Sir, - The frustrations of all who work in, or attend as patients,our accident and emergency departments have been present for at least14 years. The issue was bound to come to a head sooner or later. It isa reflection of the patience of everybody involved that no seriousindustrial action has occurred before now.
The responses and suggestions for imminent industrial placebomeasures by the Health Service Employers' Agency are typical of theresponses of this body: too little, too late - and above all, wrong.
Clearly, the HSEA hasn't an idea of what the problem is. Thisreality gap is also evident in earlier responses from the Department ofHealth and successive Ministers.
The A&E problem emerged in 1987, when bed availabilitycollapsed. This is the primary cause of the difficulties. Before 1987,patients requiring admission were admitted directly to hospitals,bypassing A&E (in which they had no business) following discussionsbetween general practitioners and hospital medical or senior nursingstaff. The remainder of A&E attenders were either brought byambulance as emergencies or were walk-in patients.
From these groups, those who needed urgent admission weretransferred to the appropriate specialty service such as medicine orsurgery, and the appropriate urgent investigations took place then.Thissystem was above all humane and reasonably dignified for the patient.
Since the bed reductions, all of these patients must now go throughan intermediate, nonsensical system following the GP's assessment thatadmission is necessary, before being allowed into the hospital proper.Investigations and acute treatments now take place in the middlesystem, blocking it beyond workability.
These are mainly patients who should never have seen the A&Edepartments in the first place, but their involvement there may takedays, obstructing services for the patients who should be there in thefirst place. So now, we have to appoint lots of A&E consultants(for the wrong reasons) and a myriad of bed managers to play Titanicdeck-chair games. An Irish solution to an Irish problem.
The Department and the HSEA still seem to be under the impressionthat more of the same approach which has failed for over a decadeshould solve problems. This is a very serious reflection on theirfitness to continue having anything to do with the matter.
The solution lies first in removing the cause, the inadequate numberof beds in the hospitals. Any other tinkering is a waste of money andwill lead to more of the same.There are now - far too late - plansafoot to increase the number of beds, well recorded on paper, but notin existence. Planned, unreal beds don't solve A&E problems.
The main contribution of the past few Health Ministers and theDepartment of Health has been the collection of millions of words, butsadly no action. There are 107 task forces in existence on healthmatters, but nothing has changed on the ground. The money given to thehealth boards for 2002 will not even cover current expenditure, nevermind expansion. The health services are victims of an officialthree-card-trick mentality, and the response to criticism is theproduction of more words.
The card sharks must be delighted with the current strife, whichwill only pit groups of health workers against each other. - Yours,etc.,
MB, FRCP, FRCPI,
Consultant Physician,
Broadwater,
Waterford.