Fadó, fadó, in the era of health boards in Ireland, a deputation of self-important men met the Minister for Health, writes Denis Doherty.
Sensing the Minister was less interested in their proposal than they expected him to be, the leader of the deputation was prompted to say- “look Minister what we’re attempting to impress upon you is the need to establish in Ireland a network of centres of excellence.” Clearly not convinced, the Minister responded by wishing the delegation well in pursuing their goal but that, in the meantime, he would gladly settle for a network of centres of competence in Ireland.
I suspect that the current Minister for Health would settle for being able to demonstrate, as his term of office draws to a close, the existence of a network of competent hospitals here. A criterion that could be applied in assessing the quality of healthcare is the level of financial resources that are required to be set aside to meet liability claims. Would a network of centres of competence in Ireland have incurred costs of €501 million in 2022 on meeting liability claims or require provision of €4.6 billion by way of provision for future healthcare claims? An interdepartmental working group on the rising cost of health related claims reportedly provided those figures. It is not possible to visualise the suffering, pain and loss that figures like that represent. The potential benefits, to patients and the healthcare system, of reducing costs of that type are surely worth pursuing
Our A & E services have attracted a great deal of negative attention in recent years. The daily trolley count in winter remains newsworthy. The use of trolleys is most often attributed to ‘overcrowding’, thereby suggesting that the blame for this state of affairs rests with the unfortunate patients who have to endure the discomfort of having to wait, often for many hours, on appliances designed to transfer patients short distances. It is also not unusual for some patients having to wait for long periods on uncomfortable plastic chairs, when ‘overcrowding’ gets really bad. Meanwhile health professionals are expected to continue to provide the high standards of care they are capable of, despite the encroachment of patients on trolleys on their work areas. Lack of capacity, the real cause of the ‘overcrowding’ problem is rarely alluded to.
Patient choice of service location, where A & E services are concerned, is most often not an option. That problem is most often experienced in the Mid-West where a single hospital is required to meet the needs of a rapidly expanding population. ‘Overcrowding’ on the scale experienced there in recent years impacts not only the disadvantaged patients but also the beleaguered staff across the entire hospital, in conditions that restrict them from providing the levels of care they are trained for, capable of and willing to provide.
Ongoing ‘overcrowding’ in A & E departments is reflective of a mismatch between the level of need of the population served and the capacity of the hospital charged with meeting that need. Capacity needs to have regard to the amount of space required to meet the needs of the population served and needs to be equipped and staffed to provide the level of care expected of the unit. The level of care provided at any A & E unit ought to be judged as much on the adequacy of the capacity of the unit to meet the role it is expected to perform as it does on the quality of care provided by staff members. In practice, staff members are expected to produce best standards of care in often challenging settings.
Forward planning of A & E provision is not as simple as how ‘overcrowding’ can be avoided or as complex as enduring ‘overcrowding’ in A & E units would suggest. Forward planning of A & E services needs to have regard to, inter alia, space, equipment, cost, clinical and service management needs. A commitment is required to meet the level of response required to accidents and emergencies expected of and promised by our health services.
I have a particular interest in health service matters in the Mid-West region having toiled there for nearly a decade towards the end of the last century. Prior to the nineteen eighties the Mid-West region was served by hospitals that were of their time, but were becoming less fit for purpose. Small hospitals in Ennis, Nenagh, Croom, two public hospitals and two voluntary hospitals in Limerick were not cost effective or capable of being rationalised at reasonable cost. Cork was in a broadly similar position but appears to have been transformed in a way that Limerick has not.
Regrettably, political dividend potential can sometimes attract higher scores than health benefit potential when the allocations of financial resources are being considered. Public opinion in the Mid-West appears to favour restoring A& E units in hospitals in Nenagh and Ennis over expansion of A&E services at UHL. That is understandable having regard to the loyalty to county that exists in Ireland. However, when regard is had to the fact that the Limerick conurbation contains significant portions of the populations of Clare and North Tipperary, perhaps a second A & E unit in Limerick, on a site west of the Shannon may be a better option. In that event, the opportunity might usefully be taken to rationalise services in the region by relocating orthopedic services from the village of Croom to the new site and by relocating maternity services from the Ennis Road to the new site also.
The Mid-West region is an important one in which development of health services has fallen seriously behind other regions in recent decades. The importance of investing in infrastructural development was recognised in the national budget this year, in which significant funds were set-aside for that purpose. Modern high quality healthcare is expensive and benefits from being located in modern buildings, equipped with the full range of modern technology and delivered by highly trained and well-motivated staff. Healthcare ought to be considered eligible to bid for the resources needed to bring our healthcare infrastructure up to the standard our service providers aspire to and service users deserve.
The French expression – ‘plus ca change, plus c’est la meme chose’ – captures succinctly our experience up until now. Decades on, the desired network of centres of competence remains a work in progress.
