Tuesday 21 January 2020

Embarrassing HSE needs serious reform, not a five-point plan

As a doctor working in both the private and public sectors, consultant ophthalmologist Michael O'Keeffe is worried about the HSE

CRISIS POINT: 6,751 patients in emergency departments had to wait on trolleys around the country last month
CRISIS POINT: 6,751 patients in emergency departments had to wait on trolleys around the country last month

Michael O'Keeffe

People are not being seen and are not being treated. The phones don't get answered. If you ring up any department, most of the time there will be nobody at the end of the phone. If you get an answering machine, nobody will get back to you. You wait in limbo because this is the public health system.

Just a short walk away at a private hospital, things are far more serene. A well-oiled machine will run as it should and so should all of our hospitals. Unfortunately, it is clear that public hospitals have been neglected for some time.

The result is the looming threat of more privatisation in our health service and the possibility that the public will relinquish control of how we treat our sick.

It is embarrassing, not only for our Government but for those striving to help. I am embarrassed.

I feel embarrassed because some of the patients think the unanswered calls, the cancelled appointments and long queues are my fault. They associate this with the doctor involved and they think the doctor is cancelling on them or is not able to see them.

It is embarrassing for me as a doctor and I feel terrible for the patients. People with serious problems cannot get appointments, are waiting and left to worry. This is not how it is for private patients because the system is imbalanced.

As a consultant ophthalmologist working in the private and public sectors, I can compare and see what is wrong with the HSE. The Mater Private and Temple Street hospitals I work at are separated by just a few hundred metres, but in terms of how they work, are light years apart.

The news that 6,751 patients in emergency departments around the country had to wait on trolleys last month came as no surprise to me.

Ten years ago, Mary Harney declared a national emergency after it was found we had 3,460 people waiting in corridors for treatment. We are now at double that figure because emergency departments have become a dumping ground for patients. They are no longer specialist medical units for handling patients who present at hospitals without the luxury of being able to make an appointment. Instead, they are glorified holding areas where patients are left to wait until someone decides what to do with them.

Now we have reached breaking point. The HSE is at an absolute crisis point. It cannot continue to cancel operations, have no staff in operating units or no beds.

People are going to die and it cannot be allowed to happen. Real action must be taken.

The five-point plan introduced by Minister Simon Harris last week is not the answer.

First, before the end of the year, Mr Harris wants to halve the number of patients waiting more than 18 months to be seen.

How do you choose what half to handle first and then, how do you verify who is going to wait longer or shorter? Some people are going to be urgent. Are you going to make them wait because some patients on the list have been waiting for longer? Isn't 18 months too long to be waiting anyway?

The second point of the plan aims to clinically validate all in-patient and day-case waiting lists where patients are waiting longer than 15 months. The minister said this will be done by the end of August, but it is something we have heard before and it will take months, not weeks.

Thirdly, the minister wants the HSE to roll out a waiting-list improvement programme in each hospital group.

However, the administrative structures within the HSE are out of hand. We have a manager at every level instead of having two or three people in charge. Then, looking at the hospital groupings, there is an enormous layer of bureaucracy for a small country like ours, designed to save face instead of lives.

The final strands of the minister's five-point plan are about monitoring hospital performance and developing waiting-list proposals. This should be happening anyway. The plan is window dressing. It is political fluff.

There is a young minister new to the job, he is enthusiastic and that is great. But the problem is far bigger and more fundamental than his plan addresses. His plan is a political exercise. We need a root-and-branch reform of the system.

First of all, the State must get the basics right. The phones are ringing when I try to arrange an X-ray but the calls are not being answered. Why?

Likewise, the minister's plan will not explain why patients do not know when they are coming in and going out.

Why are so many outpatient appointments being cancelled? Why are so few surgeries being done? The public system is not as efficient as the private system. What is the reason for that?

Privatising the public healthcare system, or at least privatising a lot of it within 12 months, will have to be considered. It sounds drastic because that is what we need. It would not be a positive step - we need a healthy mix of public and private healthcare competing with each other to get the best possible service - but anything is better than waiting on a trolley.

I am amazed people are not on the streets protesting.

People are waiting on trolleys and chairs for days to be seen. People are suffering more than necessary and the outcomes are much poorer than they should be because of the way it is now.

If you are someone waiting for an appointment, looking for results or wondering what is going on with a surgery, it is completely frustrating.

Sunday Independent

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