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On the first day back in the Dáil, a very prominent independent TD submitted 26 separate individual questions to the Minister for Health about various named people from his constituency waiting for operations. Without exception, all of these will have been passed on from the Department of Health to the HSE, which will forward them on to the hospital. I don’t know what happens anymore after that. When I was an NCHD, it used to go across the consultant’s desk. So a fairly basic query from a patient with a wholly legitimate grievance went, at great cost, from the patient to a flunkey to the TD to the Minister to the HSE to the hospital CEO to the booking office and back to the consultant, who had generally ordered the test in the first place.
The consultant sees it. Maybe he or she will bin it. Maybe they will shoot a quick email to the person in charge of bookings, asking ‘can we bring the date forward?’, to which said booking officer will, or at least should, reply “No, that’s the list”. Now, everyone apart from the patient along the way from the TD to the consultant knew this all along but everyone is playing this big game. Maybe the odd time it is possible to move it. So when the date is brought forward, to a point which is still probably less than the patient deserves, this provision of a basic level of service will be borne in mind as a favour to be called in at a later date, perhaps from the TD by the consultant or hospital staff or from the patient by the TD.
Behold our Republic in action. I always thought if you wanted public administration in Ireland summed up in one vignette, then that is it right there.
There were other examples. When I was a registrar, as it was the 21st Century, we frequently relied on timely scans to assist us in the accurate detection of disease. This process usually required the filling-in of a small slip of paper and its dispatch to an overworked office in the part of the hospital with no windows.
A few weeks later, the patient would receive a letter telling them to attend for their scan at some point 12-to-18 months hence. The patient, righteously concerned and indignant, would ring up the overworked office in the part of the hospital with no windows and be encouraged to take it up with “the team”, of which the registrar was usually the point of contact. It usually came in the form of an ear-splitting bleep causing you to shudder when you were at a delicate point of a colonoscopy or a lumbar puncture, or maybe even a wee.
The sometimes tearful patient would say: “Your consultant wanted me to have this scan, they’ve told me it won’t be until August next year. I called them and they said to talk to you about it and you could bring it forward.”
Medical registrars humbly seeking favours for patients they don’t know are (rightly) not always embraced with open arms in the very overworked part of the hospital with no windows. Being a cantankerous, yet observant fellow, and having seen the success of the odd local TD, I devised a different plan. I started writing to the head of department.
An ultrasound has been requested for this lady and an appointment given to her to attend in 15 months time. She feels this is an unacceptable delay and I’m sure you will agree she is correct. She contacted the department and was led to believe by the administrative staff that it is within my gift to bring the date forward, so she paged me. I had not previously been aware of this. As such, I would appreciate if it could be done at your earliest convenience.
The bleeps mysteriously stopped after two or three of these.
I think everyone is doing their best in the health service but we either have a waiting list or we don’t, and we have enough of a two-tier system as it stands without having two- or three-tier public waiting lists as well. We all know times when something is likely to be very urgent and will require a big personal effort to get done but the more general culture of ‘well, if you’re worried or they’re kicking-off, call down to endoscopy/theatre/radiology and we’ll try to get it done’ is both clinically and morally a really dangerous high-wire act. If we are not worried, we should not be ordering tests in the first place.
If patients are too polite or do not feel empowered or entitled enough to complain about ridiculous delays, why should they languish in the ultra-slow lane?