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Alternative realities

Health policy has been weird for at least 10 years. 

Under the health reform programme, health policy was separated from ‘operations’.

The HSE (operations) said there were enough private beds and only 9,000 public hospital beds were needed. The Department of Health (policy) announced 10 co-located private hospitals of 200 beds each.

The HSE said, because of patient safety, acute services in smaller hospitals must be reduced. But the then Minister for Finance Charlie McCreevy gave tax breaks to small private hospitals offering ‘emergency’ services. Meanwhile, under the NTPF, the HSE was diverting patients to small private hospitals.

The then Minister for Health Mary Harney said the number of cancer units had to be reduced to eight, but then she went and opened a cancer unit for a private hospital.

Then they tried to bring it all together in a new consultant contract. I didn’t take it. Consultants should not be obliged to obey corporate policy, because it can conflict with patient care.

When I pointed out the contradictions,  journalists and doctors laughed and said, ‘that’s the private sector’.

I don’t understand. Either small is unsafe, or it’s not.

Maybe they didn’t notice how small the private hospitals were. After all, ‘small hospital’ refers to the numbers treated in emergency departments (EDs) or ICU or as inpatients. Private hospitals don’t publish these numbers.

The public system looks after all illnesses in all patients. You may be treated on a trolley but no-one is turned away

It’s still happening. Last year, a private hospital was commended for treating 10,000 emergency patients. But Loughlinstown’s public ED had to shut because it only treated 25,000 patients.

Sometimes having a parallel universe is helpful.

A recent report criticised ICU in a public hospital: No patient had come to harm but the numbers treated were too low. Now, imagine if that was said about a private hospital; the lawyers would line-up immediately. And they’d be right.

Health policy is all wrong.

It only makes sense if you accept that, for about 10 years now, the Holy Grail has been to encourage patient flow from the public system to private. The NTPF tried to, but they ran out of suitable patients. Co-located private hospitals were the major blueprint.

It’s based on a misunderstanding of the role of Irish private hospitals.

The public system looks after all illnesses in all patients. You may be treated on a trolley but no-one is turned away. In contrast, private hospitals are niche specialists. They pick the illnesses and patients they’re good at. Messy, unpredictable medical cases don’t suit the commercial model.

Meanwhile back in the public system, hospitals like Nenagh had thousands of medical admissions per year. I reckon the smaller public hospitals kind of specialised in acute medical cases. Hospital stays were shorter than in large centres, and there were fewer discharge problems, due to knowing the patients and families over time. The smaller hospitals were cheaper too. After all, if bigger is cheaper, private hospitals would all be huge, and they’re not.

So the net effect of health policy has been to wind-down a network of public hospitals that focused on acute medical cases, while promoting a network of private hospitals focused on elective surgical care.

No wonder the hospital system is a mess.

Then the acute medical cases were re-labelled as ‘chronic disease management’, meaning GP cases. Well, that didn’t work. Instead, they ended up on trolleys in the big hospitals. We’re not allowed to count them as admissions, or HiPE code them, and they don’t qualify for funding. So they are invisible.

Yes, health policy is bonkers. We’re down to 11,000 beds now and it’s not enough.

There are other crazy changes. Patient priority is decided by corporate targets instead of clinical need. There are complex layers of management where everyone is accountable, and can be blamed, but no-one has authority to act.

And the economics of bed usage are all wrong. The worst use of a hospital bed is to discharge a sick or complex patient, without sorting their problems. The General Election is coming. What do we want?

The public finally get it — trolley patients need hospital care, but can’t get a bed. A nicer, bigger ED is not the answer.

No, we need beds, but how many? According to Minister for Health Leo Varadkar, the trolleys are 10 per cent better than last year, because of opening 200 beds. Do the maths: That means 2,000 beds are needed — public hospital beds.

And a rational health policy, please!

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