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Sláintecare is unlikely to provide the solution to the problems of the health service
Three cheers for Sláintecare! During the general election 2020, we were spared the usual rubbish from politicians about healthcare. Each party in turn hid behind the fig leaf of Sláintecare.
I was glad. Consider the last few elections. In 2007, the general election was all about co-locating commercial private hospitals on public hospital land. That would be unthinkable now. The 2011 election promised universal health insurance, which makes everyone a private patient. Since election 2016, we have Sláintecare, which insists we’re all public patients. Confused? You should be!
After the election, RTÉ asked me to comment on the case of Mrs Murphy, from West Cork, who spent days on a trolley. In case the politicians were on to something, I read Sláintecare a second time. No, it’s just an aspirational essay, without any real answers.
Whenever a report emerges, I look for a solution to the trolley problem. Sláintecare’s big idea is that hospital capacity will be increased by having more primary and community care, better integration of care, and by abolishing private practice in public hospitals. Sorry, lads, that ain’t gonna do it. By the way, the terms of reference state that the best outcomes and value for money are in primary and community care, so I reckon the solutions were chosen before they started.
My mind wanders back to the disastrous 2007 bed capacity report written by management consultants. I’m probably the only person who plodded through all four volumes and I spoke to people who did the extensive hospital surveys. Based solely on the medical file, they had to guess (my choice of words) what was needed to discharge patients. If I did that in real life, I could be sued for negligence. This ridiculous “research” concluded that Ireland needs only 9,000 hospital beds, provided we move to a model of community care.
Bad reports can have serious consequences. Our great tragedy is that the HSE followed the 2007 report as a blueprint. For a decade, instead of adding beds, hospital wards were closed at every opportunity, aiming for the magical 9,000 beds. That madness has finally stopped: New wards have opened, but according to a senior HSE manager, there are 90 beds fewer now than in 2009. Meanwhile, the population heads towards five million.
So that is why the trolley crisis became worse each year, not better. That is why generations of medical students think it’s normal for patients to be in an emergency department (ED) for days – until they see a functioning hospital system in Australia.
I get angry at physicians and surgeons for saying nothing, leaving it to the ED people. I’m sorry, it’s not enough to just treat the trolley patients.
I get so very angry because I’ve experienced it with my own family and friends, and also through patients. In 2003, my mother was on a trolley overnight in St Vincent’s Hospital with a badly broken arm. She didn’t mind. But more wards closed; now seriously ill patients can’t get to a ward and are stuck on trolleys. People close to me have been overnight in ED with heart rhythm problems, bowel obstruction, and stroke with seizures. Patients have said “I’d rather die” or “put me down” when faced with ED again.
Mrs Murphy’s story is really very boring. It happens every day, in every Irish hospital. The GP was concerned about a possible stroke. Despite health insurance, a private hospital sent her on to public ED, where she spent days on a trolley. In fact, she had infection and fluid overload; following “phenomenal” treatment, she is recovering. Her 90-year-old husband simply couldn’t bear to see his wife’s misery and distress at the chaotic surroundings.
Here’s a question. Did the Sláintecare people know how many trolley patients are like Mrs Murphy? How many are referred by a GP? How many with health insurance? They couldn’t: The HSE doesn’t collect that data. I’m guessing (my choice of words) they don’t know that when 600 patients are on trolleys, all we know is that they were accepted for admission, but couldn’t get a bed. I’m guessing they don’t know you must be in the whole of your health to go to a private hospital. Go right ahead: Take private care out of public hospitals. Mrs Murphy will still be on that trolley.
The scary bit is that Sláintecare could make it all much worse. Giving away free GP care could overload general practice, and make it as dysfunctional as the hospitals. Meanwhile, abolishing private practice in the hospitals will cut €650 million from the €4.4 billion budget. Instead of necessary hospital treatment, Mrs Murphy could be told to stay in West Cork with home help. That’s community care.
Would Mrs Murphy and her family give three cheers for Sláintecare? Two cheers? One cheer? I wonder.