Innocence is dead in a country that’s rapidly going off its trolley

WHEN I was just four years old my mother brought my younger brother and me to this country.

"The kids are grand, thank God," she wrote to her sister in New York. "They sure love it here. Really it is amazing how independent they are and go off by themselves. The only time I ever look for them is at meal time, and usually they turn up by themselves for it."

That Ireland has gone for some time, but it was well and truly buried this week. We really need to take stock of where we are going.

Whether it has been the impact of Hollywood or television, we have been following the Americans and making the same mistakes. We have aped their drink and drugs problems, the crime gangs, the mindless street violence, and surprise, surprise we are witnessing the same kind of social disintegration.

This week, on top of the horror of Midleton, it appears that we are developing the same kind of awful hospital system. In America ambulances are privately run, often by funeral homes. Different ambulances will race to the scene of an accident. It may be disconcerting for patients to wonder whether getting to the hospital on time is in the interest of the funeral home.

But when they get to the hospital, accident victims frequently have the complication of having to prove they have hospital insurance before they are admitted. We have never descended to such mercenary depths here, but in some ways we are actually worse.

Hundreds of people are forced to wait on trolleys or chairs until a bed is vacated so that they can be admitted to our hospitals. Many of those people in their twilight years helped build up the hospital system with the taxes they paid faithfully without the benefit of amnesties, but now when they need the service for which they have already paid so dearly, they are being treated like crap.

One day this week there was a record 422 patients on trolleys in the accident and emergency departments of our hospitals. Some of the public and media moaned that Health Minister Mary Harney was on holiday, which she was perfectly entitled to take. They should have been asking about the sense of duty and responsibility of others in the health service and the bureaucracy generally.

We have been developing a crazy system. We have people in hospitals who belong in nursing homes, people in jail who belong in mental hospitals, while people who belong in jail are on the streets terrorising communities like Midleton, or stealing from a church the money donated for tsunami victims.

Blaming Mary Harney for the overcrowding crisis in A&E departments is unfair because she has done her part in introducing a 10-point plan and securing the funding to implement the measures. Just about all agree these measures will resolve the overcrowding in A&Es.

The responsibility now rests with healthcare officials, doctors and nurses. They must implement the plan. Of course, the minister must ensure that they do so, but she has to afford them time to purchase the necessary equipment and to hire the extra personnel. The new health executive needs time to implement the changes properly.

Part of the solution is to free up beds in hospital wards by transferring those elderly patients who belong in nursing homes, or at home, and providing them with proper nursing care. The plan includes a provision for 300 new hospital beds. There are plans also to further alleviate the strain on A&E departments by providing chest pain clinics, acute medial units and other facilities to treat minor injuries.

These changes are likely to take longer to implement because they involve reorganisation of facilities within hospitals. Even with the best will in the world it will take time to implement the changes, and in the interim it should not be too much to expect that the various sectors of the health care industry would pull together in the interest of patients, if only out of a sense of humanity and decency. Dr Aidan Gleeson, a consultant at Beaumont Hospital in Dublin, argued on Morning Ireland during the week that overcrowding in A&Es could be easily rectified with the temporary solution of moving just one or two of the patients on the trolleys into each ward.

"Our problem would disappear over night," he said. If this were done, however, he said the nurses would walk out in protest, claiming that it would be unsafe to have two extra patients in a ward with just six to eight nurses to look after them. They contend that it is a safety issue.

YET in the A&E department there may be just eight or nine nurses dealing with 130 new patients each day, some seriously ill and others critically injured. At the same time they have to deal with 40 extra patients on trolleys because they cannot be formally admitted due to a shortage of beds in the wards. If two extra trolleys pose a safety issue, what do forty pose? That is not about safety. It is about endangering people in A&E. Putting a couple of extra patients on trolleys in each ward is not an ideal solution, but it is at least twenty times safer than leaving them in A&E. It would only be a temporary measure until the current plan can be fully implemented.

Leaving the extra trolleys in the wards would not be in the long-term interest of healthcare, but it would be a stop-gap measure until extra beds were provided. If nurses allow their union to block such an arrangement, they will effectively be holding patients in A&E as hostage. Such reprehensible behaviour will do irreparable damage to their professional image which has developed over generations.

It has been hard earned and should not be frivolously cast aside. For many years nurses were grossly underpaid, but most were so dedicated to their jobs that they could not conceive of using strong-arm tactics in the area of industrial relations. As a result they were grossly exploited.

Junior doctors were treated even worse. Can one imagine anything more uncaring than for a caring profession to hold vulnerable people hostage?

It is virtually inconceivable that nurses would favour such extortion tactics, so they should not allow their industrial relations representatives to adopt such tactics on their behalf.

Nursing is more than a profession; it is a prized vocation held in high public esteem, but nurses would do well to recognise that many of the professions and vocations that were held in high esteem have slipped badly because they have allowed an unrepresentative minority to tarnish their image.

Patriotism, generosity and co-operation are not outmoded concepts. It is greed, heartless mercenary tactics and gaudy ostentation that is alien to Irish society. The horror of recent days should act as a wake-up call. We have what is recognised as the finest quality of life in the world, but we need to see that it is under threat and we must ask ourselves where we are going.