Why Harney is as helpless as the rest to deal with hospitals crisis
And people are on radio offering cabins to help accommodate and treat sick people, offering to supply the bedding, carpeting, furniture on a charitable basis. And other people are on radio to protest when the hospitals can't deal with this generosity, can't include it in their planning.
Meanwhile, nurses are protesting outside accident and emergency departments, while patients queue inside. In year 13 of the Celtic Tiger.
And the queues are never-ending, according to the Health Service Executive, even though they preface every statement by saying that the problem is getting better.
But it's their figures that give the statistical dimensions. They publish them all the time. And if this is getting better, I'd hate to see what they'd be like if they ever got worse:
March 9 241 people on trolleys.
March 16 243.
March 24 212.
March 31 200.
April 6 282.
April 11 221.
April 14 231.
That's just some days picked at random from their figures. There's no pattern. In fact, if you took all the days they have on their website and did a graph, it would be all over the place. Statistically, it's a total mess.
Forget the statistics for a minute. I had a friend in hospital last week. He was brought in with a serious post-operative infection.
Not life-threatening, but painful, frightening, and in need of urgent care lest it spread. It needed two things above all antibiotics and rest. He spent the first three days on a trolley in one of the busiest A&E areas in the country, getting the antibiotics he needed but not a wink of sleep.
Through his own pain and discomfort, he was able to witness the situation other people had to deal with. One old woman he remembers, painfully thin and obviously lonely and frightened, spending most of a night alone in a corridor. In the middle of the night a nurse brought her tea in a plastic cup, tea the nurse had paid for herself from a machine.
Nobody died while he was there, thanks to an overworked but very vigilant staff. But people were scared. Some will never forget the experience. Some, maybe, lost some life expectancy as a result.
Why is this happening? Well, here's one possible explanation: "For some time, it has been evident that the capacity of our acute hospital system has not kept pace with the increasing demands being imposed on it. The consequences of that under-capacity are well known, ie, cancellation of elective admissions, long delays in accident and emergency departments, waiting lists for elective procedures and unacceptably high bed occupancy levels in the major hospitals."
Seems reasonably honest and straightforward to me. But it's not the view of some opposition spokesperson, or some commentator or health professional. It's what Micheál Martin had to say when he wrote the foreword to a national review of acute hospital bed capacity, prepared when he was Minister for Health. The document itself is revealing (and it's his document, not mine). For example, it says, among other things:
The number of acute hospital beds in 2000 (11,832) is approximately 6,000 lower than the number in 1980 (17,665);
The number of acute hospital beds per capita in Ireland is one of the lowest among EU and OECD countries at 3.1 beds per 1,000 population; this compares with 5.1 per 1,000 population in 1980.
Those figures from the year 2000 were of course the main reason why the Government committed itself, in the health strategy published in 2001 (just before the general election, but no connection, of course), to providing an extra 3,000 hospital beds.
Last year they published a progress report on the implementation of the strategy. According to that, 568 extra beds were "funded" up to the end of 2003. "Funded" doesn't mean provided, operational and working. Some of the beds "funded" up to the end of 2003 aren't available to care for patients yet.
The good news, though, is that the HSE has said it intends to provide another 200 acute beds this year.
The truth is that not only are we not keeping pace with need, we're not even keeping pace with the population. In the early 1980s, when there were 17,665 beds in the hospital system, we had a population of 3.4 million people. Now we have nearly a million people more, and thousands of beds less.
The Tánaiste, of course, has a plan. It's a 10-point plan, and she has announced it regularly since she became minister. It's designed to do everything except put the number of beds we need into the system. And for that reason, it won't work.
Cleaner hospitals are a good idea. So is a second MRI unit in Beaumont hospital. So are the development of minor accident units, expanded home care packages to support additional older people at home, the provision of more after-hours GP services, more palliative care facilities and more direct access for GPs to diagnostic services. They're all part of the Tánaiste's plan. Some of them, of course, are wildly impractical you're never going to get more doctors doing house calls at night, or even remaining on duty in their surgeries after nine o'clock in the evening, until you create a lot more doctors. And even when they're available, their fees are such that an awful lot of people are going to be propelled into the A&E services anyway.
But when it is all implemented (and it's taking a lot longer than she thought) we will still have a crisis. Because if there isn't a bed for a patient who needs one, the patient will still have to suffer on a trolley. And none of this planning faces up to the central issue we need more beds.
Mary Harney can't deliver. She knows that now. The 10-point plan will be spun and spun, and desperate attempts will be made to suggest that everything is working. But she knows what the central problem is.
It's simple. She doesn't run the Department of Health. The Department of Finance took a firm grip on the Department of Health in 1989, and never let go. And the Department of Finance doesn't believe in beds.
Beds cost money, not just to provide but to staff and maintain. Patients in those beds need looking after by nurses and doctors and non-nursing staff. Every bed costs money every year. It represents a commitment that has to be kept up.
I read someone at the weekend asking why it is that the Department of Finance would rather build a road than a hospital. Have they no sense of priorities, he asked. They sure do. Their priority, now and until there is realpolitik at the heart of Government, is to do everything possible to keep spending to the bare minimum. Roads don't need to be staffed, hospital beds do. And until someone faces down the iron will behind that simple rule, patients will continue to suffer on trolleys. In year 13 of the Celtic Tiger. And beyond.
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