Monday 24 October 2016

Bravo to you, Brendan, as straight talk is the healthy way forward

Emer O'Kelly

Published 26/03/2006 | 00:11

THE actor Brendan Gleeson caught the public mood when he railed against the situation in our hospitals on The Late Late Show on St Patrick's night. I was sitting beside him, and I could almost feel the heat of his fury and frustration. Every word he said concerning the insult it is to our humanity to have to spend hours, even days, in crowded, open, often less-than-hygienic co

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THE actor Brendan Gleeson caught the public mood when he railed against the situation in our hospitals on The Late Late Show on St Patrick's night. I was sitting beside him, and I could almost feel the heat of his fury and frustration. Every word he said concerning the insult it is to our humanity to have to spend hours, even days, in crowded, open, often less-than-hygienic conditions, was true.

Every word he said about the heartbreak it is to have to watch loved elderly parents suffering the conditions, was true.

What wasn't true was that a baboon could sort it out, which Brendan Gleeson also said, although I understand the rage that fuelled his outburst. I also don't believe that we need Ryanair's Michael O'Leary to sort it out, as was suggested by a caller to Joe Duffy's Liveline last week.

Ryanair has made Michael O'Leary a multi-millionaire because his first motive is profit and he is ruthlessly uncaring about anything else. If his passengers are old and infirm, he couldn't care less: no wheelchairs unless you can pay for them. If the health services could operate that way, we'd have no problems. We'd have a lot of sick, uncared-for people, a lot of dead people, but we'd have no problems in the hospitals.

It's unpopular to say it, but the hospital services in general, and the accident and emergency services in particular, don't have to cut financial corners in the way it is believed. Billions have been provided by the government on behalf of the taxpayers. (The phrase usually used is "thrown at them".) That is the government's job; it's not the job of government to run the hospitals, or any other part of the health services.

And the first step towards sorting out the appalling mess in our hospitals would be to stop blaming the government: any government. Brendan Gleeson said that "the other lot" would be no better than "this lot" at sorting it out. He was right there; it is not their job. Blaming the government lets the people responsible off the hook: it is what nowadays are called the "health-services professionals" who are responsible for the inhumane and chaotic conditions. They are very good at railing against the government; the rest of the time, their first word is "no". No to progress, no to simple solutions, no to a reduction of bureaucracy.

People are fond of saying that Bertie Ahern and Mary 'It's unpopular to say it, but the hospital and A&E services don't have to cut corners in the way it is believed. Billions of euro have been provided'

Harney won't ever find themselves on a trolley in A and E. Actually, if either of them is hit by a car (no, don't say it, it's not charitable) or falls down the steps of government buildings, they will find themselves on a trolley in A and E. That is perhaps the one shining quality about the service: neither riches, importance, nor health insurance will shield you.

But the fact that everyone is treated the same doesn't really matter. What matters is the quality of care for everyone, which is appalling.

And I'm afraid as long as we keep saying "the nurses are wonderful, it's not their fault", we're not going to get to the heart of the matter. Even the nurses are part of the service, and the service is at fault.

In Britain, where they have the same problems as we have, the Conservatives have launched a policy campaign saying "Bring back Matron". Like all opposition parties, they are suggesting that they, in government, will have a common-sense approach that will sort out the services within six months.

They won't; as Labour and Fine Gael won't either. Because the first thing to be done is to take a strong-arm approach, and that means losing votes by screwing both managements and unions, as well as junior doctors and consultants alike. It also means, paradoxically, losing patients' votes. Because patients want it every way.

We want a high-tech oncology unit in every local hospital, but we also want the right to be treated in a major centre rather than the local hospital if we so choose. We're insulted if it's suggested that all that's needed locally is a small health clinic that can stitch a finger, set a leg. We elect TDs solely on the basis that they've promised to "save our hospital", which is haemorrhaging money and harbouring armies of administrators, while little more than an appendectomy can be carried out there safely.

We need to tell the truth: that we will save more lives if all cancer patients receive treatment in just one or two centres in the country, and if you have to travel, tough. If you want the extraordinary skill that will save someone with a massive heart attack, again it needs to be centralised. Local pride shouldn't matter a curse.

And yes, you need modern transport to get people to centres of excellence: that can be provided with the simplicity of a helicopter landing-pad on the outskirts of every town. That way, even women with difficult labours can be got to care and safety in half an hour.

Indeed, if we have suchpatient-centred services, the Michael Nearys of this world will never again be able to flourish: they won't be the unquestioned generals of their own private armies any more.

We also need to tackle the problem of drunkenness in our accident and emergency departments: a conscious drunk who is not actually bleeding to death does not belong in A and E. He (or she) belongs in a drunk tank. I wrote that some months ago, and received a small avalanche of hate mail: the crisis in A and E had nothing to do with abuse of the medical services by drunks. Oh yes it has.

Our crisis is not based solely on numbers. Our population has risen by half a million, yes, but two major new hospitals have been opened in Dublin - Beaumont and Tallaght - while other hospitals around the country have been developed over the years. One of the reasons for the crisis is that our expectations have risen.

Only a few years ago, a sprained ankle involved a trip to the local pharmacy and purchase of a brace and a couple of aspirin. Now it's a trip to A and E. And of course there's the attitude that A and E is free, while a trip to the doctor will cost you.

Nor is it fair to complain that doctors' surgeries close at six. It is highly undesirable that GPs work day and night: at 3am on an emergency house call their diagnostic skills would not be at their best after an already long day. It is sensible for GPs to subscribe to an out-of-hours doctors' agency, and it is selfish for their patients not to use it.

We don't need a bureaucracy, medical or otherwise, running our hospitals: we need a few low-grade managers who will clear the decks so that the medical staff can work. We need people with the wit to call the local suppliers and order in a few Portaloos (has anybody fined and fired the architects who designed A and E departments with only two lavatories?).

We need to replace the bureaucrats with nurses and orderlies. And of course that means, since we don't train enough of our own, removing immigration restrictions on properly qualified nurses from abroad. Will the Irish Nurses' Organisation accept that? Or will their own bureaucracy kick in? Will the first sensible attempt to sort out the mess be, as usual, a deafening "no" from the vested interests?

And will we have the innate fairness to stand with the government in condemning them?

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