Friday 15 November 2019

Patients must come before bureaucracy

Our ambulance service needs co-ordination, not sentiment, writes Emer O'Kelly

Laverne McGuinness
Laverne McGuinness

Emer O'Kelly

THE chaos in the ambulance service countrywide, stirred by politicians shamelessly watching their own back yards, can probably best be exemplified by what happened at the scene of an accident at Cratloe on the Limerick/Clare border at lunchtime on the last day of February.

A young man lost control of his car and ploughed into a bus stop, overturning the car. A passer-by called 999. No ambulance arrived for 40 minutes, although the accident happened only 10km from the largest ambulance base in the area. In the interim, three units of the fire brigade arrived. A fire brigade officer reportedly immobilised the driver's head and neck. When the ambulance arrived, the driver was sitting in the back of a witness's car. The road was closed for 90 minutes. The ambulance transferred the victim to hospital, where he was checked, treated ... and discharged. But neck injuries can be fatal. Even so: how many fire brigade units are required to deal with a single burning car? (Actually, it wasn't burning.)

The incident can best be described as incompetent overkill on the one hand, and a disgracefully inadequate response on the other ... which might have cost a life.

Earlier in February, an 87-year-old woman suffering from lung cancer and Alzheimer's fell as she went to open the door to her home help in Kells, Co Meath. She injured her head in the fall, blocking access to the door for her husband, who is in his 90s and who uses a walking frame. What is called "a responder vehicle" arrived half an hour after a neighbour's 999 call. The ambulance, however, was despatched from Virginia, Co Cavan, and didn't arrive for nearly an hour and a half. And again, head injuries are potentially fatal.

They were fatal last December in Carndonagh, Co Donegal, when a 70-year-old woman, walking home from Mass at six in the evening, was knocked down only a few metres from her home; and less than 200 metres from the local ambulance base. Except the only ambulance rostered at that base was "not available". An ambulance was despatched from Letterkenny, 62km away, rather than 200 metres away. It arrived 43 minutes after the 999 call. The official HSE target is just under 19 minutes. The woman reached Altnagelvin Hospital in Derry 90 minutes after the 999 call. She died of her injuries at midnight.

A heart transplant patient was being transported from Cork to Dublin, a donor heart having become available. The ambulance broke down along the way. The gardai stepped in and drove the patient, who arrived at the Mater Hospital within the crucial period when the surgery could take place. You could say he didn't need an ambulance: but he did need a vehicle permitted to break the speed limit.

On St Patrick's Day another ambulance stopped dead in Raheny in Dublin, its electronics seized up. A child suffering from the potentially deadly condition of anaphylactic shock was being brought to Temple Street Children's Hospital. Nobody was able to open the doors, or the emergency exit. It took the fire brigade 40 minutes to free the child, its accompanying adult, and a paramedic. (The paramedic had to kick out a small window.) The crew had reported electronic faults in the ambulance the previous Friday; but service mechanics don't work at weekends. The ambulance in question has 350,000km on the clock. Vehicles are supposed to be retired at 250,000, according to John Kidd, chair of the Irish Fire and Emergency Service Association, but many in the Dublin fleet of 12 have double that.

And then there's the fact that ambulance crews sit on their butts in hospital forecourts, sometimes for more than an hour, because their trolleys haven't been returned to them from the A&E departments. What is the cost to a hospital budget, one wonders, of a couple of spare trolleys to be kept at reception?

What it all adds up to is a totally dysfunctional system; and not just due to under-funding. It's a system where bureaucracy is preserved at all costs, even at the cost of lives being put at risk.

And what are the bureaucrats and politicians doing? Squabbling and point-scoring among themselves. Tony O'Brien, the comparatively recently appointed CEO of the Health Service Executive, is blaming the speed with which the HSE was set up a decade ago: "like a car crash," he says, presumably referring to the set-up process being threatened with collapse when Mary Harney tried to balance the demands of the service with the demand by then Taoiseach Bertie Ahern that not a single administrative job in any of the now defunct local health boards should be lost, whatever the cost to the Exchequer.

O'Brien presumably knew that when he took the job on; he should not now be blaming a 10-year-old situation for today's failures.

Meanwhile, his deputy DG, Laverne McGuinness, told the Oireachtas Committee on Health last week that to have ambulances responding to calls within the HSE's own target response time remains "a key objective". Public time was set aside for her to say something as earth-shattering as that, presumably so that the politicians could give the impression of doing something?

And in Dublin, where €9.4m is spent by the HSE on the ambulance service in the city (the total Dublin service budget, operated by Dublin Fire Brigade, is €11m) there's

a screaming hissy fit going on about consultation between the City Council and the HSE. The HSE plans to take over the administration of the ambulance service from Dublin Fire Brigade by the end of 2015 because it has "inadequate control" over its own €9.4m, and "is constrained in its plans to develop an integrated national ambulance service". Cue blue bloody murder: fait accompli, say the conspiracy theorists, and making a nonsense of a supposed review by the Council and the HSE, and due to report in May. Siptu and various Opposition TDs are posturing against the service being taken from Dublin Fire Brigade, which has operated it since 1899 ... a damn proud record, it cannot be denied. But Richard Boyd-Barrett of People Before Profit; Aengus O Snodaigh of Sinn Fein; Maureen O'Sullivan, Independent; Joe Higgins, Socialist Party; and Clare Daly (former Socialist Party) are all up in arms. God knows, we all admire the fire service and its extraordinary, dedicated, brave operatives. But this is 2014, as all of those loud-talking TDs are fond of saying. And we need co-ordination, not sentiment.

To leave Dublin divided from the rest of the country, as might suit all of them (most of them represent solid working class Dublin constituencies with a strong sentimental streak in the electorate), will perpetuate the ambulance mess: 40 per cent of all calls to the ambulance service annually happen in Dublin.

What we need in the ambulance service nationally is a ruthless concentration on patients to the exclusion of all else, and ruthlessly indifferent to bureaucratic vested interests: what Mary Harney tried to do in the setting up of the overall HSE a decade ago but was prevented by her Taoiseach's indifference to anything except electoral advantage. We won't get it, of course. But in the meantime, let's feel sorry for the people who need an emergency ambulance today; and feel almost equally sorry for the over-stretched paramedics who see their dedication lost in a morass of self-serving incompetence.

Sunday Independent

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