Wednesday 21 August 2019

Leo's Buddhism won't fix the trolley crisis

Acceptance, a bit of hope and blaming the people who care seems to the be the Minister's policy on the A&E crisis, says Brendan O'Connor

HOW TRULY AWFUL: Health Minister Leo Varadkar’s sanguine approach is no longer working
HOW TRULY AWFUL: Health Minister Leo Varadkar’s sanguine approach is no longer working
Brendan O'Connor

Brendan O'Connor

Leo was philosophical last week. Which is one of the things we used to like about Leo. But sometimes, the very things we like about politicians can become things we don't like so much about them, when they take up a different role. Remember Brian Cowen? Cowen was a great Rottweiler in opposition. He was even a good number two. And then there was a clamour for him to be made Taoiseach. And suddenly his temperament was all wrong.

Leo's 'whole telling it like it is and being philosophical about things' was very attractive at some point. But it is becoming an increasingly unattractive look for someone who is supposed to be the Minister of a department that deals with people when they are most in crisis, a department that is falling down very badly on that job.

Leo's tone seemed inappropriate last week, as he spoke in the wake of the revelation that a 91-year-old man with Parkinson's was left on a trolley in Tallaght hospital for 29 hours. The story emerged after an outraged email by Dr James Gray, who works in the hospital, appeared in the media. Even as more appalling stories began to emerge - the Daily Mail reported how an elderly lady was sexually assaulted after she was left in a room with five men, while Deirdre O'Meara rang Anton Savage to tell him about her 96-year-old father-in-law who spent 36 hours on a trolley in CUH - Leo was sanguine about it. He thinks it's awful. Indefensible, in fact. He doesn't blame the staff. They are doing their best. He doesn't seem to blame himself either. But he does think it's awful.

He even goes so far as to say that, "Unfortunately, this isn't an isolated incident." And indeed, he tells us that there will be more of this over the next while. The reality is, he says, that many of these people are old, and getting older. And we need a comprehensive solution.

The Taoiseach agrees. It's awful. The two of them could get jobs at the Irish Times at this rate, delineating problems and then saying, "Isn't it awful?"

Enda Kenny wondered who was responsible and said it was hard to understand how this could happen. He also pointed out that we will see other shocking cases coming to light over the coming weeks.

So the response of both the Minister for Health, and the Taoiseach, is essentially to say, this is terrible; I'd like to know who is responsible and, most importantly, if you think this is bad, just wait a few weeks. There's going to be much more of this. Maybe it's Government by Buddhism. Maybe Leo and Enda just accept dukkha. Life is suffering.

Of course, it wasn't just last week that everyone accepted that there would be an A&E crisis this Christmas. One of the major reasons that Enda Kenny was encouraged to hold an election in November was so that the Government wouldn't be hit by the annual A&E crisis that everyone knew was coming. Everyone just took it for granted, despite this Government's repeated promises - which date back to campaign ads with Enda Kenny promising to end the scandal of patients on trolleys - that there would be another crisis this year.

Leo has known this was coming too. In August, remember, Leo sent an email to top brass in the HSE and Department of Health expressing his concern at the number of people on trolleys. He said the improvement in July was less than he had hoped, and August was shaping up to be the worst August ever. He pointed out that with the increased resources, "we should be doing much better". Not as good as he hoped. No more than acceptance is, hope is not a policy.

And by September, Leo was complaining again, and encouraging more haste on the appointment of someone to head up a Special Delivery Unit dedicated to waiting lists. By September, Leo had decided the issue was now "urgent". Now, Leo was threatening that heads would roll if overcrowding was not sorted. The Taoiseach backed this tough talking. Clearly, Leo and Enda were moving beyond hope and acceptance. They were now outraged citizens of the State demanding that something should be done, and someone should be fired if something was not done. Such rhetoric would qualify them to be taxi drivers, or perhaps pub bores.

But Leo was back to acceptance shortly after that. "As a minister, I don't have the authority to dismiss anyone", he admitted, speaking about the heads-must-roll talk. "I think that was just an expression of my personal frustration. I don't have the authority to dismiss anyone who works in the health service."

Leo's response to last week's inevitabilities was to say that there is a plan.

But the plan wasn't the main issue really. The greatest urgency around the revelations about the 91-year-old man at Tallaght seemed to be for the hospital authorities to initiate an inquiry into the leaking of the email that an outraged Dr James Gray had sent regarding the situation on the ground in Tallaght. You and I also paid for an expensive PR company to aid in any ass-covering the hospital needed to do. And what happened next was an extraordinary intervention, whereby the doctor who had highlighted this intolerable situation was essentially made out to be the bad guy.

The 91-year-old man was apparently not unhappy with the care he was getting. His real problem was that his personal details, including the illness he suffered from and the length of his marriage, had been made public. You'd have to say that if an ill 91-year-old man did not feel tortured by lying on a trolley for over 24 hours, it must be some form of torture for him to have the Minister for Health acquiring his number and ringing him up, and hospital authorities checking in with him so that they could say on his behalf that he was very happy with everything. Did they maybe think of asking him to send a postcard saying how nice it was there? It was becoming hard to see who was playing football with whom at this stage. Leo was accusing Dr Gray of using the patient as a football in some dispute in the hospital, while Leo seemed to be simultaneously using the same frail, elderly ill man as a football to kick at Dr Gray's groin.

And in all of it, you couldn't help but wonder: where was their capacity for outrage? Why was Leo so concerned with trying to convince everyone that actually this 91-year-old man was mainly bothered about his details (if not his name) being reported? Should Leo's sole concern not have been to try and ensure that this kind of thing stops now? Were Leo and Enda not sickened by how old people are treated in this country? Were they not too ashamed to start engaging in ass-covering?

We've all been in emergency rooms with older relatives. I don't need to tell you that it is the most disempowering, undignified, frightening position for them to be in. Firstly, they are ill, but on top of that they are completely at the mercy of other people to tell them what might be happening to them.

Every time someone comes near, people look up hopefully thinking a nurse or a doctor might have something to tell them. But generally everyone is too busy to reassure any patient of anything.

People have no idea if they have been forgotten about and if they might in fact be dying, or if they are just being ignored because they are fine. It is, you'd have to say, a very, very low place for a person to be. Often you will get lucky in these situations and you will meet someone who has the time to show some kindness and offer some reassurance. And that tiny bit of kindness or reassurance can be invaluable to someone who has been stripped of their identity and their power and rendered a 'patient'.

And as we all know there are loads of great, humane people in the health system who offer that comfort and make these awful situations tolerable. Dr James Gray seems to be one of the humane people in the health system. And he doesn't practise acceptance and he doesn't practise mere hope. And despite years in the system, he clearly hasn't lost his capacity for outrage. Maybe instead of trying to demonise him, Leo Varadkar should try and learn something from James Gray about refusing to accept things just because that's the way they are.

Sunday Independent

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