Friday 18 October 2019

What the public can do for public health

Others will diagnose systemic problems in the HSE, but Sarah Carey has some ideas on public health and public discourse

Change: St James's Hospital Photo: Mark Condren
Change: St James's Hospital Photo: Mark Condren

I have three proposals to solve the trolley crisis. They are by no means comprehensive but there's no point repeating suggestions made elsewhere. And since 'multi-factorial' is my new favourite word (last year's was 'authentic') I think they should be given due consideration.

The first is a censorship issue concerning irrelevant comparisons. I have never been to the Third World. I suspect neither have those who claim that our hospitals are "just like the Third World". In Sierra Leone, the maternal mortality rate is 857 per 100,000 births. In Ireland - where the constitution is supposedly killing women - it's 10 per 100,000 births. That is nothing like the Third World. Falling back on this lazy cliche is a gross insult to people who live and die in the Third World. So could we stop that please?

I'd also like to extinguish the idea that this annual problem is uniquely Irish. The Red Cross has declared a humanitarian crisis in the UK and yet we continually refer to the NHS as the gold standard in public health. We're not the worst. They aren't the best. So let's just think before we compare.

Secondly, I'm fairly certain that money is not the problem. Based on our gross national income, Ireland is the second highest global spender on health, beaten only by America. Whatever we do must be done within the budget. The proof that many of our problems are managerial not financial is the pudding that is St James's Hospital.

St James's is not merely located in one of the poorest areas of Dublin but also within a community with a particularly aged population. Yet throughout the hysterics of last week, the spreadsheet updated three times a day by the HSE repeatedly showed St James's single-digit trolley figures highlighted in green. This was in stark contrast to the glaring reds at many other hospitals.

There were several hospitals in green, in fact. Clearly, they were doing something right. What was it?

Professor Rose Anne Kenny is a dynamic physician at St James's, a world expert in gerontology and director of the flash new Mercer's Institute for Successful Ageing at the Rialto campus. Reluctant to judge other hospitals as she wasn't familiar with their practices, she explained on my show on Newstalk yesterday morning how St James's keeps its numbers in A&E at manageable levels.

Fully expecting the annual peak in demand, St James's decided that all hospital activity would continue as normal. There was no Christmas winddown. Rosters and diagnostics were fully staffed throughout the holiday period.

As Prof Kenny observed, our bodies don't know it's Christmas. It's hard on the medical profession working round the clock in the holiday season, but that's the reality of their jobs. It's no different from retail or farming or a dozen other trades where there's no Christmas break. Clearly, the decision worked. Did other hospitals do likewise, and if not, why not?

St James's has led the way in other work practices. For example, if you go into St James's with an epileptic fit or a fall or faint, you are immediately referred to a specialist team that sends you down a care pathway separate from standard emergency care. It has a special unit in the community to deal with COPD, a progressive breathing disease that requires acute care from time to time. The point of immediately directing patients to these specialist teams is that they aren't waiting in A&E. It makes perfect sense.

I had previously heard that St James's was one of the first hospitals to solve the cleaning problem and the first to text patients to remind them of outpatient appointments. So it seems to me they've something going on there that's working.

And it seems to me that while the media loves to park cameras outside the worst- hit hospitals in the country because the drama makes for great coverage, it's time that we focused on the hospitals with no drama but great management. Let's make stars of the consultants who are solving problems, and not the ones showing up on the news every five minutes complaining about the system not working.

Thirdly I want to focus on the 'public' part of public health and - don't panic - follow Donald Trump's policy lead. What is the public doing to add to or alleviate the problem of winter overcrowding? As my favourite blog, Best of Both Worlds, observed last week, seasonal bugs are predictable for the hospitals, so they're also predictable for the patients.

We know bugs get out of control at this time of year. People have an obligation to themselves and others to avoid infection by handwashing, using hankies and not wilfully spreading their germs everywhere by going to work and socialising when they know they are sick. Where is the cultural approbation for giving us your child's vomiting bug by coming into work with their germs over your infected hands?

Trump has it right. He refuses to shake hands with people. Who knows where they've been? My granny's generation wore gloves and when I start to think about the filth of escalator rails, public toilet doors, money, ATM machines and this affectation for continental-style kissing, I think they were right.

But worse, when people trail in and out of pubs at a germ party over Christmas, overindulging, losing sleep and making themselves vulnerable to illness, why do they insist on bothering GPs and A&E departments when entirely predictably they get the flu or a dose of the skuts? We have been repeatedly told that if you've got vomiting and diarrhoea or the flu, there is no point getting medical attention. Stay home. It'll pass.

I wouldn't necessarily recommend my mother's brand of stoicism - we were reared to presume that bothering doctors unnecessarily was a mortal sin - but off-air and off-the-record, doctors will freely admit that many of the patients they see are time-wasters. Increasingly free access to doctors lies behind many frivolous consultations but 'awareness' and the dreaded Dr Google play a part. Now every toddler's temperature could be meningitis and every bump on the head a fracture. Get a grip.

What I find most irritating is the reluctance of doctors to name this phenomenon. They are terrified of being seen to judge their patients and fearful of driving away conscientious types who should attend but don't. We've got to create a culture where being sick at home is not a medical emergency. It's normal.

Finally, I was appalled to learn of the low take-up rates for the flu vaccine, in particular the take-up rate among health professionals. Just 28pc of healthcare workers get the vaccine. Of all people, it behoves nurses and public officials most to get the vaccine. It stops them giving flu to their patients and means they aren't absent from work through illness. Unbelievably, apparently there is an anti-vaccination culture in the health service which for a scientific sector is just extraordinary.

The point being, this isn't all about the crisis being someone else's fault. We all have a part to play in doing our bit to ease the pressure on the health services. So wash your hands. And send Simon Harris down to St James's - because some problems are solvable.

Sunday Independent

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