Sunday 23 October 2016

Rude health: Ladies-in-waiting

Freshly cut flowers may not improve maternity services, writes Maurice Gueret, but airy new thinking might help.

Published 08/06/2015 | 02:30

Maurice Gueret
Maurice Gueret

Some pretty dire maternity tales made the news recently. Following a great tradition of Irish government, we will wait six months for the group report.

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 Leo wants it in his Christmas stocking, so don't expect anything like a rapid response. Baby matters will be on the desk of the next Health Minister under all the blazing scandals that arise in other specialities. It has always been thus. Blood, Cancer, Heart, X-rays, Disability, Dementia - a scandal around the corner just the same. I know in advance that this new maternity report will say that small units are too small to stay open and that big units need bigger staffs to stay open. There will be a nod to governance and a cap doffed containing cash that is pilfered from somewhere else. From some distant date, all Irish babies will be delivered in cities, or at least on the hard shoulder of motorways leading into them. Most Irish counties will only host accidental births. And perhaps that's as it should be. Except that the group entrusted to review Irish maternity services have a real opportunity to suggest something fresh and something radical. They could call on Government to treat all women equally and abandon all private obstetric care in public hospitals.

Closure of Mount Carmel

It might have escaped your notice, but since the closure of Mount Carmel in Dublin, no private hospital in the State is offering to deliver babies. Horrendous insurance bills closed the market in private birthing suites. But cash for deliveries continues unabashed in all the State's major maternity hospitals. For the cost of a 28-day Caribbean cruise, the personal care of any obstetrician of your choice (minus the junior staff) is available for hire. I won't be popular for saying it, but the mountain of money available to obstetricians in the capital is one prime reason for the discrepancy in care quality between Dublin and the regions. Jobs in the big three Dublin maternity hospitals are closely watched and highly sought after. Small county hospitals have fewer deliveries, less colleagues to cross-cover nights or holidays and hardly any patients who are willing to pay thousands of euro a pop to have consultants personally test their urine. Leo hasn't asked me to join his 29-member National Maternity Strategy steering group. My suggestion of a level playing field for all ladies in maternity remains a dream. A simple Aisling for Irish hospitals, where every lady-in-waiting enjoys the same status, the same doctors and the same tea and toast when the really hard work is done.

Pharmacist awards

The Pharmacist Awards for 2015 have just been launched and happy customers up and down the country are asked to nominate their favourite chemist. The big prize is the Patient Award. This award goes to the pharmacist whose professional conduct is deemed the most remarkable and noteworthy. You can visit before the end of July if your own medicines expert went beyond the call of duty. Having watched a recent edition of The Consumer Show on RTE, I'd be surprised if any of the pharmacists offering food intolerance tests manage to top the nominations list this year.

Pressure on GPs

Pharmacists regularly make representations to Government about their ability to take pressure off busy GPs and hospitals. What they mean by this is that they want more medicines off prescription. This would allow them to deal directly with the health of members of the public, without waiting on a doctor's diagnosis. But more medicines over the counter has a sting in the tail. They are soon picked up by supermarkets who can offer lower prices than chemists. In recent years, pharmacies have been losing a lot of their core business to supermarkets. I recently visited a Sainsbury store in the UK and was amazed at the huge array of medicines and health aids that I thought would have been pharmacy only. The pressure from pharmacists to play a more active role in healthcare is perfectly understandable. But the Achilles' heel of ethical pharmacy can be the quasi-scientific promotion of high-margin products that doctors wouldn't buy in a month of Sundays. Just recently I saw a pharmacy window advertising a cosmetic cream that "activates the skin's immune function to allow its natural beauty out". Whatever about magic creams, in my book, the link between beauty and the immune system is tenuous at best. I'd be very worried about my own immune system if it wasn't.

Banning of flowers

An old friend had an emergency recently. A family member was admitted to hospital with a grumbling appendix and it was positively gangrenous by the time it came out. My friend thought he would cheer up the patient with some freshly cut flowers, but they were banned by the ward on arrival. Now this wasn't the case when I trod the boards at the old Baggot Street Hospital. I vividly remember bedside lectures from the wonderful Dr Stanley Jagoe on the medicinal benefits of almost every flower he found in hospital vases. The benefit of flowers to recuperating patients was obvious. But nurses would often be heard grumbling that it shouldn't be their job to find vases and change the dirty water. Coronary and intensive care units were first to ban them. There followed some scare stories about allergy to pollen and tales of a bug called pseudomonas, which hijacks old water in vases and darts into open surgical wounds given half a chance. So the message now is that fresh flowers are a big no-no in most surgical wards. Even for your favourite nurse!

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

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