independent

Wednesday 16 April 2014

Martina Devlin: Hospitals' shame – this is no way to care for our sick and dying

Caring for our ill – but conditions in hospitals mean there is little hope of preserving patients' dignity

A television set in the ward blaring out a football match. A curtain separating one cubicle from the next, offering the flimsiest semblance of privacy. That soulless scene described by actor Gabriel Byrne, as he watched a friend's life peter out, is familiar to anybody visiting a public hospital.

Now compare it with a private hospital. A luxury hotel springs to mind. Peace and quiet in comfortable surroundings, with en suite bathrooms and titbits of food to tempt weary appetites, are guaranteed – because people pay for such privileges.

Yet to call privacy a privilege when people are seriously ill, never mind if their condition is terminal, seems profoundly wrong. Surely it ought to be a right. A courtesy extended automatically. Such tokens of respect, taking the edge off the burden carried by patients and their families, are far from the norm in the public hospital system, however.

Healthcare staff are superb for the most part – compassionate as well as professional – whether working in the public or private sector. But the infrastructure in the public category tends to be dismal.

Where improvements are made, they are often brought about by donations – such as this week's appeal for the Irish Hospice Foundation by Gabriel Byrne in New York.

I'm not pretending conditions in our hospitals are Third World, but they aren't First World either.

This gap between what ought to be, and what is, appears to be a constant in Irish life. It can be glimpsed in other spheres. But it is as plain as truth, and just as hard to dispute, that the public health service provided to our citizens is not the one they deserve.

Yet it costs. The health budget is running at almost €14bn a year, with the healthcare spend accounting for more than a quarter of all day-to-day government expenditure.

Clearly, inefficiencies are squandering resources – and patients are consequently suffering. Which is wanton. No other word adequately describes it. The troika said as much in its off-the-record briefing last week.

In taking the pulse of the nation, the troika identified concerns around healthcare costs. It said they had mushroomed, exceeding even the scale of the boom.

Among issues highlighted were poor structure and information flow in the health sector. That's down to inefficiency. It also said GP services in Ireland cost more than twice as much as in Brussels, and that generic and branded drugs alike were too expensive.

That's down to vested interests, and the Government has an obligation to tackle them.

The troika said reforms were needed to avoid impossible choices being made – unpick the meaning, and it's a reference to patient care being sacrificed. Sometimes to that tinpot dictator bureaucracy.

Here's a classic example of duplication, an inefficiency which wastes resources. An acquaintance accompanied his partner to an appointment with a consultant in the public sector. They turned up at the hospital – St James's Hospital in Dublin, but it could be any public hospital in Ireland – and had to make their way through three reception areas.

First came the main reception at the entrance. From there, they were directed to a second reception at outpatients, at which the patient's personal details were taken and her appointment was confirmed.

Next, they were sent to a third reception in the area where the consultants were located and once again asked to supply their details.

At least one of those layers of bureaucracy was surplus to requirements – staff could be reassigned to more useful functions.

If bureaucracy is stripped back, additional resources become available as a result. It is not just prodigal but immoral for healthcare resources to be frittered away.

Here's another example of funds being wasted. It involves a scheme which can only have been devised by someone who knows the cost of everything and the value of nothing. An incentivised career break scheme has been introduced in the HSE which pays staff up to €12,000 a year, for a maximum of three years, to stay at home twiddling their thumbs. Don't turn up for work and you'll still earn €1,000 a month.

It reduces the payroll bill, but this is creative accounting – not a solution. There is zero benefit to the patient. Just fewer pairs of hands doing the work.

Hospitals would function better – for the benefit of patients, not administrators – with more single rooms for terminally ill people.

Failing that, bays within wards offering greater privacy would be an improvement.

Granted, such initiatives cause more work for staff who are already under pressure, but they would make treatment more tolerable for patients and their families.

So the money has to be found, not only for the improvements but to adjust staff ratios to take account of them.

Funds can be provided for other expenditure, after all – such as iPads for members of the Oireachtas.

Well-resourced care in the community is also a must so that people can be supported in familiar surroundings. And hospices are a vital halfway house for the dying.

Health workers are being demonised during this debate. We keep hearing how the wage bill is too high – as though employees are greedy. But we hear less about sloppy use of resources and unnecessary tiers of bureaucracy.

Hitting targets and controlling overspend matter, of course. But in the final analysis, the dignity of the human being who is suffering, perhaps dying, in one of those hospital beds must be kept in mind. That's the overriding priority.

Otherwise, what's a hospital for?

Irish Independent

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