Heart Beat/ Maurice Neligan: "Clean the air! Clean the sky! Wash the wind" - TS Eliot
I know what TS Eliot was writing about. In fact I have just gone through a similar experience. The Highest Source ordained today that the summer was over and that the house had to be ordered for the advance of winter. My heart sank, as I knew there was no possible way I could avoid the whirlwind. It is a peculiarity of the Highest Source that were I to enlist the Twelve Apostles, they would be incapable of performing the various tasks involved, to her satisfaction.
My chances were zero, and so it proved. It was made clear that this was real work, not to be entrusted to mere poltroons like me. My sole function was to move furniture so that cleanliness and light could penetrate the darkest crevice. I proved I was incapable of even this. I always got in the way or stood in the wrong place. I never learned to cross a freshly washed floor without putting my feet on the ground.
I alluded last week to the latest pronouncements from the HSE. In a way it was reminiscent of Baldrick's pronouncements in the TV series Blackadder: "I have a cunning plan." I suspect the end results will be the same. There is a disturbing concept included in the recent scheme. This is the stipulation that hospitals must admit 20-25 per cent of their patients as elective patients, rather than as emergencies or through the A&E department.
This would be a reversal of everything good hospital care is all about. The large teaching hospitals, in particular, have built up departments in all the major specialties. These are highly staffed and capable of dealing with the most complex cases. They treat, they teach, and they train students and junior staff. If only a quarter of their patient volume comes from planned admission, they simply cannot function properly. It is not proper medicine or good practice that the vast majority of the patients should be urgent or emergency; in fact, the essence of best practice is to prevent patients from becoming such. Best practice should be calm, precise and planned, while maintaining a capacity to deal with emergencies. A hospital deriving 75 per cent of its patients from casualty would be little more than a clearing house and would be unable to maintain excellence in its specialties.
Another disturbing feature is that there is something very good about doing things quickly and ensuring a rapid turnover of beds. We are told that dealing with patients within a six-hour framework will attract efficiency bonuses. Sometimes this is possible. Vastly more times it is not. We are talking about patients here, about sick people. We are talking pain and discomfort; apprehension, fear, even terror. First and foremost, we should meet these human conditions with compassion, kindness and understanding. Listening to and reassuring the sick is the best time spent in their care. At Lamborene in the hospital founded by Albert Schweitzer, there is inscribed: "Here at whatever hour you come, you will find light and help and human kindness."
This is what we should be about; a few hours here or there or even a few days are not always that important. The alleviation of illness is the goal. Compassion and expertise are the weapons. Patients are sick people who defy packaging and processing. Any doctor or nurse knows this. It would appear that some of the luminaries of the HSE do not.
In a recent interview, Prof Brendan Drumm was very critical of his erstwhile colleagues, some of whom he felt were holding up discussions on a new consultant contract. This has been answered both by The Irish Hospital Consultants Association and by Irish Medical Organisation who between them represent almost all the consultants in the country. How then he can maintain that their views are unrepresentative is a mystery to me. However, Drumm, in the same interview, asked where in the world could consultants double or treble their public salary by undertaking private work. That's an easy one. Just look across the water at the NHS. It's not common there, but it's not common here either. There is also another significant difference. Here, 50 per cent of the population carry private insurance. In England the figure is nearer 10 per cent. I would also point out to him that many consultants have their incomes augmented here by doing work for the NTPF in the private hospitals. Does he envisage a system whereby we have two absolute tiers, public and private? Does he even remember that everybody is entitled to treatment in the public hospitals? Is this entitlement to be withdrawn? How can he explain the contradictions?
This is a sorry mess with no clear policies and few decisions. It is with interest that I note the re-emergence of Hanly over the Roscommon hospital issue. The good people of Roscommon should not worry unduly; with an election coming they will probably be promised a copy of the Mayo Clinic. As for Mr Finneran's brave stance, he would be well to remember the words of Disraeli: "Damn your principles, stick to your party!"
• Maurice Neligan is a cardiac surgeon.