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How many miles to Babylon?

How many miles to Babylon? How deep is a black hole? Have we reached ‘peak trolleys’?

A record of 600 trolleys was reached in early January.

I know about two of the cases. On that day, my vet sister queued to have surgery on a serious facial fracture. Across town, Carol Hunt of The Sunday Independent began 57 hours on a trolley with suspected stroke. Both were very well looked after. Trolley patients need hospital care.

There was an outpouring of ‘usual suspect’ theories and solutions. Here are some items that won’t solve the trolleys: Building bigger emergency departments; admitting patients on the day of surgery; more diagnostics and more medical assessment units; and transferring work from NCHDs to nurses, or to consultants or GPs.

All nice ideas, but the trolley problem is bigger than them all.

A commercial enterprise, such as Ryanair or Aer Lingus, would get rid of unprofitable lines. In the public system, it’s the profitable bits that are privatised

The usual numbers have been quoted. So what if the OECD says Ireland has a large number of nurses on the Register? They’re not working for the HSE. Every time it’s said, another nurse is taken from an understaffed ward. Then the number of administrators is noted. That leads to more cuts in front line admin staff, like medical secretaries and ward clerks, who keep the wheels turning.

Fixing the Fair Deal mess would help. Under the old system, there was a six-week maximum delay between applying for a nursing home grant and getting it. Let’s go back there.

But even if everyone got their nursing home bed right away, the hospitals would still be full. So it’s not enough.

And if a hospital has 30 trolley patients and a 30-bed ward opens, more trolleys will appear.

How many beds will fix it? How deep is the black hole?

In 2002, a careful report from a public health doctor said Ireland needed 14,000 beds. In 2007, a report from a commercial consultancy said only 9,000 beds were needed, including (bizarrely) day case beds.

Unfortunately, the HSE followed the latter report.

We’ve been guinea pigs in a national health experiment ever since.

We know overcrowding in emergency departments leads to higher mortality. Many people have been lost: Every pneumonia or heart failure case that might have pulled through on a better day, in a better place. Ill patients are fragile.

Other cases stand out from news reports, such as the elderly man found behind curtains “in cardiac arrest”. Sometimes there’s a double tragedy.

A family brought a patient to hospital with psychiatric difficulties, but he left the ED and killed a stranger.

Some deaths are not recorded, like my 50-year-old relative who was discharged from ED but died in another country.

In Celtic Tiger times, money poured into the public system but the ceiling on recruitment set a deliberate limit on what could be done.

Instead, expensive contracts were made with the private sector: Catering and cleaning, cervical smears sent to America, surgery under the NTPF. If the recession had not happened, I believe chunks of our public hospitals were to be privatised: Radiology and ‘cold’ laboratory work; minor injury units and day case units; palliative care and maybe transplant surgery.

A commercial enterprise, such as Ryanair or Aer Lingus, would get rid of unprofitable lines. In the public system, it’s the profitable bits that are privatised. So, we heard recently that 42 per cent of elective surgery is done in private hospitals. I presume it’s mostly day cases. Private hospitals don’t tell us how many overnight patients they treat.

But indemnity premiums are rising and the MPS says it’s because more consultants in private hospitals are being sued, and for larger amounts. Now, if that was said of public hospital consultants, I’d expect headlines about how dangerous public hospitals are. Maybe I missed that debate?

Let’s be charitable and presume that private hospitals are treating more complex patients than before and finding out just how difficult it is.

But mostly, the easy bits of healthcare were outsourced, and to rather small private hospitals. Meanwhile, large public hospitals fill up with medical patients.

Before health reform, a lot of those medical patients, especially the elderly, went to the smaller public hospitals. In the Mid-West, half the medical patients used to be in the regional centre and half in the small hospitals. Not now. They’re nearly all sent to Limerick and are competing for trolleys.

How many miles to Babylon? How deep is this black hole?

Perhaps there’s a formula, such as: (Fair Deal patients) + (3 x peak trolleys). Or we could go back and look at the 2002 report.

Have we reached peak trolleys? Maybe not.

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