Wednesday 13 November 2019

Dr Ciara Kelly: 'Measure it any way you like - patients on trolleys is failure'

Health Minister Simon Harris. Picture: Collins
Health Minister Simon Harris. Picture: Collins
Dr Ciara Kelly

Dr Ciara Kelly

I have heard senior doctors and health managers bemoan that numbers of patients on trolleys is not a recognised international measure of health outcomes. They want us to instead look at survival rates in heart disease. Or length of survival after a cancer diagnosis. That kind of cutting edge thing.

And technically they're right - although the reason it may not be internationally recognised is that other countries don't have patients on trolleys in the way we do.

But the fact that they want to be judged on different criteria to trolley watch reminds me of that survey where they asked doctors what they thought patients wanted in a doctor. And doctors answered along the lines of: up-to-date, encyclopedic knowledge, an understanding of a broad range of treatment options, plus good technical skills. They then asked patients what they wanted from doctors and they answered: kindness and easy access to appointments.

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How doctors view healthcare and how patients view healthcare is not the same. And I defy any doctor to say to the face of a patient on a trolley or their family that their ordeal in an emergency department is not a measurable failure by the health service.

All over the country right now there are hundreds of people, mostly old, lying on trolleys in emergency departments. They are there because they are too sick to be sent home. So they're in pain, they're nauseated, they're feverish, they're weak, dehydrated or confused.

We all know what it is to feel very unwell - we've had the flu or a broken limb or a gastric bug. Well multiply that feeling by 10 - because you're now sick enough to be admitted to hospital.

And imagine feeling that way when you're also old and frail. And then experience it lying on a hard, 2ft wide trolley that hurts your arthritic hips and your aching lower back, under fluorescent lights that never go off, day or night, and add noise and smells and commotion with people throwing up and shouting and fighting - so you're frightened by your surroundings.

And just to make it worse you worry because you're not properly dressed for being out in public and you're anxious about what will happen if you need to get to a toilet in a hurry - that is what it's like to be on a trolley in an Emergency department. You're sick, frightened, anxious and in pain.

All of us know when we're sick we long for our own comfy bed, dim lights and peace and quiet - well this is the absolute antithesis of that. It is horrendous.

And October 2019 - despite us not having hit full winter yet, despite no widespread flu outbreak, no major catastrophes or other unusual incidences - had the highest number of patients on trolleys around the country that we have ever seen in an October since records began.

According to the Irish Nurses and Midwives Organisation, 11,452 people ended up on one last month and November is not looking like it's shaping up any better. When we hit the winter flu season our emergency departments will be like hell on earth for everyone who works in or attends them.

Truthfully, our service is set up poorly and no one is brave enough to tackle the roots of the problem. We do spend what should be an adequate amount of money on our health service - we just don't spend it properly. And the upshot is we don't have enough beds for acutely ill patients who need one - as a direct consequence.

So what should be done?

Well, first and foremost, let's call a spade a spade - we have too many hospitals. Many of which are sub-standard for the level of care they're delivering. We need to close some and upgrade others in conjunction with a massive investment in our paramedic, ambulance and air ambulance services as people will have to travel further to hospitals.

We also need to make use of telemedicine so true expertise in diagnostics and treatment, located in centres of excellence in Dublin, Cork and Galway, can be accessed by a number of other centres around the country.

This rationalisation of our hospitals is imperative to achieve real expertise and affordability in health - it cannot occur without it. But you name me one politician who will support their sub-standard, constituency hospital being closed down? And without this our parochial health service will never improve.

Secondly, we need to bite the bullet on funding proper nursing care - both at home and in nursing homes for our elderly population. We have a situation where a funding cap on this is causing massive hardship for families but also is resulting in acute hospital beds around the country being occupied by long-term patients in a way that's totally inappropriate.

Move those patients out to a more suitable setting and you would free up a whole hospital full of empty beds.

And last but by no means least, we need to challenge restrictive work practices among healthcare staff. People don't get sick Monday to Friday, 9-5. Our health service cannot operate like a bank.

Expensive diagnostics like MRI and X-ray should be open from 7am-10pm as they are in private hospitals. We need to move people through the hospital system much faster than we do - no one should be occupying a bed so they can access a scan or a scope, as is the case at the moment (because if they're discharged they go on a longer waiting list).

It creates bed-blocking and an inefficient use of resources. Staff use the hashtag #carecantwait when they are calling for pay equality and they're right - but our recruitment crisis is caused by people not wanting to work in a broken system as much as by issues related to pay.

Improve the whole system - by actually changing work practices - and pervasively people will prefer to work in it.

Do these three things: Rationalise the hospital infrastructure. Fund home care and nursing home care. And run the service for the patients who use it - not the staff who work in it.

And we would then, for no additional cost long term, see a wholly different level of access for patients when they are sick and need it.

Politicians, unions and a lack of true leadership are directly responsible for your mum, your grandfather or you being left on a trolley for days.

We do need to spend money upfront on rationalisation of current resources - but neither #SlainteCare or any other plan I've seen has given me hope that we will see true change in our health service. A radical overhaul and real political courage - not just money - is required to do what needs to be done. Mais plus ca change.


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