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Tom Clonan: ‘Ireland is on the brink of a perfect storm in our health services’

Minister Varadkar needs to do ‘the bleeding obvious’ and demonstrate real leadership, writes Tom Clonan.

Tom Clonan

WHILST LAUNCHING AN initiative to measure patient safety metrics in Ireland this week, Minister for Health, Leo Varadkar had a classic John Cleese moment.

In other words, he made a ‘statement of the bleeding obvious’.

Referring to the state of patient safety in Ireland, the Minister observed, ‘Ireland is behind the curve when you compare us with the NHS or other western countries on patient safety’.

The thing is – we know this already. This is an issue that has been raised continuously by front line medics across all specialties in Ireland for at least a decade now.

Most recently, Dr James Gray a hospital consultant specialising in emergency medicine raised, for the umpteenth time, concerns about overcrowding in the Emergency Deparment (ED) in Tallaght Hospital.

Varadkar’s departmental response was to trigger an inquiry into the manner in which this information got into the public domain. Particularly annoying was the revelation that a man in his 90s was forced to remain on a trolley.

This year alone, a rather large number of elderly people in their 90s – some even in their centenary year – are languishing on hospital trolleys.

Varadkar’s perfect storm 

As Storm Abigail lashed the country, Ireland is on the brink of a perfect storm within our health services. This negative cycle consists of a number of key features.  The first is chronic underfunding.

The Health budget for 2015 is 15% lower than it was in 2008. This is despite the entirely predicted and forseeable growing demographic pressure on our health system. In an aging population, the numbers of complex cases presenting at Irish hospitals has increased to 1.5 million per annum – an increase of 21% since 2008.

This increase in patient load will continue to grow at a further 3% per annum. Quite simply, our hospitals have reached saturation point.

In June of this year, a low-demand month, the number of patients treated on trolleys stood at 7,775. This was twice the number treated on trolleys in the ‘black’ June of 2006 which prompted Minister for Health, Mary Harney to declare it a ‘national emergency’.

Leo Varadkar was appointed to the Fine Gael, Labour Cabinet in March 2011. Since then, as a member of cabinet with collective responsibility, he has signed off on every cutback and austerity measure to our already underfunded health services.

The funding deficits he and his colleagues have mandated include shortfalls of €279 million, €70 million and €284 million in 2012, 2013 and 2014 respectively.

Worst ratios of acute hospital beds 

This annual under funding has led to a situation where Ireland’s health services have one of the worst ratios of acute hospital beds per head of population in the OECD.

Ireland has an average of 2.8 acute beds per 1000 head of population compared to the OECD average of 4.8.

In other words, we have approximately half of the number of hospital beds needed to service our ageing population profile.

In addition to this lack of capacity, the Irish health services have become a toxic work place environment for front line medical professionals.

Repeated large scale studies carried out by both the HSE and the INMO show that more than one in twenty front line medical staff experience bullying in the workplace on a daily basis.

This is a shocking and unacceptably high level of bullying within any workplace. A consequence of this corrosive environment and an adversarial management style within the services means that staff recruitment and retention has reached crisis point.

Nine out of ten Irish medical graduates have indicated that they will emigrate and have no desire to work in the Irish health system. A similar number of nursing graduates are emigrating to less dysfunctional health systems elsewhere. A consequence of this brain drain and flight of medical expertise is that the remaining nurses and hospital consultants are an ageing cohort.

Whistleblower reprisal 

Those that speak out and advocate for patient safety are routinely sanctioned and subjected to whistleblower reprisal.

Our harried and harassed front line medics are also spread very thinly. During Varadkar’s time in government, the Irish health system has deteriorated to the point where all of our medical specialties are seriously understaffed and under-resourced.

For example, we simply do not have nearly enough neurologists, psychiatrists, obstetricians or other specialists to cope with existing and predicted population demand.

But, Varadkar has a solution. He and his team of highly paid advisors and strategists have decreed that hospitals who continue to ‘underperform’ in the current sorry state of affairs should be ‘fined’.

In other words, they will be deprived further of funding and robbed of the ability to treat the growing numbers of – often elderly – complex patients presenting for treatment. It places hospitals and front line medics in a Catch 22 situation.

Kafkaesque state of affairs

Deprived of the necessary resources to do their job – in a process of ‘victim-blaming’ they are then sanctioned with further cuts to resources. This Kafkaesque state of affairs is the brain child of the current minister, who states glibly, ‘You have to have a system of incentives and disincentives’.

Ireland’s Health and Safety Authority’s guidelines on bullying are clear and explicit. To make ‘repeated requests with impossible deadlines or tasks’ or to ‘blame staff for things beyond a person’s control’ or to ‘repeatedly manipulate a person’s job content and target’ are each classic, text book examples of workplace bullying.

Front line medical staff in Ireland are subjected to all of these bullying pressures on a daily basis. Bullying – already rife in our health services – now appears to be a core component of government policy.

As Storm Abigail announced the arrival of winter, the situation in our acute hospitals will deteriorate. It is a man-made, predictable and foreseeable emergency which requires leadership. The last thing it needs is the further undermining of our medical professionals.

Minister Varadkar needs to do ‘the bleeding obvious’ and demonstrate real leadership.  Glib and facile sound-bites are simply not enough in this time of crisis.

Read: Tallaght Hospital to probe how information on 91-year-old patient was given to media>

Read: Hospital admits it was ‘unacceptable’ that woman (102) spent 26 hours on trolley>

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