At the end of the day the needs of people who are in pain have to trump vested interests, writes Fergus Finlay.
I’VE had to attend to my health over the past few months. As a consequence, I’ve spent a reasonable amount of time in and out of hospital. The first thing I have to report is a positive experience of the health service, and a good outcome so far. I know that’s not what you’re used to hearing, but the truth is, my experience was a good one.
There’s been a lot of poking and prodding, and the things that happen to men as they’re getting on in years frequently involve indignity and loss of privacy, but all of it was in my best interests (or so I kept telling myself, anyway).
I’m not going to bore you with the details, but I did want to share some observations. I’ve been a member of the VHI for more than 30 years, and never had to use it on my own behalf before. I did this time, and as a result I’ve experienced both the private and public health sectors.
Don’t bother giving me a lecture about that. I believe in public healthcare, and always assumed that would be the route I’d go if I needed it. But sometimes you’re told that things are urgent, and it’s just simply foolish, if you have the VHI, not to use it. In my case, it meant the difference between being on a several week long waiting list, and being able to arrange treatment in a way that didn’t unduly conflict with other responsibilities.
On the face of it, the differences between public and private don’t seem extreme. There is no difference that I can discern in the quality of care — we only ever hear about the things that go wrong, but for the great majority of people, the quality of care is exemplary in both situations. (The big difference, of course, is in speed of access, but I’ll come back to that.) The consultant I worked with spent most of his (very long) days in the public hospital, working with public patients.
And I can vouch for the fact that there’s no significant difference in the quality of the food either. Healthcare professionals spend a lot of their time telling us about the dangers of comfort eating — but when you’re in hospital (public or private), toast is always made from a white sliced pan, and jelly and ice cream is the default offering after a meal.
But if you’re checking in to a private hospital, you go in the front door. You take a ticket in the admissions department, fill in the relevant forms, and you’re sent to a pre-arranged bed. Once you get there, a nurse introduces herself to you, and makes it clear that she’s there to help and advise throughout your stay.
If you’re checking in to a public hospital — and it can be on exactly the same campus — there’s no front door. You have to go to accident and emergency, and sit and sit and sit. Eventually you’re seen by a nurse, then by a young doctor, then perhaps, eventually, by someone more senior. How quickly you’re seen will bear no relation to how much pain you might be in. If there’s something obviously broken, or there’s lots of blood visible, that will speed up the process — but there’s no guarantee.
Everyone you meet will be too harried for introductions, and you can be reasonably certain that the first people you meet, you’ll never see again. You live in hope that if notes are being made, or a file created, they’re being passed from person to person. But actually, the more usual experience is that you’ll be asked the same questions by everyone you meet, and never actually figure out who is going to make the decisions that will start you on the road to getting better.
You meet people in accident and emergency who are alone, sometimes elderly, and terrified. They can be in pain, but for most, it’s far worse that nobody ever tells them what’s going on, what they can expect to happen next, when it will all begin and when it’s likely to end. People who go into hospital frightened and alone often get more frightened, and feel more alone, as time drags on. We all know that hours, even days, spent on trolleys in open corridors is not an unusual experience.
In my observation, it’s much more likely to happen to those who are too shy to complain, or have no-one to complain on their behalf.
Within the hospital setting, it’s hard to figure out who, if anyone, is to blame for this. The public health system appears to have thousands of managers. But there is little visible sign of managers accountable for admissions. They all appear to be working at some remove from where the problems actually are.
The issue, of course, is beds. More than 3,000 were removed from the public health system 30 years ago, and the system has never recovered from that. When you’re in pain, and sitting in the emergency department, the decision you need is that someone will find you a bed. But that is clearly the most difficult and intractable decision. That’s simply because the beds aren’t there.
But here’s the thing. Any manager or administrator (or minister, for that matter) who wanders around a private hospital will find empty beds and rooms every day. I’ve been treated in what’s called a “day room” in a private hospital —that involves occupying a cubicle, surrounded by curtains and therefore with adequate privacy. Typically, when I’ve had to use one, there are 12 cubicles in a row and never more than three or four of them are in use. The same is true of the bed situation.
There is spare capacity in the private system — not something anyone wants to admit, but it’s the case. And most of these private systems are operating within hundreds of yards of places where people in desperate need can’t be admitted for want of beds.
That’s mad. There is no doubt whatever that the never-ending waiting lists crisis can’t be addressed without more beds — thousands more beds — in the public system. And of course the system has to be staffed up so that those beds will have adequate numbers of nurses.
But in the short term, I can’t think of any good policy reason why private beds, lying idle, can’t be sequestered on a daily basis for use by public patients who need urgent treatment — or who, at the very least, need dignity while they’re coping with suffering. I don’t know what vested interest prevents that. I do know that public patients shouldn’t be forced to wait while private beds, a few hundred yards away, are empty.
Of course there’s a bigger and deeper argument about whether access to timely health care should depend on the quality of your health insurance or the size of your wallet. But in a crisis, it is completely unacceptable that the two systems are allowed to remain separate, rather than being forced to help each other. At the end of the day the needs of people who are in pain have to trump vested interests.
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