Image may be NSFW.
Clik here to view.
After almost 40 years of a worsening trolley crisis in our emergency departments, Dr Garrett FitzGerald believes the excuses from our politicians and health managers are as pathetic and inept as ever.
The blaming has been going on for more than 38 years. It is the Irish approach to any problem encountered.
One week there are, say, 260 chairs/trolleys (chollies) in the EDs nationally. The next there are 600. The response is to do the math; 600 on chollies minus 800 bed blockers equals minus 200 places in hospitals, no problem at all, QED.
Solution is simple: throw out the 800 and close more beds. In fact, if you (someone who is not me) had thrown out the 800 before the extra patients presented, there would have been no problem at all in the first instance.
Naturally, one can conclude from this that the guy (you) who was in charge before I came here is to blame.
Time and tide have waited for no man. Over the 38 years in question there has been a relentless increase in hospital emergency activity. This is caused by three main factors.
1. The population has increased, particularly elderly survivors of big conditions requiring hospitalisation. Outright success through expertise/advances, and relative success in ensuring their continuing survival — but with need for subsequent ongoing intensive therapies are the largest cohort of patients distinguishing today’s hospital achievements from times past. Cardiovascular, cancer and complicate multi-system disease treatments have evolved to a level unimaginable a few short decades ago.
2. Amongst these ‘half-successes’ survival has been achieved but frequently, ’instead’ produce consequent disabilities with need for ongoing and slow care. (Amongst these latter are a percentage of the group of criminal patients known as ‘bed blockers’.)
3. Attendances at EDs follow the normal patterns established decades ago: most patients are there because they obviously need to be there. Steadily increasing numbers are there because they have been referred from primary care, which does not have the simple facilities of urgent x-ray, scan and blood work necessary to come to a diagnosis that would be well within the compass of good GP care.
Added to these, you have over-anxious persons who are convinced they will receive proper care only at the ED, drunks and vagabonds. These we have always had with us and always will.
Worse to come
The bottom line is that we have more sick patients requiring more intensive treatments than ever before. As time, population numbers, and expertise advance, the future holds the prospect of an inevitable worsening of the same.
Let’s be very honest about what measures have been taken to date, perhaps using the analogy of the latest motorways.
The traffic has virtually come to a standstill because of the numbers of vehicles using the road compared with previously. From on high, an edict ensures closure of one lane on either side of the central barrier.
Naturally, less maintenance staff are needed (apart from managers, where more will be needed). It will now take two days rather than two hours to get from A to B.
Some cars can only do 30 miles per hour so these are shunted to the side of the road and gardaí with clipboards are called to have them removed (road-blockers).
Conditions of workers and expectations of them ensure that they are constantly pissed off and many will walk off the job. An All-Ireland Final will occur twice in September. Punters will be asked by management not to go to the match, unless ‘you are playing in it’. Following the game, a further lane on each side will be closed in line with overspending of announced budgetary restrictions. All solutions are on the table EXCEPT the opening of the closed lanes.
Then the ‘motorway flu’ hits the scene! (This is where all the cars crash into one another). Nobody in command has ever, ever, ever heard of the flu coming in that non-existent season ‘WINTER’ before. “It’s just not fair,” they all whine.
Flu excuse
This nonsense has being going on since the late 1970s in the hospital services. Some years, respiratory infection is mild, some years more severe. After flu has begun to abate some weeks after its appearance, the flu excuse can no longer be used; so you get really mean and vindictive with the ‘bed blockers’.
I have seen these misfortunates hounded out of hospitals by twisted healthcare workers who could ideally get a part in One Flew Over the Cuckoo’s Nest.
Too early discharge brings patients with chronic conditions back into hospital within a month with a worsening of their original condition.
The flu is only the trigger of a cascade of other disorders which lead to heart attacks and strokes some weeks down the line — keeping the hospitals as busy in May and June as in January. No HSE head has even noticed this after decades of its happening!
We’re now almost 40 years (commenced with bed cutbacks in 1977/8) into the same but worsening ED disaster scenario. The excuses remain pathetic, childlike and suffused with magical thinking.
Our masters, managerial and political, do not have a clue how to fix it. Not one single manager or politician who has overtly failed at the problem, many for decades, should be allowed through the door of the services again.
Decades on, the decent honest letter should be published soon:
Dear Citizen,
We have, to a man, made a total balls of the hospital services for almost 40 years. Please put us out of our misery immediately by accepting our unconditional resignations, and please get someone who can do the job.
Yours humbly — and FINALLY,
The Health Boards,
The Department of Health,
The HSE and Successive
National Governments.