Denis Doherty makes ten suggestions of ways that could contribute to giving our hospitals a better chance of delivering what is expected of them.
I worked for a number of years with the Matron of an acute hospital who just wouldn’t countenance having trolleys in her hospital. She took the view that the hospital had a defined number of beds and that the budget of the hospital was based on that number. Patients were admitted and discharged by Consultants and, therefore, whenever the hospital was full and a Consultant needed to admit a patient he (they were all men back then) needed to discharge a patient in order to make a bed available for the new patient. It worked surprisingly well and I never felt it necessary to interfere. In defending her approach with senior staff on one occasion she asked – “ and where do you think it would end, when the trolleys were out to the gate?” That prospect doesn’t sound so far fetched now!
Solutions that got us by in the past are no longer options. The problem most hospitals face is that the level of demand exceeds the level of need, and even the level of need cannot be satisfied within the resources – staff, technology, accommodation and support services- available to the hospital. Our expectations of our hospitals have not, up until now been realised. Fresh approaches are called for.
The contracts of employment currently in use have their origins in a different, pre modern technology era and are totally unsuited to the delivery of a modern health service.
Here are ten suggestions of ways that could contribute to giving our hospitals a better chance of delivering what is expected of them.
1
Examples of healthcare reform that have succeeded are rare. Ireland is not an exception in that regard. Reforms tend to be based on what has been introduced elsewhere, often a year or two before that new approach turns out to be yet another seemingly good idea that didn’t work. We too have experienced that!
For a change, why not look to the private sector for guidance. Irish companies such as CRH and Kerry Foods have shown that they have the ability to compete very successfully with the best in the world. They are highly skilled at integrating, empowering and achieving high returns on their investments across multiple geographies and extensive product ranges. Substitute social returns on investment for financial returns, and it is difficult to identify healthcare systems that have achieved comparable success.
As Ireland moves out of recession, there is a need to improve the effectiveness and efficiency of our public services. Companies like Kerry and CRH are masters at doing what needs to be done. Why not engage with companies like these to explore how public sector reform can benefit from their experience and expertise. The health services are as good a place as any to begin.
2
Morale in the health services is at an all time low and is continuing to decline. The pay cuts, increased working hours and reduced staffing levels are still hurting. Health service workers, who are feeling beleaguered and are looking for signs that their working lives will improve, need to be offered the prospect of that happening.
The contracts of employment currently in use have their origins in a different, pre modern technology era and are totally unsuited to the delivery of a modern health service or to fostering team working in satisfying working conditions. An industrial relations agenda focused on restoring pay cuts and fewer working hours needs to be replaced by an approach focused on how best to deliver a modern service that values the role performed by those who deliver it.
3
It would be reasonable to expect, in a country that has attracted so many technology firms, that the health services would be technology enabled, but that is not the case. Other areas of the public service have shown the benefits that can accrue from adopting technology enabled approaches to delivering public services. The thinking that, for far too long, has viewed technology as an overhead rather than an investment in modernising service delivery needs to change.
Break the cycle of training health professionals in generous numbers and at great cost, then failing to employ them when they qualify.
4
Develop, resource and require primary care services to deliver the range of services that can be delivered in the community. That will only be achieved when services are organised and delivered on a 24/7 basis. A network of Primary Care Centres ought to be equipped with the range of diagnostic facilities needed to support the level of services that can delivered in community settings.
5
In hospitals, the full range of diagnostic support services needs to be available when they’re needed and not just when staff to operate them are available. In the health services the term ‘out of hours’ needs to be consigned to the dustbin of history.
6
Break the cycle of training health professionals in generous numbers and at great cost, then failing to employ them when they qualify and expect them to return and take up employment when it suits the State to employ them.
7
Over two thirds of deaths occur in hospitals even though most people would prefer to die at home. The State leaves it to charities like the Irish Cancer Society, the Hospice Foundation and local hospice groups to provide end of life specialist home care for many patients. Residential palliative care facilities and services are underdeveloped and overly reliant on voluntary organisations. By resourcing the expansion of end of life care in hospices and in public and private nursing homes, more end of life care could be provided in more appropriate care settings than at present and would also free up hospital beds to be used for purposes more appropriate to hospitals.
8
Older people, and indeed others, who require recurring admissions to hospital should not have to endure very long waits on trolleys in A & E units. Engagement of all the stakeholders who can contribute to designing better ways of meeting the needs of that type of patient could be initiated immediately.
9
Stop paying lip service to road safety. Start with the courts, many of which send out the wrong messages by accepting infantile sounding excuses from drivers who won’t pay fixed penalty notice fines. By imposing derisory fines in cases brought by the RSA, because the RSA considers them to be serious, and by resorting to offering recourse to their ‘charity boxes’ as an alternative to imposing convictions. Hospital A & E departments end up dealing with the consequences of our preference for the creative use of laws to avoid penalties over accepting the consequences of failing to observe our laws.
10
Co-payments are a feature of how our health services are funded at present. If that is to continue, make it easier and less costly to collect co-payments by enabling attachment orders to debtors’ income to be sought.
