Thursday 13 December 2018

Disaster rhetoric does system a disservice

The INMO is good at presenting the trolley crisis as one simple problem with one simple answer, says Brendan O'Connor

It was very telling that people were reluctant to moan to the Irish Independent's Nicola Anderson when she went to St Luke's General Hospital in Kilkenny, which had, at that point, the most overcrowded A&E room in the country. Those waiting praised the staff, the quality of the care, even the level of organisation. They felt sorry for the staff.

The dominant voices in this annual ritual tend to paint a picture of chaos, seething masses of humanity. But behind the numbers and behind the disaster rhetoric, there are people working away efficiently offering excellent care as best they can. There may be hundreds waiting on trolleys but there are thousands being cured every day too, lives being saved by the miracles of modern medicine and the wonderful people who use their skills and dedication and the tools and technology to work those miracles.

Anthony O'Connor, a consultant gastroenterologist at Tallaght, who wrote a thought-provoking piece for The Journal last week, pointed out something very simple at the start of his piece. He works, he said, in a hospital where 96pc of the patients last year described their care as good or excellent. And the vast majority of us would probably concur. Once you get in to the system, it works for most people.

We all have our stories. I had to divert a taxi to Vincent's when a hematoma exploded in my arm. Blood everywhere, I staggered to the bone clinic, the only place I knew the location of; they sprang into action like something out of the TV show ER and a friendly giant of a young doctor put all his weight into applying pressure until the bleeding finally stopped, others keeping me engaged so I didn't pass out, others cleaning the mess as it was made. I have never seen people work so intensively and calmly and efficiently under such pressure. And that was just another case in a long day for them.

The vast majority of people who have had any recent brush with the health service will sing its praises to you. It can be frustrating waiting at Crumlin or Temple Street but most of us don't mind it because usually, all around us, are reminders that things could be far worse, that we are lucky that we and our children are only briefly dropping into the land of the unwell.

Which is not to say that we shouldn't be angry that there were children waiting on trolleys last week, two of them for more than nine hours. And of course we should be angry at the thought of older people being stripped of their dignity and their privacy on trolleys in corridors or in temporary beds in wards.

Sickness is degrading at the worst of times, those awful hospital gowns being the perfect symbol for how we are there, already at our most vulnerable, and then we are stripped of our very personhood and rendered impotent and exposed, from people to patients. And that's before you think of the pain, the fear, the danger, the fact that you might be dying, or that you might worry you are dying, and this is how you are spending your final hours.

Of course we should be angry about it. But the simple populism of judging our whole health system, our whole country, by days like these, of using these extreme moments to damn everything, is to do a disservice to the fact that 96pc of the patients at Tallaght last year thought their care was good or excellent.

To boil everything down to one simplistic message that our healthcare system is a disaster, a national emergency, a rolling inhumane crisis, is to do a disservice to the fact that the numbers on trolleys had fallen by 200 between Wednesday and Friday. It is to do a disservice to the fact that we cannot run everything and resource everything based on what the maximum need in a crisis or emergency surge is going to be. It is also to do a disservice to the fact that part of the job of managing is to prepare for such surges, especially when they are entirely predictable.

The simple, populist answer is that we need to pump more money into the health system, and we do and we are, with more beds coming on stream all the time and hundreds of millions extra in the budget last year. But there is never just one simple populist answer to something as complicated as this. And sometimes, simple populist answers contradict each other. So on one hand, people are up in arms about how much consultants get paid. It is fashionable on the left to deride these demigods for thinking they deserve the large sums they get. But then we come to the annual trolley crisis and we discover that part of the problem is that the populist cutting of new consultant contracts means we can't get consultants to take up jobs in Ireland. So suddenly we need more resources to pay them more.

It is understandable that the INMO, which is a union, would attempt at this time every year to take this one very simple trolleywatch measure, and use it to frame one big simple debate about our health service, suggesting one simple answer, which is more resources. And you'd be very reluctant to suggest any cynicism by this sector because we all know how hard they work and how little they often earn, and we all understand that they demonstrate extraordinary grace under pressure doing a job that most of us couldn't do.

But we also know the truth is that this is not one simple problem with one simple answer. And of course, right now, the whole thing is complicated by the fact that it is flu season. So there are many mundane things feeding into the current overcrowding. And many mundane things could feed into it in the coming weeks.

Will parents keep children with cold- or flu-like symptoms home from school next week, or will they take a chance and send them in because they've had them home for two weeks? Will adults with symptoms stay at home from work or will they be tempted to go in because they are still catching up after the Christmas break? These are just a few of the many diverse and rather mundane factors that will influence trolleywatch over the next few weeks. Medicine is often about the seemingly mundane.

Peter Pronovost was the young intensive care specialist who popularised the notion of checklists in ICU units, just mundane lists of all the hundreds of tasks that had to be done in every case. It is thought he saved more lives that any of his contemporaries who were laboratory scientists, engaged in much more complicated and sexy research. You would imagine that if Pronovost was looking at the Irish situation this weekend, he would have, as one of the items on his checklist, that everyone working in a hospital should have the flu jab. Indeed, health care workers are on the list of people who should absolutely have it, along with various other categories of vulnerable people - those with chronic illnesses, cancer patients or those with reduced immunity, pregnant women, people in long-stay facilities. The flu jab was such a no-brainer this year that I even took it for the first time. Only 38pc of people working in our hospitals have had it. Just half of those in work in acute hospitals have had it. This is apparently an improvement on previous years. And hospital workers cannot be coerced into having the flu jab.

The answers to these crises are never simple, are they?

Sunday Independent