I doubt very much that if we all went into Paddy Powers and looked for our losing bets to be refunded we would be met with a smile and cash being handed over. Nor do we expect them to. When I placed a bet on number 7 I did so in the full knowledge there were 9 other horses in the race that were also trying to win. When my choice didn’t win I have to accept that and take the loss. But that rule doesn’t seem to apply to investors. These people were aware of the risks and won’t accept the consequences. I know many pension plans and the like are tied up in this but that is a separate issue as to the competency of the pension fund administrators.
What our financial governors don’t seem to grasp is that if they have a bowl of money and keep dipping into it to repay the losing gamblers then when our health or education systems come looking for money in order to stay afloat the bowl will be empty.
So what can we do about it? Something needs to be done and as a father of two I worry about my kids getting ill in the current system. We have some experience of this and as with my stay I have the utmost respect for the nurses and doctors who do an incredible job under ridiculous circumstances.
I believe the following, in no particular order, would go some way to helping restore a health system that we can all trust in. I am probably wrong as I am not one of those people elected to govern us, but I don’t hear anything remotely like a suggestion from anyone in the Oireachtas.
Change the culture in the Hospitals. Money, while important, cannot be the deciding factor.
- Allow our hospitals to decide where their budgets go. If they have a capital budget and decide they don’t need it, let them divert that money into care and front line support.
- Revisit the structures in the hospitals. There needs to be an acceptance that front line staff are the most important asset of the hospital.
- Understand that if you don’t help an ill person they are not going to get better. The problem is just postponed until the cure is provided.
- You can’t make decisions about something you don’t understand.
- Every member of the Oireachtas should be forced to give up their private health insurance. That way they will be encouraged to make decisions through the fear of having to go through the current public system.
- The minister for health should spend a weekend as a “patient” in an A & E ward. This is not a suggestion for a great photo opportunity. This is going through the A & E as if they were any ordinary patient.
- Ensure that the managers in hospitals understand that if you take staff from one area to help somewhere else you create problems for the remaining staff. This happened when I was there and the frustration it created for the nurses remaining in A&E was understandable as they suddenly had to cover three roles.
- The government should publish a clear numbered list of their priorities. That way it is simple to see whether health gets priority over roads, whether education gets the nod over sport, and exactly where on their list of priorities they slot repaying bankers who were bad at their jobs.
We need a dramatic change in our approach, our culture and our ethos. It’s as if the country needs a standstill moment, where we all just look around us and realise what’s truly important. If we do we will understand what we need to target and how we can get a system and society we can be proud of.
There is no magic cure for the health service. It’s going to be a long, tough road before we get a structure we need and crave. The same applies for the economy. There are tough decisions that need to be made. I am in agreement with the politicians on that one. However I cannot agree with their approach that as a nation we can neglect and abuse the core services that will allow us to grow and flourish as a nation. If we do turn our back on our nurses and doctors can we really expect them to be there for us when we need them most?