Sign in. It’s quick, free and it’s up to you.
An account is an optional way to support the work we do. Find out more.
LAST UPDATE | 26 Nov 2024
THE VOX POP on the news the other night had the price of groceries, fuel and housing as the election issues occupying most people’s minds, a single older man mentioned the health service.
Reading some recent headlines in our national papers about the ‘grey’ vote and the importance of the pension issue, it does seem it will ‘be the economy stupid’ here in this constituency too, as it was and always will be seemingly in the US. I’d love to think that for our 2024 election, it might be ‘’it’s the hospital’s stupid’ that might be the defining issue of our election. In many respects, it would be a better consideration for the investment of older people and all of us who hope to live any length of time.
One in four of us will have a stroke, one in 10 will break a hip and over half of us will die in a hospital setting. It might be important then to consider what care you might get and what that care will look like. Currently, our public university teaching hospitals are struggling and for many, it will be a traumatic experience, not just because of the illness, but the environment and mechanics of our creaking public teaching hospital system. From my many visits and chats with staff in our hospitals, I see the challenges of our health estates across the country’s teaching hospital system.
The political solution to our health service is Sláintecare, the somewhat hypocritical illusion of a single-tier health service. Cross-party consensus and all that seems grand, until you ask a politician if they will be using their local public teaching hospital for their own healthcare needs, and then the consensus conviction of a single health service for all, begins to look a little shaky and one gets an awkward mumble or averted gaze.
Health for the political classes is conceptualised as a comfortable private tower, far from the madding crowd.
Sláintecare is about hospitals for ‘other people’ or even worse no hospital, as the system leans and lurches on a gamble on what is termed a ‘leftward’ shift (not a political term I hasten to add) into more community-based treatments. This is good and I’m an ardent fan as a geriatrician of people receiving care nearer home or at home, or receiving care in “the right place at the right time” in Sláintecare speak, except the notion that the hospitals are holding inpatients unnecessarily or that we can treat much more of our emergency admissions at home is a fallacy.
To some extent, the recent unprecedented population spurt has exposed our inability to plan and revealed the inadequacy of our hospital system and the dangers of sole reliance on a community care investment strategy. Our acute hospitals have been left by the wayside as if denizons of healthcare, no longer needed in the smart world of ‘left-shift’ community services, innovation funding and AI.
Yes, we need all those facets but we also need an increase in hospital capacity. Stroke, cancer, trauma, cardiac care and pandemics cannot be managed by ‘integrated this’ and ‘enhanced that’ in the community. The current HSE multi-million euro investment in community models without proper structure, leadership or any auditable meaningful outcome measures, other than the often duplicated and at times, even unnecessary, activity, is hardly an alternative compensation for a functioning hospital system.
Our Government has latterly acknowledged our error in not increasing our adult bed capacity which it has been letting wither for the last two decades, despite the repeated warnings from the Irish Medical Organisation, amongst others. At the time of the pandemic, we had over 2,000 fewer beds than we had in the early 90s. The catch-up will take time and likely be a pocketed approach, but let us a least start to acknowledge the precise nature of our healthcare estate problems.
Hospitals, in case anyone had any doubts, are expensive to design, build and maintain. Heath inflation exists in an ‘upward only’ economic environment as technology and public expectation are unidirectional influences on health spending. Rebuilding a functioning public university teaching hospital system will be expensive and will need continuous fiscal nurturing. The Sláintecare ideology of discouraging a ‘public’ hospital from being able to attract a patient’s insurance income, will not only serve to impoverish that system further from the much-needed investment in infrastructure and technology but also embeds the concept that health insurance is not about social solidarity but rather a privilege.
God forbid a person might decide ‘I have health insurance and want to go to a public teaching hospital where I heard the care is excellent and I like the concept of my insurance money going to a “not for profit hospital” to contribute to the care of everyone’. Heaven shirk at any attempt at a competitive well-funded appealing ‘not for profit’ universal health service. We have an excellent and needed private health service, but it should not be better than our public teaching hospital system, where we train our healthcare staff, which it currently is fast becoming if it’s not already there.
At a meeting recently a colleague described his father’s distress in hospital when hearing someone die next to him on a six-bed ward, an experience healthcare staff struggle with every day in our hospital system. Doctors and nurses spend hours worrying about how someone who is dying can be moved to one of the few side rooms they may have at their disposal. A move that should be routine, but complicated by unavailability, to give patients and their families that dignity without frightening the patient with the move into a ‘special’ room, and to afford other patients the solace of not witnessing death live.
I worry about the psychological trauma of the hospital environment on patients, playing bed moves over in my head so we might be able to make an attempt at some individualisation of care and help people feel safe and secure, within the limitations of space and appropriate beds.
It is a sapping emotion for healthcare staff to be ashamed of the environment where they are trying to ‘heal’ people. A patient’s frustration, sleeplessness, fear and anger are often manifest in our hospitals and impede their recovery or worse.
And the HIQA model of oversight is not a system I would be altogether impressed by. A classic example of ‘regulation makes the compliant more compliant’, HIQA seems more often concerned with the banal than the important. When I asked a HIQA inspector once if he had noticed the lack of space to nurse or toilet people on our six-bedded bays with dignity or prevent infection, he commented ‘That’s not on our list’.
But poor hospital environment has broader effects. Time and again we read troubling stories of the fate of patients because of hospital overcrowding, bringing that issue into sharp focus. As a result of continued exposure to such conditions, staff may suffer from a lack of medical rigour or frank disinterest. They are human.
Imagine day after day leaving work with the moral injury of ‘I couldn’t do my best or help that patient get comfortable, feel better, feel safe’ or ‘that was a really de-humanising experience for that poor patient being incontinent, vomiting, acutely confused or dying in full view of everyone’.
The mounting build-up of this psychological injury is the real cause of the phenomenon of ‘burnout’ in healthcare staff and a major reason why so many of our doctors, nurses, and therapists are abroad in Australia and other countries, so much so that we can’t even provide a minimum of cultural context to the care of older people on our wards. The healthcare staff here are excellent from all corners of the world, and we are fortunate to have them, but it’s also rare to see Irish-trained nurses on our wards since it is so difficult to work within the system where they were trained.
‘A design for older people will include and enable everyone’ to paraphrase the great geriatrician, Bernard Isaacs’ was a call for a non-ageist inclusivity in healthcare and must most critically apply to hospitals. Our public teaching hospitals are old, undersized, poorly designed and not fit for modern healthcare and all that it entails. Our recent experiences with Covid cruelly exposed this.
Our hospitals are not designed for those who most need them, our older age groups, and those most likely to have serious illnesses.
Instead, our hospitals do not hasten recovery but rather decondition older people with trolleys, endless noisy days under glaring lights, immobilised and made incontinent, ‘sit down’, ‘just go in your pad’. We lose their hearing aids, dentures and phones, disabling people and removing their means of communication. We provide wards without privacy or spaces to discuss the most intimate of things, or to be assessed with dignity. Places without TVs, radios, or any form of aesthetic with no room to mobilise or even toilet to get sick in, in private.
These are not the places of care or sanctuary they should be and we wonder why people get confused, depressed, decline cognitively or physically, fall or get infections and end up needing long-term care. Our hospitals have become a Keatsian place ‘where palsy shakes a few sad last grey hairs, amongst the groan and fret’.
Let’s change this. Let’s have a new social contract for our nation’s healthcare. Let’s state that our University and Teaching Hospital system will:
All generations should be invested in this so when it is our turn to need hospital care, irrespective of our income or background, we can have faith in our public university teaching hospital system, which trains our healthcare professionals, to have the best of technology, personnel, design and can meet all our needs, so even our leaders would be happy to be treated there.
If the economy and housing are the issues coming to the fore in this election, then healthcare must be at the top of the list with them. If any of our public teaching hospitals are not as good or comfortable as our private institutions, then they are not good enough.
That must be our standard.
That must be our Sláintecare.
Professor Rónán Collins MD FRCP (Lond) FRCPI FESO is a Consultant Physician in Geriatric and Stroke Medicine at Tallaght Hospital. Follow him @ronancollins7.
To embed this post, copy the code below on your site
It’s a sad state of affairs when you see Regina doherty doing well with her track record. Just goes to show how stupid we are as a nation, we deserve this atrocious so called government of ours. It will be the same when the general election comes, everyone will forget how we are working long hours to make ends meet. Not having money to save for a rainy day, just living from week to week and nothing on the horizon looking like it’s going to get any better. Squeezed middle as usual.
I’d say this comment will get a reply from Sean o’dhubhghaill with his usual condescending fine gael answer about how we should unskill or leave the country if you’re not happy!!!!
@den: What a ridiculous post. You might as well write “my life is not where I want to be so I’m blaming everyone else for my woes”. I agree Regina D is an idiot but when the “alternative” are deemed worse then I don’t blame people for voting safe. Not risking a punt on some independent nut.
@den: Now, where did I mention we should ‘unskill’? Could you remind me, please? And the only time I suggest to people that they consider leaving is when they call this country a ‘joke’.
@den: democracy is a b1 tech
@den:
I overheard a young lady complaining that there were no “FFG” candidates on her ballot as she exited the polling station in a strop. Very amusing to those of us in her vicinity.
@den: Irish electoriate shit ourselves when it comes down to it.
@den: majority own their homes, land and have jobs and health insurance. You got to understand that right? Check out the CSO for majority stats, therein you’ll see what you can’t understand.
@Vincent Wallace: No, we just don’t buy the shyte the lunatic fringe hatefest are selling.
@den: it’s called democracy, people are speaking in large numbers nationwide. Regina Doherty will be excellent in Europe & good luck to her.
Where is this “MASS ANGER” on the street against FFG? They’re topping polls. Apparently we were told to “go talk to people on the streets, they’re SO ANGRY at the govt”. If they called an election they would get another 5 years in power. There’s only been a small bunch of loud agro heads shouting on social media, as there has been NO CHANGE.
@9QRixo8H: Calm down.
@9QRixo8H: A lot of the angry ones too lazy to vote I’d imagine.
@9QRixo8H: the devil you known is safer than the devil you don’t
@David Corrigan: saw one patriot lamenting her husband putting x’s next to the candidates he didn’t choose.
@David Corrigan: Maybe, or maybe the anger has been over estimated. Surely if you’re genuinely angry, you would avail of your one means of actually doing something about it? Or maybe, like 2019, these local election results won’t be replicated in the general election
@SYaxJ2Ts: I think the anger is there alright but people just couldnt be bothered anymore. The “Shur it won’t make a difference anyway” attitude. The anger will probably be unleashed the wrong way in time though. Protest rather than vote.
We will see. I personally think no matter who you put into the top office, nothing will change.
@David Corrigan: Maybe there is a silent majority who are not angry. They have worked hard and life, in general is going well for them?
@9QRixo8H: For some I am sure you are right but there’s a lot of folk working week to week and they can’t be happy. Like I said, I don’t think anything would change for the better no matter who gets in. We just have to get used to the fact that housing and the health service etc will never be fixed.
It is what it is.
@David Corrigan: What a depressing outlook. There’s always hope, even if it’s the hope that kills you
@9QRixo8H: Not depressing at all. It’s just a fact. When those in charge are not interested in fixing things like housing and health, then there really isn’t much point in putting too much thought into it is there?
@David Corrigan: I take it you didn’t vote then
@9QRixo8H: crazy
@9QRixo8H: I did my civic duty. Only going through the motions. You know yourself.
@David Corrigan: True, the Health System has been in freefall for decades, housing shambles is getting worse by the year and it gets to the stage where those who have failed us try to make out that this is normal.
““Independent Ireland candidate Ken O’Flynn is, if tallies are to be believed, taking an extraordinary lead in the polls. It is expected he will get 22.57% in first preferences.”
Dangerous times ahead folks as we watch the rise of fascism in Ireland. Anyone for a slice of 1930s Germany??
@SYaxJ2Ts: Did you vote for the party you used to pretend you liked when you first started posting here (PBP) or your latest favourite party, FF?
I hope you don’t think I’m being nosey.
It was actually the soc dems you frenzied about at first, lol.
@Frank Cauldhame: gargle is never the answer, Frank
Is that a life lesson you learned from experience ?
@Frank Cauldhame: it’s the only reasonable explanation for the absolute garbage that you post
@P. V. Aglue: How do you know? Stay in an abusive relationship because the next might just might be worse? Not a great way to live.
@SYaxJ2Ts: Reasonable in your head Kevin what with the stimulants you must be using to be ever present on this site, try stopping and your anger will go away, your very obviously not a people person.
@9QRixo8H:
Money buys you big social media campaigns where you complain about everything and anything.
Truth is, if you own your own chimney pot things aren’t that bad. Yes, inflation but that was a global thing.
@9QRixo8H: Sure the “mass anger” is just an excuse for the toe rags to light the place up, throw a rock at a gard and rob a new pair of dunks. Record it, get a few likes on SM and be a ledge with the crew….. 16 years later the austerity mentality STILL enforced from the govt has allowed society to slide into a sess pool of disrespect and has become full of degenerates that have no fear of any “repercussions”. Gardai, Nurses, first responder, reserve firefighters…. Etc all struggling with retention because FF/FG and DPER have ruined T&C’s and think they can run the place on a show string. Take a bow lads. GDP is great but the country is a kip to live in day to day!….. “Dublin is safe” my b0!!ox. Now let’s live feed the Sh.te.show to NYC!!!! *Clap clap*!
@David Corrigan: Don’t forget that it’s local elections. Totally different then overall elections with different candidates.
Outside dublin exists.
@Setanta O’Toole: Thankfully.
Nice to see the lefties happy, enjoy your new neighbours while you sons and daughters leave Ireland because there are no houses, healthcare and no future, on a cheery note at least Healy Rae’s and milking it in
@Terry Molloy: I’d prefer to have immigrants for neighbours than the Irish far right.
@Brendan O’Brien: You sir! talk lefty speak but I won’t call you Far left, and I don’t vote FF,FG Lab,SF and many individuals, so I guess you are a FfG kind guy with you stuck up rhetoric
@Brendan O’Brien: absolutely
@Terry Molloy: I’m not even looking at Kerry too embarrassing over the years at who they have elected, such creeps
@Terry Molloy: you know Ireland has never had anything resembling a left wing goverment yeah? FF and FG are both centre right parties. The anti everything brigade played right into their hands demonising sinn fein at every turn.
Lots of plastic Paytriots realising today that twitter likes from right-wing yanks don’t actually translate into votes at the local ballot box. Who knew?!
@Jason Memail: There was a wad of them on your voting slip too! Ireland or Irish followed by some variation of the usual far right buzzwords. Hopefully this will prove how many of these comments , profiles and accounts that appear to be popular, are not being upticked or supported by the Irish electorate.
There are some absolute doses among us but it’s a tiny minority who actually support this kind of hatred and violence. Burning buildings to the ground is dumb regressive stuff imported from elsewhere and not wanted by the vast majority of us. Equally delighted that the Greens look like having a great result overall.
@Jimmy Wallace: Oh but of course it is! The standard response for absolutely everything within a certain cohort. Things don’t go your way = conspiracy! It’s so childish. Some of the comments under the article about the Russian hack are bonkers too. We’ve officially reached the religious-like faith stage with this stuff. If something doesn’t fit the facts and evidence, make up something else. it doesn’t matter how bonkers it is. Just never ever admit when reality is banging on the door!
Anyone know how long it took Alison O Connor to mention the FAR RIGHT on Rte
@John Hally:
Way too long.
@John Hally: you are right, their efforts were barely worth mentioning.
@John Hally: is she still going? comes across like an absolutely entitled weapon.
FG are flying everywhere, hard work pays off :)
@John D Doe: what’s this about a pay off?
@Hayagriva: your desperation is amusing lol
@John D Doe: your cowardice is amusing. Post under your real name you coward.
@John D Doe: constantly pushing yourself forward and littering the public with massive ADS as well as those eyesore posters (yes everyone who does it) that despite their size tell you absolutely nothing useful isnt hard work. FG are not hard workers in government. They are also not democrats after pushing SF out of even government formation talks.
I hope a clear message is sent to Harris, he is nowhere near strong enough to lead mighty Ireland.
The far right have driven votes back to FF/FG that I’d suggest they would have lost to SF..who in turn don’t know if they are coming or going and have paid the price in certain areas.
I cannot believe the greens have polled well in places!
The peanuts that was given in the last budget seems to be working for FFG
@Martin Finnerty: certainly questions need to be asked again about the folks who see these people plastered everywhere, the likes of Mcentee and Heather Humphreys spring to mind first who either have an extremely poor to terrible track record including ignoring all constituents who call them out in a most basic manner but who get re appointed in our selections by the mé féin brigade and a lot of very lost souls out there/ FG made their usual load of cock and bull false promises and of course offered up a few bribes to the sheeple last winter.
Anyone in Offaly the Offaly independent have actual up to date numbers for our area. Not the Dublin centric journal care or anything
Why can’t a sovereign small nation of people(good people)govern themselves to the benifit of themselves at that particular time in history. It baffles me, Why throw of subjugation by the British (English) and hand your backside to Brussles?!?!
@david mcentee: The greatest ever voluntary union of nations … we are lucky to the part of it. Average life expectancy in Ireland now is 11 years more than when we joined. We are so much more prosperous that it’s like living on a different planet.
A voluntary pooling of sovereignty and an imperial/colonial arrangement are two very different things.
Wonder will the shinners be banging on about being elected on first count after this election?
@james comiskey: I asked a Sinn Fein canvasser who was spouting “We need Change” what “Change” the party is proposing.
Answer: Wha.
Nasty people do well when propaganda & distraction & fibbing win out for those who watch these cowards on their self promotion for our selections. Doherty should be polling near the bottom but appears to be performing fine like Frances Fitzgerald did after she helped smear Maurice McCabe & john Wilson. The story isn’t SF not competing, the story should be about Fine Gael being as harmful for Ireland as Fianna fail have been and not given a firm NO from the electorate.
@Sean oSuilleabhain: no its thay they under performed, although Im assuming now because I dont want to keep up as its done me enough harm knowing Doherty is back on the gravy train and has been accepted for Brussels. Since you think she is suitable, we’ll leave it there PSC card/exploitation/cervical check anyone
Shame there’s No mention of our FANTASTIC ATHLETES winning GOLD in ROME
@RIP: There’s an article in the 42 about it.
@Brendan O’Brien: Ta
Not once has the journal given us an update on Leitrim. Forgotten as always
@David Fox:
It’s Ireland’s smallest county by population, of 0.6% of the total.
Get used to it
@P. J.: oh that may be the case however there are a number of people running for office and they deserve the same coverage as all the others in Dublin and bigger cities. As usual people “down the country ” get ignored. Just like all the services and money is also spent in Dublin and the rest of the country get f all. So no, I won’t get used to it.
Is there anything to be said for another mass?
I hope the mouse did not piss on all the votes in the box and spoil them.
@Sean Money: Ink runs, hence pencils.
Of course people voted for the government party their handing out money left right and centre to everyone bar the people that work . We are a welfare state and that won’t change . You’re rewarded for contributing nothing to society , now we’ve bus loads of more people looking for payments and they’ll get it not a bother . People will only realise in 5 years when corporation tax is gone and your taxes have risen see them will people be so cavalier with their votes. Weak opposition doesn’t help Mary Lou’s job is on the line now open goal and still can’t get votes . Pointless moaning on social media for change then don’t bother voting
@tommy little: You really are clueless.
So party politics is far from dead? The SF and independents wave is a bit flat….
@sean o’dhubhghaill: Sincere apologies Sean, forgive me for my typo. It should have read “upskill” not “unskill “.
Please forgive me.
@den: :-)! Forgiven!
SF won’t get to decide what pot holes get filled in around the country for the next few years in each county lol oh well. Focus on the main election..that’s all that matters and if they fail in that, well all young people in this country old enough to vote and who don’t bother doing it and have no house or future prospect of having one should genuinely be laughed at. FF and FG followers flock to the polling stations like a clockwork zombie apocalypse, always have and always will.
Oh well, maybe next year !
@Terry interesting contribution. As in replace completely out of touch for interesting. It is the Tories in fine Gael FF whove divided the country harshly over immigration, cost of living and totally alienated younger voters across decades of ineptitude. I’m amazed people like you can type this crap with a straight face anymore.
Sweeney rock bottom in Galway. Funny looking 90% those Irish People lads speak for.
Live Dublin election results do the journal know there is life outside the pale and I’m not talking about your news from abroad posts.
Down the Country FF,FG getting so many votes I’d not be suprised it’s from a lot of farmers,the Greens are doing very bad,the farmer could be to do with that,FF,FG always made sure the farmers were looked after for years,but it’s the EU giving the orders now,hopefully the other EU Counties have voted against their EU puppets.coz if the EU that’s been in power for the last few years,have laid down to the US,and destroyed all our lives,the 1 in a few weeks it will be giving out again about the migrants,housing,health,and they probably didn’t vote r if they did,they didn’t vote properly,if FF,FG get loads of votes,they will destroy the Country,because they know the can do what they like.u had buses and taxi’s put on for free to bring the migrants to vote,is it legal that these can vote.
@Kathleen Peters: All citizens can vite in European elections. All residents can vote on local election. In both cases their names must be on the electoral register.
Well done PJ Murphy.
Hhh
have your say