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The health service needs to resist slipping back into the old way of doing things
O ne year on from Covid, it can be difficult to think back to last spring and all the memories of sheer terror and uncertainty that faced us. It is striking how different the first wave of last March and April felt to this winter’s wave that has left us all completely exhausted with barely any fuel left in the tank. Back then we were filled with a collective sense of purpose and almost excitement mixed with fear as the entire health service was completely upended to face the looming onslaught.
Previously static and slow to change, the HSE seemingly was transformed into a dynamic force where ICU beds were created overnight and new staff and returning ‘healthcare heroes’ were embraced with open arms. All these new changes seemed beyond imagination and it gave hope that this was a great new dawn. However, all these months later one could fear that it is now slipping back to its old ways.
The doctors and nurses who came back from the other side of the world to a hero’s welcome found themselves kicking their heels on zero-hour contracts with no real jobs planned for them, despite the sustained pressure that the system has been under for the year. As quickly as they arrived from the southern hemisphere they’re on the way back. They are leaving with the appeal of decent working conditions and the thought of being able to go out for a meal or a drink after their shift.
They have chance to live relatively normal lives once they’ve completed their mandatory quarantine. No thought was put to how we could capitalise on these returning assets, no attempts to meaningfully increase training opportunities were made and any gains have been squandered.
We see it again with the pulling of the extra intern jobs that were created last year. The HSE has said that this was a once-off event but it seems illogical that we have gone to all this effort to train these doctors in the Irish system only to wave them goodbye at graduation.
Sure, one could argue that we already have enough interns in the system and not enough quality jobs in quality training hospitals for them all, but we certainly don’t have enough SHOs and registrars in training schemes and we definitely don’t have enough consultants. If we lose doctors at this early point in their careers it is certain that we’ll never get them back.
One year on from its arrival, we can no longer continue to solely run on an emergency footing and the health service will have to plan how to function while, to use that now tired phrase, ‘living with Covid’. It has to consider how it will continue to deliver training to its junior staff. It has now got to the point where trainees have completed large chunks of their speciality training without the same clinical exposure that they’d normally get.
This is obviously in effort to keep patients and staff as safe as possible, but this reduced opportunity to do the day-to-day doctoring that was a routine part of pre-Covid life may leave trainees somewhat unprepared for their post-Covid lives.
More importantly, consideration has to be given to the ongoing impact on patients. All the cancelled clinics and surgical lists, the lengthening of waiting lists that were bad before Covid are now almost insurmountable. We don’t even know what’s out there in terms of the coming crisis of delayed diagnoses, yet no plan seems to be made to address it.
New initiatives, such as virtual telephone outpatient clinics, have become a very efficient way of providing routine reviews for the patients they are most suitable for. But some patients will still need to be seen face-to-face and clinics need to be back up and running as soon as it is safe for staff and patients. Telephone consultations cannot become an excuse to offer a lower quality service and still say that patients are being cared by specialist teams in order to massage waiting list numbers.
One year on, it is a great relief and hope to see vaccines slowly come through the system and with them some light at the end of the tunnel. We learnt a lot about the Irish health service in the last year, both good and bad. Covid has taught us that things can change overnight if they have to and that we can all pull together in a crisis. As we hopefully come out of this, it is important that that we do not slip back into the old ways of doing things and that we use this experience as an opportunity to always keep pushing for more.