Alison O'Connor: How sick is our health system that people are afraid to go to hospital?

The latest crisis has done psychological harm to the public and health service staff alike — and hope is in short supply

In a recent survey, 72% of respondents said they would only attend a hospital A&E if their life depended on it. Picture: Victoria Jones/PA

Abandon hope all ye who enter here. Is it an out-of-season Halloween warning, or the attitude to arm yourself with upon entering one of our hospital emergency departments?

Last week was the worst on record for trolley numbers in hospitals, with 931 people waiting for beds. The already very damaged reputation of our hospital system has taken a further battering.

People, it now seems, would rather stay at home in pain, possibly in danger, rather than ‘risk’ a trip to an emergency department.

A Sunday Independent/Ireland Thinks poll found that almost three quarters (72%) of people said they would only attend an emergency department if their life depended on it. Unsurprisingly, just under 60% of people asked pinpointed the state of our healthcare as a top priority.

We already know an overcrowded emergency department is associated with an increased risk of avoidable death and this added dimension, a reluctance to even go to hospital, surely pushes the danger even higher.

The Irish Cancer Society issued a warning this week that overcrowding could put at risk efforts to catch cases early with people putting off seeking medical attention.

What happened in our hospitals post-Christmas wasn’t that difficult to predict given the pre-existing conditions.

We had the reports of a severe flu season in Australia — usually a predictor of what we can expect when our winter hits. Equally problematic was the level of respiratory syncytial virus (RSV), prevalent in young children and older adults. Covid-19 is still lurking everywhere — less lethal, but still capable of causing significant havoc.

Add to that mix the fact that medical staff are utterly exhausted from dealing with a global pandemic. Health Minister Stephen Donnelly described it as the “perfect storm” but weather systems never give warnings months out.

Health Minister Stephen Donnelly raised hackles among medics when he called on consultants to work weekends. Picture: Gareth Chaney/Collins

The minister rose the hackles of consultants by calling for more of them to work at weekends to discharge more patients. He had a point. A lot certainly do work weekends, but they are not obliged to.

However, those remarks did also have elements of a ‘pass the parcel’ approach. The minister was shifting blame.

We all know that our health system operates in stormy conditions all year round.

The problem with what is happening now is it has added to the sense of hopelessness felt by everyone involved: staff, potential patients, politicians. It has culminated in people actually being afraid to attend an emergency department.

Stephen Donnelly will have been hugely relieved to have been able to give much-reduced trolley numbers to Cabinet on Wednesday, with the HSE count at 385 patients and the INMO count at 528, including those on wards.

But, in the longer term, he knows he was lucky to survive last month’s reshuffle and that if he remains in situ until the next general election he’ll never have to suffer this brief again.

No doubt there are similar feelings among the other previous health ministers in the Cabinet — current Taoiseach Leo Varadkar, former taoiseach Micheál Martin, and Higher Education Minister Simon Harris.

The incumbent knows that his best plan, as things are set up, is to ride it out, doing certain things, but not too much.

As a further defence, you’ll hear people in government and the HSE mention difficulties in other countries’ health systems.

In Britain, the NHS is under severe strain. Their health services are part of the worst wave of industrial unrest seen for years with nurses and ambulance drivers seeking better pay and conditions.

'Not wishing to be unfair to the man but, such is the sense of malaise, there is little, if no, anticipation that we’ll be seeing any great change arising from that appointment [of Bernard Gloster as HSE CEO]'. Picture: Denis Minihane

We are used to hearing the French health system being feted for its quality. But it too is in crisis. The lack of GPs in certain areas is a significant problem affecting millions in many parts of France. There have been inducements such as signing up bonuses for GPs of €50,000 in areas where GPs are needed and an increase in the numbers of students studying medicine.

A large French health union called for an “unlimited walkout” this week and this follows strikes by GPs.

It was a surprise to learn recently that a country as affluent as Canada, one of the richest in the world, also has significant problems with its health system.

Not only are their emergency departments crowded, but some have actually had to close, because of a lack of staff. Clearly the vast size of Canada presents logistical challenges in providing health services but budget cutting, policy decisions, hospital closures and, of course, Covid, are being blamed.

Leo Varadkar said this week our Government could not be blamed for what is a wave of infection affecting the entire northern hemisphere.

So a variation on the ‘perfect storm’ defence, but nothing to comfort citizens or staff who know, even when things get ‘less bad’ after this latest crisis surge, they will still be pretty awful.

I doubt any of his EU counterparts will be looking to our Taoiseach for advice on how to turn around their health service when next they meet.

In a similar vein, Tánaiste Micheál Martin said, on governance and management, “the overall edifice of the HSE” needs to be looked at. So far, so yadda yadda yadda. Same old mouthing off on health without any real intention of taking it all by the scruff of the neck and sorting it out.

Just to take one example: For years, people in the HSE and government politicians have been muttering out of the sides of their mouths about the situation in University Hospital Limerick and how poorly it performs.

No surprise to anyone to see it the subject of a ‘major internal incident’ in recent weeks. If people nationally felt fear at the thought of going to their local emergency department, the people of Limerick will tell you this is their normal.

But the situation just goes on and on, with surface-level changes and nothing that will make a real long-term difference.

We’re five years on from Sláintecare. What was to be a groundbreaking plan now feels like it is on a slow train to nowhere.

There is a new chief executive of the HSE taking up his post in March. 

Not wishing to be unfair to the man but, such is the sense of malaise, there is little, if no, anticipation that we’ll be seeing any great change arising from that appointment. Medical and nursing graduates will continue to emigrate straight after graduation.

As well as the overall issues, this latest ‘crisis’ has done significant psychological harm to the public and staff in relation to the health services. The Government would just love to be shot of it all. Any sense of hope is in short supply.