Monday 23 September 2019

Ciara Kelly: 'Why we need fewer - but more sophisticated - hospitals'

Scandal of the dead left on trolleys is just one symptom of an underlying problem, writes Ciara Kelly

Dr Ciara Kelly . Photo by Kyran O'Brien
Dr Ciara Kelly . Photo by Kyran O'Brien

Ciara Kelly

The mortuary at University Hospital Waterford made headlines last week as consultants complained facilities were so bad that people's remains were left to decompose on trolleys in corridors, leaking body fluids on to the floor and causing distress to patients and staff.

This situation is clearly wrong on so many levels. Leaving someone in such a condition after death is an affront to human dignity - a dreadful way to treat them and their families.

Decomposing bodies are a major problem for infection control. And that the hospital cannot manage the presumably not-very-large numbers of bodies says something about its management structures.

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An upgrade is clearly needed but this will take time and money. Current plans are suggesting it will cost in the region of €5m and be completed in 2022.

Which doesn't address what's to happen to the dead in UHW in the interim.

In terms of healthcare, this depressing story is more of a symptom of an underlying problem than the problem itself.

We simply cannot afford our current hospital system and if we want healthcare that delivers good outcomes, then someone needs to be brave enough to say it.

We spend as much as any country in the OECD on healthcare per capita but are plagued with poor access, long waiting lists and an ever-growing trolley crisis. Other countries simply do not experience these to the same extent.

This is because we are still operating off a parochial system of having hospitals in too many locations. Which was important back when Ireland had no infrastructure and our roads were pockmarked, unlit boreens and we could justifiably tell ourselves Roscommon and Cavan were far away from each other.

But in an era of good roads and modern transport, this simply isn't a sustainable or desirable basis for healthcare delivery.

And it was fine to have multiple hospitals around the country when all they really provided was a building for the sick to lie in while they either got well or didn't. All you were paying for was bricks and mortar and a handful of staff and utilities.

Modern medicine is light years from this and now massively expensive to provide. Diagnostics. Drug inflation. Vastly upskilled healthcare professionals, who are now much better paid and work with improved patient/staff ratios. Plus enormously costly medical interventions and surgeries - now routine in Irish hospitals - mean hospital running costs are now multiples of what they once were.

Take as a basic example someone who had a heart attack - 40 years ago their treatment would have involved them lying in a hospital bed for observation only. Nothing much was done while staff waited to see if they survived or not. These days their treatment would involve complex MRI scans, cardiac catheterisation, angiograms or angioplasty, bypass surgery, high-priced clot-dissolving drugs and a prolonged stay in a high- tech, coronary care unit bed, cared for by specialist doctors and nurses.

What once cost a couple of hundred quid now costs tens of thousands of euros - if not more. The truth is that in a country of four-and-a-half million people and a relatively small geographical area, we need far fewer hospitals than we have.

What we need are fewer but bigger, more-sophisticated hospitals that are centres of excellence and expertise. Hospitals should be viewed by providing health care to a population area, not a county.

The National Children's Hospital, while a behemoth in cost, is right in terms of ideals. We should view hospitals as national resources, not something every constituency is entitled to, irrespective of how few people live there in order to prevent people having to drive way up the road.

Instead of a hospital in every provincial town, we need ambulance helicopters in each county. Upgrade our road ambulance fleet and recruit advanced paramedics. Paramedics should no longer have to wait with patients in emergency departments - those patients should be handed over on arrival and the paramedics put back on the road.

We should only provide step-down beds and home-care packages in the community - not acute care on your doorstep. And we should develop a system of telemedicine for relaying diagnostics and simple outpatient-based instructions to patients to reduce the need to travel.

We spend as much or more on healthcare per capita as anywhere - but we aren't getting a good service. In modern medicine, money should be spent on diagnostics, drugs, evidence-based interventions and staff.

We spend it instead on the upkeep of bricks and mortar, propping up second-tier hospitals many people already bypass if they're truly sick.

And we're doing it at the expense of having the fewer, but better, tertiary facilities we need and might actually be able to afford. All because we believe we should have an acute hospital on our doorstep.

This needs huge reform, but while people in Gweedore believe Letterkenny is as far as they should have to travel for care, we will never see any politician brave enough to say we don't need a hospital in every county.

What we actually need is a very good, efficient hospital in every region - with a proper system to access it. Even the people don't want the changes that would actually deliver quality healthcare patients deserve.

But unless we bite that bullet, trolley numbers, waiting lists and a lack of timely access to diagnosis or treatment will continue. And lives will be lost.

Waterford's mortuary situation is a mess. But there will be more messes down the line. At what point will we see some real leadership in healthcare reform?

@ciarakellydoc.

Ciara presents 'Lunchtime Live' on Newstalk, weekdays from 12-2pm

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