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(en) Ireland, Workers Solidarity #80 March 2004 - On the frontlines of the health crisis An interview with Dr. Ciara McMeel, a GP working in West Tallaght

From Worker <a-infos-en@ainfos.ca>
Date Mon, 12 Apr 2004 07:34:53 +0200 (CEST)

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There is a common perception that our health service is in crisis.
However, there is little understanding of where the problems lie
and what can be done about them. We interviewed a GP working
in one of Dublin's poorest areas to get a view from the inside.

> Is there a problem with the Irish health service?
Yes, there are serious problems in both primary care (GP
service) and in secondary care (hospitals). The GP service has less
obvious problems than the hospital system, as those who are seen
are generally well looked after.

However, there is a large number of people who aren't eligible
for medical cards and who can't afford to pay to see a GP or to buy
prescription medicine. The first time that these people come into
contact with the health service is often when they appear in an
A&E department with critical symptoms. Often times these crises
could have been avoided if they had seen a GP in time.

Although the hospital system is generally free to use and you
are generally well looked after once you have been admitted, the
major problem is getting in. The only ways to get admitted to a
hospital is through an A&E department or by being referred by a

If you arrive at an A&E department with serious symptoms, you
might have to wait at least 8 hours before you are even seen, then
lie in a trolley for 3 days or more waiting for a bed to become free.
If you are referred by your GP, you will generally have to wait for
between 2 months and 2 years before getting an appointment to
see a specialist - and these people aren't even included in the
government's waiting list figures.

Is it just a problem of not enough money?

Money is obviously important, but it's not the only problem.
The fact that many people can't afford to see a GP means that
they come to hospitals only when a crisis hits. Also, people who
are waiting a long time for an appointment have to show up at
A&E departments when their symptoms flare up.

For example, if you are waiting for an operation on your gall
bladder for a couple of years, you might have to visit A&E six
times or more before your operation is scheduled. This is a serious
problem as crises obviously have to be prioritised and they are very
expensive to deal with.

If you arrive at A&E, having had a heart attack, you will need to
use expensive equipment and be cared for by highly skilled staff in
an intensive way. If you had been able to afford to see a GP in
time, or had an appointment to see a specialist sooner, this could
have been avoided and the care would end up being far cheaper. In
fact, a system where primary care is free, like the NHS in Britain,
probably ends up being cheaper in the long run as many problems
can be spotted through screening and prevention before they reach
crisis point and require expensive treatment.

Another problem is that it is increasingly difficult for the health
service to recruit and retain key staff, such as doctors, nurses and
physiotherapists. Many of them have to put up with extremely
difficult positions and low pay. In particular, I don't know how it is
possible to survive on a nurse's salary in Dublin and as a result
many are emigrating or getting jobs in the private sector. This is
the main reason that wards are being closed in hospitals.

Nurses in most units are highly skilled and when one quits it is
often impossible to replace them. For example, if there aren't
enough specialised nurses to man an intensive care unit around
the clock, the hospital has no choice but to close the beds.

Finally, there is the fact that many private patients are heavily
subsidised by the public system. When a private patient takes a
bed in a public hospital, their insurer pays for the bed and the
consultant. The public is left to pick up the tab for all of the other
areas that are crucial to their care, such as nursing, junior doctors
and administration.

If you compare the difference in costs between a private bed in a
public hospital and a bed in a fully private hospital, you get some
idea of the level of subsidies. I don't mean to blame private
patients, it's a problem with the system and people who can afford
it are obviously going to opt for the best care available.

The government are reforming the health service administration
and are creating an executive to replace the health boards, is this
likely to address the problems?

In general, relations between doctors and the government have
been very poor. The health boards are bureaucratic, inefficient and
mainly run by people who have no experience of actually working
in the system. They are manned by senior civil servants and
business people rather than doc-tors or nurses. Doctors also have
a lack of faith in the health boards due to a history of guidelines on
working times and various EU regulations being ignored.

The health service executive will be another top-heavy
bureaucracy run by people with no experience in health care. It is
part of the government's drive to introduce private sector
management into a system which has to be run on ethics and
where cost can't be the bottom line. This leads to a situation
where hospitals are tied to a fixed budget and are penalised if they
exceed it. Thus, medical staff are unable to respond to crises
when they arise. Again this can actually be more expensive in the
long run.

When hospitals aren't allowed to purchase new machinery for
screening or have to eject the 'least sick' patients to admit new
serious cases, the consequence is more people coming to A&E in
crisis conditions which are expensive to manage.

How can the problems be addressed?

Well, as a GP, I'm biased. Prevention is better than cure and we
should spend more money on picking up problems early. Free, or
at least affordable, access to GPs for check ups and screening
would pay off in the long run.

In hospitals there is currently a crisis that has to be managed.
They are using all the money that is available to them and they
simply need more money, especially to pay for more nurses with
better pay and conditions. There are currently many beds that are
empty for lack of nurses. Re-opening these would provide badly
needed beds for patients. Hospitals should also have the right to
break their budgets in times of crisis.

The administration of the whole system should be radically
reformed. Health boards should have much more direct
accountability and should be made up of people who actually work
in the system. Representatives of doctors, nurses and other
hospital workers have a much better insight into the problems. It's
a waste of time to have to ex-plain problems to outsiders and the
benefits of certain spending decisions are obvious to health
workers even though they might go over budget.

This page is from the print version of the Irish Anarchist paper
'Workers Solidarity'. We also provide PDF files of all our
publications for you to print out and distribute locally

Print out the PDF file of this issue
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