Saturday 21 April 2018

Rude health: What's in a name?

When your local hospital changes its title to a University Hospital, Maurice Gueret asks who is paying for the ink

A trolley is a trolley.
A trolley is a trolley.
Dr Maurice Gueret.

Maurice Gueret

Ample fingers will be professionally wagged at you this month, so I won't add to the tedious annual doctrine of New Year's resolutions. If you are going to do something positive about the bags of fluid under your eyes or the sacks of sugar around your waistline, then spring or summer are much better seasons to begin. Winter is a good time for humans to wrap up, hibernate and keep warm. Ears should be well muffled against advisory do-gooders and medical mean-wells. I make an honourable exception for government ministers.

Our good friend Doctor Leo always welcomes your policy suggestions at ministersoffice@health., so I'm going to give him the benefit of some of mine over the next few weeks. He could start by taking an interest in the curriculum of Irish doctors and nurses. They may know all there is to know about flu-vaccine antigens, the racemose structure of Morgagni's glands and the name of the best emporium in which to purchase discreet incontinence wear, but it's safe to say that most of us who play doctors, nurses, and dare I say ministers, know feck all about health economics.

Why should we? Old thinking was that student medics had enough to learn in the anatomy department where it took them a full three years to dissect a body. New thinking suggests that a skeleton course on the basics of home economics, running a business and money management could reap huge dividends.

This new doctrine of clinical prudence with the cash of others emanates from America, spiritual home of rampant medical inflation. The New York Times reported recently on a lady doctor who is chief executive of a major hospital group in Utah. With an annual budget of US$3bn, she decided to look in minute detail at where the money was going, to see if some could be saved without compromising care. She discovered that one minute in a hospital emergency room was costing 82 cent. Somebody tell Tallaght! This compares with one-and-a-half dollars per minute in intensive care and 12 dollars a minute for an orthopaedic operation in theatre. Most laboratory procedures were quite cheap, 10 or 20 bucks each. But some groups of doctors were spending millions each year on blood tests, many of them quite unnecessary. The software programme can flag up when one nurse is using more bandages than her colleagues, or when a doctor is costing far more than his keep.

Recently, Brendan Howlin's Department of Public Expenditure and Reform prepared an internal paper which suggested that Irish hospital costs were 80pc higher than the EU average. The figures were compiled in 2014 and looked at all sorts of expenditure, from patient food to staff salaries and laundry to medical consumables. Criticisms were levelled, with some saying that you cannot directly compare our costs with those of Latvia or Albania. But surely it cannot be right that the only time trainee doctors come face-to-face at university with health economists is when the latter donate their corpses to medical science. This really has to change, and could make a fine New Year's resolution for a distinguished health commentator like Dr Varadkar.

Tittering was overheard when a hospital formerly known as Sligo Regional, Sligo General and the County Hospital, Sligo, announced that it was now Sligo University Hospital. Rude catcalls of "Where's the University?" were overheard on social media. This excellent 320-bed hospital might well point out that Waterford set the precedent. Its campaign to have a University in the city was assuaged by the much cheaper option of appending 10 letters to its hospital's name. District hospitals may soon look for the word 'technology' to be added, while cottage hospitals may have to do with 'thatched'. I have pointed out before that Ireland's six medical schools (of which we possibly have five too many) have all hitched their names to these new fancy hospital groups. Whether they do much for patients is up in the ether. But this peculiar arrangement ensures that every medical school in the state survives and every town gets a virtual university.

Patients are less than impressed with fancy titles in healthcare. A trolley is a trolley, whether it's an Executive Trolley, a University Trolley or a Trolley of Excellence. I have been looking out for long-winded job titles in Irish healthcare. The HSE takes the biscuit with their Assistant National Director of Performance Management and Management Information.

Hospitals play the game too. A lady who sorted X-rays is now Deputy Business Manager of the Diagnostic Imaging Directorate. A bed manager is Head of Bed Management and must have a colleague at the other end in charge of Foot-of-Bed Management. The PR guy is Head of Communications and Stakeholder Engagement.

The person in charge of the typing pool is Data Manager & Secretaries Supervisor, and the lab chap in the short white coat is Pathology Quality Co-ordinator at the Diagnostics Directorate. The new uniformed porter is Interim Fire Safety Executive and Health & Safety Co-ordinator. Matron is Director of Nursing, Quality & Clinical Services and the Acting Director of Operations has never set foot in a theatre.

I write with authority on these matters, as this magazine's Executive Director of Health News Engagement Protocols and Clinical Informatics Dispersal for Weekly Stakeholders.

Dr Maurice Gueret is editor of the Irish Medical Directory

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