Letters

“Health system crushes idealism and rewards cynicism”

The enthusiastic, the chastened, the burned-out and the cynical

Wed Jan 11 2023 - 00:12

Sir, – As a hospital consultant working in an outpatient-based specialty within a “dysfunctional health system”, I am unsure how I should be classified within Fintan O Toole’s four varieties of Irish healthcare workers – the enthusiastic, the chastened, the burned-out and the cynical (“Ireland’s dysfunctional health system crushes idealism and rewards cynicism”, Opinion & Analysis, January 10th).

I have just noticed a large dent in my clinic wall that conforms very nicely to the shape of my head. I do hope Fintan will be pleased to learn that based on my experience as a “new entrant” consultant, the notion of the consultant as God, in Ireland’s public hospitals, is very definitely dead. – Yours, etc,

Prof NIALL CONLON,

Castleknock,

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Dublin 15.

Sir, – Fintan O’Toole makes an important argument about the depressing way in which our dysfunctional healthcare system destroys the good intentions of many of its staff.

However, as your columnist rightly says, “the primary problems are structural”; they are caused almost entirely by chronic and persistent underfunding.

For instance, Germany and France spend nearly 13 per cent of their GDP on healthcare. According to the CSO, in 2020, Ireland’s spend on health was a meagre 7.1 per cent of GDP.

We get the healthcare system we’re prepared to pay for. – Yours, etc,

JOE McCARTHY,

Arbour Hill,

Dublin 7.

Sir, – Fintan O’Toole writes that the historical foundations of our public hospital system mean that Irish hospital consultants hold a godly status that makes them immune from accountability. That immunity, the author posits, is a contributory factor to the current trolley crisis and other structural dysfunctions in our health system.

These assertions, however, don’t stand up to even a basic amount of scrutiny.

There are 31 hospitals in Ireland where the Irish Nurses and Midwives Organisation count how many patients are waiting in the emergency department for a bed for their trolley watch dataset.

As of January 10th, 2023, 425 patients were on trollies, yet two-thirds of those patients were in hospitals owned and managed by the HSE.

Patients remain on trollies not because consultants have some God complex, but because that specific hospital is underserviced and operationally incapable of meeting, and managing, the patient demand.

Ireland ranks ninth place in cancer survival rates in the OECD and has the highest life expectancy in the EU.

One thing we can be sure of is that the reason for this is, in part, attributable to the skill levels and clinical care provided by the over 3,000 hospital consultants who work in our public hospitals. – Yours, etc,

Cllr JAMES GEOGHEGAN,

Fine Gael Group Leader,

Dublin City Council,

City Hall,

Dublin 2.

Sir, – There are many elements to solving the emergency department crisis which occurs every year at this time.

First and foremost, maximal staffing at Christmas and the new year at all levels and in all units, not just “extended weekend cover”, should be in place in all departments in hospitals and in the community. Second, in the hospital emergency departments, triage should be carried out by senior medical staff and not by relatively junior nurses, as it is at present.

This would have a major effect on ensuring that very sick patients are not missed and on expediting the throughput through the emergency department. – Yours, etc,

J BERNARD WALSH,

(Clinical Professor,

St James’s Hospital

and Trinity College Dublin),

Blackrock,

Co Dublin.

Sir, – The only way to expand capacity in the short term is to use private facilities if they have the staff to look after the patients. Increasing capacity in the public service will take years and years, with planning permissions, design teams, etc.

Patients only need to be in bed if they are sick and even this can be counterproductive for frail and elderly patients who get worse rather than better in hospital, becoming immobile, being exposed to various infections, and, if suffering dementia, becoming more confused for a variety of reasons. In the short and medium term, we need radical solutions, including rapid investigation, properly resourced home care and increased co-operation with primary care. Not endless winter plans! Doing things the same old way and expecting different outcomes is plain stupid. Endless meetings to achieve consensus on the way forward is not an option. The slow implementation of impactful changes in the the Sláintecare process is very disappointing and the optimism associated with the changes may be displaced.

In this ongoing disastrous situation, a degree of autocracy is required. The main group of patients being affected by this debacle are the elderly. You may be young now but unless things change radically, you’re next. Currently there is no light at the end of the tunnel. – Yours, etc,

Prof KEN

MULPETER, FRCPI

Letterkenny,

Co Donegal.