Heart Beat:'The frost still continuing more and more severe, the Thames before London was planted with boothes in formal streets, as in a City or continual faire" - Sir John Evelyn, January 24th, 1684, diary.
I am not going to give you the whole global warming bit again, however I did write recently about our recent spell of inclement weather, marked by gales and heavy rain. I omitted to point out that apart from this, temperature wise, it has been extraordinarily mild.
These thoughts came to mind while pondering the debate about our accident and emergency crisis. Is it getting better or worse or merely stagnating?
Well, it all depends on who you believe. On the one hand you have the doctors and nurses and ambulance personnel, who daily deal with the problem; on the other hand you have administrators, with zero hands-on experience, trying to assure the Minister for Trolleys that things are getting better, while simultaneously trying to enmesh the rest of us in this web of illusion.
Walter Bagehot wrote in a different context in 1867, "we must not let in daylight upon magic". He was talking about the trappings of monarchy, I don't think we are, or rather I hope we're not, but we are talking about illness, death, compassion and human dignity. Let us therefore turn on the light.
I will state at once that there have been some modest improvements in places, other than the purely cosmetic. Sometimes these involve the provision of additional beds, in woefully inadequate numbers, it must be said.
To save face they are called "admission lounges" or something equally meaningless. They are simply beds, as the front-line staff correctly pointed out from day one, and unless they are provided in adequate numbers, this problem can never be solved.
In truth, there is little else to enthuse about. A cynical attempt is being made to dupe us into believing that progress is being made and that the final solution, rather like the National Development Plan, is a reality, almost within our grasp.
Almost, is the key word here, it goes without saying of course, that we can only emerge from this self-created morass if we entrust ourselves completely to the people who landed us there in the first place. We've been here before, I think.
To revert to the beginning; nobody lies or spins about the weather. It does its own thing. It is a fact however, that a bitterly cold, icy winter brings a harvest of flotsam, in illness and trauma, to the A&E departments of the country. It has been noticeably less so in this mild winter, as has also the so-called "winter vomiting bug".
It goes without saying that "improvements" in overcrowding of this nature are beyond the control of the Minister and HSE, and may indeed prove to be illusory.
There is no point in evading the next problem. It is simply dishonest to reckon the patients' waiting time on a trolley starts only from the moment a decision has been made to admit them. The hapless person may already have spent many hours of misery in this situation, before such an eventuality arises.
Many wait for assessment, more for the results of laboratory tests and the multiple investigations of modern medicine. We all know this and to pretend otherwise is deceitful and self-serving. Your waiting time is from when you arrive until you are admitted or discharged. No amount of tautology or spin can change this basic fact.
This leads straight to the next problem. Premia for the quick movement of patients through A&E and into the wards merely mask one problem, while exposing another. The influx of such patients paralyses the elective work of the hospitals.
This leads to intolerable waiting lists and untold suffering. Some are removed from these waiting lists and delivered to the private sector through the National Treatment Purchase Fund (NTPF). Without this abject failure of the service, many of the private hospitals, extant or planned, would be unviable.
Meanwhile in the general and teaching hospitals, the emergency nature of their workload jeopardises training, research and teaching. It is a real possibility that many of our leading hospitals will lose their international recognition for training doctors in many specialties.
Simultaneously, we are being fed pious platitudes about the need for doctors to commit to continuing education and peer review as at the same time, unwittingly or ignorantly, the foundations of such learning are being destroyed.
That won't do in election year; set up an inquiry. Then the cloud cuckoo bit - "if only two extra beds had been set up in each ward this needn't have happened".
The joined-up thinking that would prompt the association between overcrowding, ward cleaning, and infection control is missing. Get the patients out of A&E and put them anywhere, but get them off the front pages in election year, seems to be the primary motivation.
I seem to have been writing about all of this for as long as I can remember. Many others have also. They have told harrowing and shocking tales of their engagement with our health services at all levels, from children to old age. As Noel Coward wrote, "It is discouraging to think how many people are shocked by honesty and how few by deceit."
Deceit we have aplenty, in this mad tea party health service, complete with hatter and March hare. As for progress and caring, we seem to have little or none.
As I write it appears we are to have 1,500 new consultants. Given present circumstances, they might have a bed each.
Bullying, bluster and balderdash from the Minister. She has achieved little, except to make a bad situation worse. Time has run out, so back to the tried formula, blame the consultants.
Maurice Neligan is a cardiac surgeon.