Dr Ina Kelly: We must learn lessons from the pandemic

Dr Ina Kelly, newly elected president of the Irish Medical Organisation, says many doctors will be dealing with Covid-19 for the rest of their careers.
Dr Ina Kelly: We must learn lessons from the pandemic

The biggest crisis in our health system at the moment is the crisis in morale amongst our key workers, says Dr Ina Kelly

It’s hard to imagine that it is just over 16 months since our first inkling that the pandemic was coming our way. 

So much has happened in that time. 

We remember most of all, of course, the thousands of people who have lost their lives due to Covid-19 in this country and the tens of thousands of people who were ill, including healthcare workers and other essential workers, some with very serious consequences. 

We are very aware also of the social and economic disruption to try to minimise the tragedy from Covid-19 — the awful hardships that people have had to endure — the mental trauma suffered by people across the country especially our young people, and the knock-on consequences of the pandemic which will be felt for years to come in areas like waiting lists for those who are ill, and so much missed class time for young people in schools and universities.

But there are positive memories also. The extraordinary social solidarity which has, pretty much, held firm now for over a year, the phenomenal work of scientists across the world who have developed effective vaccines which we were not sure could be done, and at a speed which was unimaginable. 

And, of course, the dedication, the sacrifice and the heroics of doctors — and indeed nurses and support staff — up and down the country who have risen to the challenge of the pandemic, again and again, and who have demonstrated all that is most special about our profession.

Pandemic fight not over

However, it is also clear that the fight against Covid-19 is far from over. 

We are making progress certainly. We have largely succeeded, so far, in halting and rolling back the third wave of the virus here in Ireland, and the roll-out of vaccines gives us huge hope that we are, at least, at the beginning of the end of this phase of the pandemic.

But the threat from Covid-19 is going to be with us for a long time to come, and as happens during pandemics, we can see now the threat posed by variants. 

Covid-19 is a difficult and relentless foe that exploits our vulnerabilities and weaknesses and we are going to have to keep adapting our responses as the threats themselves change and adapt.

For doctors of my age, we may be dealing with Covid-19 and related issues, probably for the rest of our careers in one form or another. The importance of pandemic prevention and preparedness is evident and this must be prioritised into the future.

And so too the broader health system.

We in the Irish Medical Organisation have long highlighted weaknesses in the health system and persistent policy failures including, most particularly, the failure to adequately resource the system. 

There has long been a disconnect between the resources the State spends on its public health services, on the one hand, and the real and urgent need for those health services for the public on the other.

And while we have to acknowledge the huge investment which has been made over the past year to help resource the fight against Covid-19, a lot of that investment was required for the very simple reason that the system was unable to meet the challenge of Covid-19, because of years of neglect, and of compromise, and of just making do.

Goal of learning lessons from Covid crisis

So, as we move to the next stage of this pandemic, one of our goals must be to make sure that we learn the lessons of this crisis.

One such lesson is the need to invest in fully functioning services, all the time — not just at a time of crisis — so that we are never again exposed in the way we have been this year.

That doesn’t just mean increasing our ability to respond to infrequent though predicted events like a pandemic. 

It means increasing resources across the board so that service readiness, like our ICU capacity, doesn’t have to become a routine topic of conversation and worry in homes around the country.

It means enough beds in our hospitals so we don’t have to worry about elderly patients lying on trolleys in hospital corridors, enough consultants at work so we don’t feel ashamed at the horrific waiting lists for key and urgent procedures. 

Dr Ina Kelly: The Irish Medical Organisation has long highlighted weaknesses in the health system and persistent policy failures including, most particularly, the failure to adequately resource the system
Dr Ina Kelly: The Irish Medical Organisation has long highlighted weaknesses in the health system and persistent policy failures including, most particularly, the failure to adequately resource the system

We need enough GPs in our communities — properly resourced for the 2020s — so that we can have a genuinely primary-care led service, enough community health doctors to provide the absolutely essential preventive services and enough public health doctors in place employed and empowered to lead and provide a properly functioning public health medicine system which can really help reduce the avoidable demands across the health services, and help to improve all health services, as they are trained to do.

That’s a challenging goal and it will require significant and ongoing financial resources. But the challenge isn’t just financial.

The biggest crisis in our health system at the moment is the crisis in morale amongst our key workers. 

The low morale of young consultants facing impossible demands on their time and knowing that they are earning over 30% less than their colleagues because the Government thinks it’s okay to have a two-tier salary system; the low morale of GPs who are under immense pressure all the time, the low morale of our NCHDs who are queuing up to apply for opportunities to work abroad, rather than stay here and face systematic neglect and inexcusable working hours, and the low morale of foreign doctors working here in Ireland who have no clear path to enable them to make the most of their careers, or to serve this country as well as they can.

And of course, the low morale of our public health doctors through 2020 who have had to juggle attention over the past year between fighting the pandemic on the one hand and fighting for the recognition of their value to the health services on the other.

Struggles in public health medicine

While I’ve long been in public health medicine, I’m the daughter of a GP and indeed I trained as a GP in Australia in the early '90s. I found Australia to be a wonderful place to train and work. It will keep attracting our colleagues as long as we don’t look after our doctors in Ireland properly.

Public health medicine is endlessly interesting and intermittently very fulfilling, but I know that like all my colleagues I have been fighting with one hand tied behind my back. 

In many respects, the struggles in public health medicine are replicated across the specialties. Hard-working people doing everything they can but constantly being undervalued and under-resourced.

I also want my experience in public health medicine to inform some non-Covid-19 issues which I hope to highlight during my term, in particular the cause of women in medicine and the two crises of mental health and climate change.

Covid-19 may be the defining issue of the moment but the crisis in mental health and the climate crisis are like silent pandemics of their own and each demands our urgent attention.

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