Addressing the shambles in the health service

COMMENT

WE are told that July 11 will be a dark day in Ireland in terms of medical services in emergency departments.

Only five of the 32 emergency departments in the country are currently fully staffed. On the 11th, there will be a change over of staff and if the media reports are to be believed, experienced non-consultant hospital doctors will be replaced by newly qualified doctors beginning their post-graduate training and attempting to learn the ropes of their chosen profession. As it currently stands, there is a one-in-three shortfall in registrars, a number that has serious implications for patient care in the coming months.
While this crisis is now the problem of the new Government, it is most certainly the fault of many previous administrations. Fianna Fáil and the Progressive Democrats have perhaps the greatest case to answer with regards to the situation, as a lack of planning and good management are among the main factors that have led us to this situation.
With Mary Harney at the helm in health, an ideological war was waged on the Irish health service, with the focus on privatising the system at the expense of those who could not pay. What we were left with in the aftermath of this war was a two-tier health service that does not even benefit those who can afford to pay for exorbitant health insurance.
While ideology was doggedly followed, structures and systems within the health service were allowed to degenerate into something approaching chaos. Training schemes for doctors developed into anti-family devices where they existed and many people in the profession were left with no option but to emigrate in search of proper training.
Those who stayed on in Ireland were working hours so brutal in their duration that patient care was almost guaranteed to be suffering. The European working time directive was adopted into law by Ireland but owing to the sickness within the system, the conditions could not be met. As a result, doctors in Ireland are still working in excess of 80-hour weeks in contravention of the legislation and to the detriment of patients.       
Dr James Reilly now has a very serious struggle on his hands because he must find short-term solutions to what are deeply ingrained, long-term problems. In order to fully address the current crisis, plans needed to be put in place six years ago. How he will do this remains to be seen and it must be acknowledged that he is facing an unenviable task. In the meantime however, the real losers will be those who have the misfortune to fall ill and seek treatment. We have had the announcement in the last few days that the emergency department at the regional hospital in Limerick will no longer be open at night from July on. Those needing emergency treatment will be dealt with in Cork or Galway. The chairman of the hospital’s medical board, Dr Sandy Fraser, said it would no longer be possible to maintain emergency services at the hospital 24 hours a day. He told the Irish Independent that less than half of the positions required to staff the emergency department from July 1 have been filled at this stage.
People in Clare, who for years have watched Ennis general being continually downgraded in accordance with the establishment of “centres of excellence” such as the Mid-West Regional in Limerick, must be finding this particular bit of news especially galling.
One of the solutions to the current problems being considered is the suggestion from the EU and IMF that a free market policy be applied to medicine by allowing the number of general practitioners to increase significantly and encourage competition. For the sake of patients, we must hope that this is not allowed to go ahead. Somebody who is in need of medical treatment is a patient, not a customer, as they would be in this situation. Such an action would also do little to boost the number of GPs in rural areas or places with a small, disparate population.
There is a danger however, that the level of influence being wielded by the EU and IMF in Irish political circles makes such action more than a possibility. Similarly, there is a suggestion that Irish medical graduates might be ‘bonded’, as happens in a number countries. This means that the cost of the graduates’ medical education is essentially viewed as a debt owed to the nation state, which they must repay through years of service in that country. The mindset that sees education as a privilege and not a right is a dangerous one.
The fact remains that if there were proper post-graduate training schemes for doctors, humane working conditions and structures that allowed them to achieve their career goals in Ireland, they would stay. It is difficult to identify where the mindset developed that doctors go into medicine for the money came from.
Certainly Irish governments have done nothing to dispel it but in fact it is very far from the truth. It is a caring profession and for most who undertake a life in it, it is a vocation as much as anything else. Private health insurance has certainly introduced large sums of money into healthcare but this is not the fault of the professionals themselves. As a result of successive Irish governments and their policies, how much money you have determines the level of care you will receive and this is simply wrong.
With the level of reform currently needed in the Irish health service the Government has an opportunity to overhaul the system completely and try to remove some of the inequalities built into the system by their predecessors.
Let us hope that they seize this opportunity with both hands and that not too many people die in the time it takes to address this shambles.