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Trying to pass a Lada for a Mercedes-Benz

17 Feb 2016

As the Trolleyland cancer spreads, Dr Garrett FitzGerald believes Irish politicians are like car dealers, trying to sell us scrap metal on wheels and telling us it’s the real deal.

Trolleyland, having conquered hospital ward corridors, is now to neutralise the remainder of the hospital. Since the recent nurse-HSE dispute, there is agreement that, in times of hiberno-viral war, the elective functions of the services will be shut down sine die. This is part of an Escalation Policy that, at least in theory, elevates ED needs to a higher level in hospital priority than its long-standing F-minus status. The nurses had been pushed too far.

The deck-chairs have now been switched. A different group of patients (electives) will get a fairer share of the punishment that is being doled out at many venues across the country. Much needed R and R downtime will become available to the medics who languish in operating theatres carrying out non-emergency interventions from long waiting lists. Lots of early morning phone calls (stay where you are boss, we’ll call you) and all manner of things shall be well.

In the 1990s, the half-century-old tradition of admitting all patients who required urgent admission to hospital wards — irrespective of availability of beds, was abandoned in favour of keeping them in ED. The practice of putting up temporary beds in every ward became outlawed. The nurses had been pushed too far. Trolleyland, a terrible beauty, was suckled and reared.

By 2011, partial reversal of this ‘previous’ solution to the crowded ward problem allowed for two or three trolleys to be moved into each ward — as a (partial) new solution to ED chaos. The deck-chairs weren’t switched, but they were put facing in different directions.

Which all brings us to 2016, where the furniture is to be placed in the engine room and the engines shut down. One right can make a wrong.

Underlying all of this ongoing — and worsening — situation lies the dreaded R-word. Reality. Not a word to be trifled with, or taken lightly. It is, as current zeitgeist goes, best denied absolutely.

Yesterday, upon the stair
I met a man who wasn’t there.
He wasn’t there again today,
I wish, I wish he’d go away.

Pic: Getty Images

Non-deniers, of which there are few, say daft things like the following:‘The population has grown. The elderly multiple-afflicted population has increased. The population of survivors of major illnesses such as CVA, cancer and heart disease has enormously increased. General practice does not have the weapons (bloodwork, imaging) or therapeutic armaments (drip, oxygen, IV medications) to provide modern acute care outside the hospital setting. Modern diagnosis and treatments cost a fortune. Current capacity restraints guarantee that the problems are insoluble.’

The bottom line is that we cannot have the Mercedes E-class for the price of a 1980 Lada. Yet, somehow our administrative zeitgeist says “Yes, we can!” There have been notions abroad for a few years now that, if you had cut down on the number of ‘pen-pushers’, given Michael O’Leary the reins, did extra rounds of a Sunday morning, and sent in Martin McGuiness to negotiate the price of the oncology drugs, you’d be able to start up the old world-class waffle again. All, of course, equivalent to valeting the Lada. To quote my late Armagh-born mother-in-law, “me arse and parsley!”

The real conversation around the crime of what is being done to our sick brethren has yet to take place. It has to do with money. The citizens are not really being told, or perhaps are not ready, to contemplate the real deal; they cannot have the Merc unless they pay for it. Successive ministers have evaded the real Merc-Lada debate and pretend that there are solutions in the handbook Machiavellian Aphorisms for Simpletons. Policy is this: show ‘em the Lada and tell ‘em it’s a Mercedes.

Paying for it all would consist of an immense increase in contribution. The real cost is probably something like a 50 per cent increase on today’s spend. Not paying for it gives you the nada-Lada — exactly what you have now, a furniture interchanger’s paradise.

The current Government ran with the universal health insurance delusion for a few years. Then they found out, to their astonishment apparently, that the real cost was off the walls. They dropped it pronto.

It would mean hitting the election doorsteps with proposals for a vast increase in financial charges for every citizen. It would have the same chance as Pol Pot coming to ask for the daughter-of-the-house’s hand in concubinage.

The criminal conversation will not happen this side of the Leitrim three-in-a-row. Get ready for same old. Reality isn’t coming soon to a theatre near you. Bring War and Peace next time you’re in an ED. If you are lucky, you might get to finish it in a non-elective ward.

When I came home last night at three
The man was waiting there for me
But when I looked around the hall
I couldn’t see him there at all.


Click here to view the full article which appeared in Irish Medical Times: Opinion