Medical MattersAmbrose Bierce in The Devils Dictionarydefines a physician as "one upon whom we set our hopes when ill and our dogs when well"
I don't think you're afraid of dogs John. Prof John Crown is a physician and a very good one. I do not believe for one instant that John's replacement on the recent Late Late Showwas unrelated to his unrelenting opposition to the current direction of our health service under this Minister and the HSE.
I feel that pressure was put on RTÉ to alter the panel to exclude John. It all depends on what you mean by pressure; a wink is as good as a nod to a blind horse. What occurred was a sinister development in a free society. This was particularly so, as the Minister and the HSE were offered balancing places on the panel.
I accept that the Minister had a previous engagement. Could the HSE not have provided a speaker from their myriads of highly paid staff? Surely somebody was available?
Maybe not; it was a Friday night and the aspiration for a 24/7 service obviously applies only to patients, doctors and nurses. It was a sordid little episode and attempts to justify it only made matters worse. These ranked from a Ministerial protestation that it was all right to interfere in the affairs of the national broadcaster, to a more senior Ministerial and HSE bleat that it never happened at all.
Did it ever occur to those involved that there is only one reason for John Crown to step into the breach of the crumbling health service? It is clearly not money, the Taoiseach pointed out gratuitously that he had a very big private practice.
No, it is simply the right of the concerned doctor to advocate for all his patients. The very advocacy that was sought to be controlled in initial drafts of a possible new consultant contract, the very advocacy that is a core issue of the doctor-patient relationship; you're too big a man John to be cowed by veiled threats.
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It must be my advancing years that are slowing my brain. I have waded through the distressing HIQA reports on hospital hygiene and am slightly mystified. There are apparently defects in "corporate governance".
I am left with the doubtless simplistic notion that this essentially means that in some of these hospitals, there is no one person responsible for telling the cleaners to get the lead out. Come back Matron, all is forgiven.
Reading further, surprises abounded. Mallow General Hospital fell from the lofty pinnacle attained in the last (but different) survey to the nadir in this one. "Evidence of unauthorised smoking was found in five areas." Still it could have been worse; they could have found brothels or opium dens.
I am not trivialising this report. Some hosp- itals clearly had no cleaning protocols, let alone adequate infection control. Flaking paintwork was widespread and many areas and items of equipment were dusty, indeed dirty. Nobody could be happy about this. Rectifying the problems, however, is not going to be "cost neutral". Money is going to have to be spent.
Does this come from already overstretched, indeed overspent, hospital budgets? If so, something else has to give in an already poorly functioning service. We are told that no more money will be forthcoming from central Government funds. It gets worse; no extra staff can be hired to remedy these real defects.
A circuitous problem indeed and the conflicting choices, mutually exclusive, remind me a little of the mythical bird that flew around in ever-decreasing concentric circles till it finally disappeared up its own backside. Maybe we could get Paddy the Plasterer to get a few crews together and sort out the décor problems?
On another matter, the OECD report, Health at a glance, 2007, states we have one of the highest bed occupancy rates in the group. It furthermore says that as occupancy rates have increased, the number of acute care beds has actually declined. It gives the figures.
So riddle me this Prof Drumm; how is it that you seem to be one of the very few people associated with the service, who seem to think we have enough beds?
Far-fetched plans of almost hot bedding patients and reliance on non-existent or poorly developed community facilities have no place in the solution of the crisis apparent across the service yet denied by yourself and your backers.
When you next sit down with your board and your political supremos, ask them how many of them carry private health insurance. Don't bother asking why.
Interestingly, in Britain about £700 million worth of contracts for outsourcing work from the NHS to the private sector are to be cut back to £200 million, according to a report in the Financial Times.
I wonder what that's about? Maybe somebody over there is having doubts as to whether health- care should be delivered as a commercial enter- prise, corporate governance, line managers, etc!
Meanwhile, our Minister opens the first of a series of 20 private clinics to provide services for patients requiring intravenous drugs or infus- ions. In my humble opinion in light of our overall difficulties, we need this like a hole in the head.
At least it keeps the Minister occupied, I suppose. It's better than watching the paint flake.
Maurice Neligan is a cardiac surgeon.