I’m frequently asked which emergency care system the Republic should aspire to be like. There is no debate: it is Australia’s.
It’s no coincidence that doctors in training, and more senior doctors at the end of their training, are opting to go to Australia in increasing numbers rather than work in Ireland in what they see as a dysfunctional healthcare system.
In a week in which new records were set for the numbers of patients awaiting acute-hospital admission, we should ask ourselves why Australia is so attractive to many of our brightest graduates and why the experience of Irish emergency medicine (EM) and emergency departments (EDs) is so negative for them.
This also applies to our well-trained nursing colleagues. All week there has been increasing concern about the patient-safety implications of the truly frightening numbers of patients accommodated on trolleys.
The evidence that patients were more likely to die unnecessarily in situations where EDs are overcrowded was uncovered in Australia. Studies by Richardson and Sprivulis published in the Medical Journal of Australia in March 2006 scientifically confirmed what many of us had suspected, namely that mortality rose for all patients admitted during a period of ED crowding, resulting in unnecessary and thus avoidable deaths.
Rather than ignore or suppress this valuable information they published it and received the appropriate response of state and federal governments in Australia, which acted promptly to try to address their overcrowding problem.
Apart from the terms and conditions of employment, which are vastly superior to those available in the Irish healthcare system, doctors and nurses also benefit from working in large, well-equipped, well-designed EDs that are fit for purpose and can deal with the patient workload. They are part of much larger medical and nursing teams with necessary support staff that are led by much greater numbers of EM consultants than is the case in Ireland.
A typical ED in Australia seeing 60,000 to 80,000 patients a year would be staffed by 14 consultants. By contrast, the 29 EDs in Ireland have fewer than 80 consultants between them.
High-quality trauma care
Australia has been at the forefront of developing high-quality trauma care with inclusive, integrated systems which provide optimum care in spite of the enormous geographical distances and the remoteness that characterises much of Australia.
In contrast, Ireland has a poorly organised national trauma system which does not obtain the clinical outcomes that can be delivered in well-organised, inclusive systems elsewhere in the world.
EM has been in existence in Australia for half a century, little different than its history here. Perhaps the biggest difference between Ireland and Australia is that, as a country, Australia has accepted and embraced the vital role of EM as a cornerstone of the healthcare system.
State and federal government alike recognise the pivotal nature of EM; listen to experts in emergency care; spend money on its development and enhancement; and generally seek to ensure that the best possible medical outcomes are achieved for patients attending Australian EDs.
In contrast, Ireland is characterised by a lack of political and health service management understanding of, and commitment to, emergency care; a failure to accept the extent and safety implications of ED overcrowding; and a desire to develop unproven alternatives to ED care rather than fix the fundamental problems for which clear solutions have been identified.
Ireland is also characterised by a failure to deliver on commitments and promises, made as long ago as 2006, to finally deal with ED overcrowding; a general inertia that allows ED overcrowding to continue to imperil the lives of our citizens; and a scenario in which health-service performance is used as a political football by political parties that have often been equally culpable in its failings.
Strategic direction
Just as Australia did decades ago, Ireland needs to grasp the nettle. We need an effective national emergency care system which sets strategic direction; a properly resourced ambulance service; and emergency care networks that ensure local injury units and EDs are organised in a consistent way to deliver optimal patient care for our population.
We also need a national ED information system and enough consultants, trainee doctors, nursing staff and resources (including timely access to diagnostics, outpatient specialist access and an inpatient bed as required) to provide the level of service provided in EDs in other developed countries.
National blueprint
Ironically, we have such a blueprint, the
National Emergency Medicine Programme Report
launched by the then minister for health in June 2012.
While this has been adapted enthusiastically in some northern European countries that are just developing EM systems, and has even been recognised as a valuable reference in Australia, the Department of Health and Health Service Executive seem to be as far away from implementing it as they were when it was published, 30 months ago.
The alternative is the current vista of patients dying unnecessarily as a result of system failings while those who should know better continue to wring their hands and obfuscate.
This is happening in spite of the superhuman efforts of those medical, nursing and support staff who work in our EDs, areas the health system seems to use as warehouses for admitted inpatients. These professionals cannot continue to provide care in this inhumane environment, and many are joining the exodus to Australia.
I know which option the public requires to look after their health needs and it’s not what they are receiving currently from those they have elected or those employed to strategically manage our health service.
Dr Fergal Hickey has been a consultant in emergency medicine at Sligo Regional Hospital since 1995 and is communications officer for the Irish Association for Emergency Medicine