MICHAEL WOLSEY: It’s little things that make our hospitals look sick
Big changes have just been announced for Ireland’s hospital system. That worries me, for I remember other announcements of big changes. They always cost a lot of money; they rarely made things better and they sometimes made them worse.
The new plan for Regional Health Areas sounds disturbingly similar to the plan for Regional Health Boards, which was a big announcement in 1970. It failed because local politicians were given control of the boards and most of these councillors put regional point-scoring before public health.
The system collapsed in 2005, under the weight of its own bureaucracy. It was replaced by the centralised Health Service Executive (HSE). It has been the object of several grandiose schemes, the grandest of them all being Sláintecare, of which the return to regionalism is a part.
While the big targets have been debated, dissected and discarded, opportunities have been missed for small changes that, while they would not have revolutionised the hospital system, could have made actual hospitals better for real patients.
And there is a lot of room for improvement. A recently-published Independent Review of Unplanned Care found little sign of planning and not much care in the nine hospitals surveyed.
There was widespread placing of patients almost at random – any bed, any time, anywhere, including mixed gender wards. The report said this did not create extra capacity, but led to “safari rounds” as doctors hunted around hospitals to locate the patients they were meant to be treating.
None of the nine hospitals was found to operate a 24/7 model of safe and effective care.
The HSE says things have improved in the two years since the report was compiled and, on some specifics, that may be true. But I fear the system is still dominated by a culture that concentrates on big ideological objectives – like Regional Health Areas – and ignores the value of sound hospital management.
At around the time the Independent Review was being conducted, I had personal experience of some of the failings it discovered.
My wife had suffered a surprise seizure and was directed by a GP to the emergency department of a large public hospital.
It was packed with would-be patients and their escorts. The most overcrowded place was the reception area because nobody could get out of it until they had seen the one triage nurse on duty. There were three receptionists but only one nurse and the logjam was made worse by the fact that she would regularly leave her station and head off with a patient to find a doctor, or show the way to the x-ray unit.
When my wife finally got out of the packed reception area she ended up on the inevitable trolley. ‘You could do with a pillow there,’ said a passing nurse. And indeed she could. But, despite several requests, she never got one.
Five or six medical people spoke to my wife over the course of the next few hours. They all asked her pretty much the same questions and not one of them ever completed their inquiries before being called away to deal with someone else.
Twice she was asked if she was on any medication. Twice she replied that she was but couldn’t remember the names of the drugs. She pointed out that she had been in the hospital after a recent fall and they had her records. Twice she was told that the staff couldn’t access records at night.
Similar difficulties were being experienced by people all around us. None of them were problems that required much money to fix, just a bit of sensible management.
The hospital staff were all working extremely hard in very trying conditions, but they were not working to good effect and its resources were not well-used. There were more people working in the carpark than in the reception area, and while there may have been a shortage of medical staff there should certainly not have been a shortage of pillows.
These are issues for hospital management. They are not the sort of problems that focus the minds of politicians and public health chiefs and I doubt, somehow, that they will be the focus of our new Regional Health Areas.
But these are problems which directly concern patients and somebody needs to fix them. If the little details continue to be ignored, regionalisation will be just another big idea that leads nowhere.
