THE HOSPITAL CRISIS

The maxim that, if you don’t deal with a problem, it eventually deals with you probably doesn’t need much practical demonstration – but it is getting a highly conspicuous one in the overcrowding chaos afflicting the Irish hospital system this week.

The good people of the Monaghan General Hospital Community Alliance, and the other campaigners who fought valiantly if largely unavailingly to resist the removal of acute services and emergency medical provision at smaller Irish hospitals in recent times, must be shaking their heads sadly at the scenes that have convulsed the commentators and dominated this week’s domestic news.

There is only a poor sort of satisfaction, bitterly ironic in hue, flowing from witnessing patent good sense arguments vindicated by the suffering and severity that is the current portion of the patients awaiting urgently required care and the nursing and medical staff overwhelmed by the unmanageable pressures being placed upon them.

The cause of the problem would seem to be crystal clear, although senior spokespeople for the Health Service Executive are doing verbal cartwheels in their efforts to obfuscate it.

The demand placed on existing accident and emergency departments by the closure of this provision in smaller Irish hospitals in recent years has not been adequately provided for in terms of resources, and indeed is of such a scale that even the most lavishly resourced of the existing hospitals would struggle to accommodate it without substantial capital development.

Adding to the problem has been the steady reduction in the number of active hospital beds, another consequence of the severe cuts smaller hospitals have been systematically subjected to – and another significant reduction in the coping capacity of the health service when it comes to its fundamental function: caring for people when they get sick.

Public comments yesterday by the HSE Director General Tony O’Brien sought to explain the current situation by reference to the logjam created by the delay in transferring people out of acute care situations in hospital beds and into other settings appropriate to their recovery. But surely this is merely another symptom of the malady the HSE itself has inflicted upon the hospital system, rather than its underlying cause and cure?

It is because the HSE has cut services across the board in pursuit of an unsustainable vision of hospital care provision that the alternatives to keeping patients in hospital beds are not more readily at hand. And they and their predecessor structure have been able to do so down the years relatively unrestrained by any effective system of democratic checks and balances, in the chase after a model of care that vaunts the vested interests of an aristocratic elite within the medical profession over and above the needs of the patient.

The trend of health policy in this country over the past three decades, and probably longer, a trend that has dangerously undermined the local hospital system that remains in most other countries the essential supporting structure in the delivery of medical care, is the cause of the current crisis and those of similar ilk in the recent past – that is the pure and simple truth of the matter.

The course of this trend has been allowed to cut a deep and very dangerous channel through the ties that should properly and securely bind the provision of health care to the governance of the State.

It may be an embarrassment that Minister for Health Leo Varadkar was reportedly in the United States this week when the latest overcrowding crisis in our hospitals unfolded, but in the end it is an irrelevance where the Health Minister of the day is and what he is doing: it has long been demonstrated that, where this particular portfolio of government responsibility is concerned, the incumbent is a mere figurehead.

If Mr Varadkar is rushing home, it is only to take the flak that is the occasional inconvenient obligation of ministerial responsibility – like his predecessors, he is impotent when it comes to solving the crisis.

And, as is the way of things, that crisis will eventually abate and pass from the forefront of media and public concerns. Mr O’Reilly told us yesterday that the HSE was currently focusing on cutting away much of the red tape which the process of getting people out of hospital beds and into appropriate alternative care is usually subjected to – a very telling remark, indeed. Would it offend the sense of administrative propriety of the real masters of our health service to venture the question: if the red tape can be cut away now, why not all the time?

But such are the efficacious expediencies of crisis management, which is fast becoming the default setting for the way in which our hospital services are operated. There will be a flurry of movement, and the latest emergency will pass – but the fundamental sickness will be left to linger unaddressed until the next critical point comes around.

What a brave new model of hospital care we have created in this country – were it not for all those bothersome patients, it would surely be something to behold!