Heart BeatPass me my Zimmerframe and let's go. I laughed out loud at the Taoiseach's portrayal of me as some sort of one time, homicidal geriatric. The many, many years of retirement are actually five, and I don't think I'm senile quite yet. You never know though, the Highest Authority thinks maybe I am becoming a little forgetful. But I'm not alone in that, Taoiseach?, writes Maurice Neligan
My interest was also aroused by your sincere felicitations to the consultant who had a big private practice as well as his public commitment. I can tell you how that happens. He was probably very good at his job and patients wanted to go to him and doctors referred to him. That's how the old order worked. But it did work.
I have been writing recently about the insidious notion that if standard business practices are applied to medicine, that things will get better. This was the principle behind the establishment of the Health Management Organisations (HMOs) in America and indeed other private healthcare systems there. There is a certain simple plausibility about it, and worryingly some signs of its adoption here. Classically it comes in three phases:
1. Over promise: We will give you everything you need - liver, heart, lung transplants, perpetual dialysis. No need to wait in A&E departments. And consultants will look after you even if you need only an aspirin. We will establish centres of excellence and we'll diagnose, treat and cure everything with no mistakes. We'll be data driven by the latest information technology and we will employ only evidence-based medicine.
2. Under fund: Jesus! this is costing a fortune. We can't go on like this. We have to get out of it somehow. Let's tell them that there's a slight delay, due to planning and consultation with the social partners. Tell them any old mumbo-jumbo. Slip it in that that's the reason we need such well-paid managers and bonuses. They'll understand the strains we must be under. Tell them it's their fault anyway for protesting about lousy service; distracting our gaze from the bright horizon of a world class health service so ardently desired by the Minister for Trolleys. Do anything, ration services, deny care, stifle everything in bureaucracy. Let them die; it's cheaper. Screw the complainers and the doctors.
3. Shift the blame: They are on to us! It's those greedy doctors who are causing the problems. The bloody nurses are out of control. The pharmacists, dentists, whoever, are robbing the nation blind. Repeat ad nauseam; it's not our fault, but just keep voting for us and paying up and things will get better.
Will they? This retired, ancient, ex potential assassin doesn't think so at all. I think that things can only go from "mad to worse".
This newspaper recently carried an article headlined "Shorter stay, more free beds". This was based on an interview with the national director of the HSE's Winter Initiative Plan. I think that's kind of equal to a Field Marshall and paid and bonused accordingly. Put firmly out of your heads any notional similarity to Napoleon's march on Moscow and the eventual outcome of that debacle. This is the real thing. Please don't laugh; concentrate. Like all emanations from this organisation it is very strong on aspiration. There is grand talk about expanding and developing community healthcare measures that would eliminate the need for some hospital admissions and provide a suitable home care package for discharged patients. It waffles on and on.
The spokesman is quoted as saying, "we're not saying this can happen overnight". Ah yes, put it with the centres of excellence, the cancer strategy, the primary care strategy and whatever the multiplicity of "advisers" and spin doctors can dream up for our grateful approval.
Meanwhile, back on planet Earth, in Ireland we are actually reducing patient services. Minister Cowen tells us we can expect little more money for State services next year, other than covering inflation. We know what that means.
There's more; "increasing the capability of diagnostic facilities such as radiology and laboratories by 25 per cent would result in a 6 per cent increase in total inpatient discharges". Wonderful, just tell that to the hospitals with diminishing staff numbers, old equipment and a moratorium on improving the situation. Don't ask why basic services are being shipped out of the State at this time, cervical smear testing for example. Just more talk and deception, I'm afraid.
We are being compared with countries that have far better infrastructure and community facilities than we have. That's why our patients spend a little longer in hospital. No doctor wants to discharge patients into an unsuitable environment where help is not at hand.
Maurice Neligan is a cardiac surgeon.