Tipperary-based GP Dr Pat Harrold argues that the Nenagh Hospital report, published last week, which argues against downgrading smaller hospitals, should be a template for the whole country
Sometimes the best ideas are the most obvious. Somebody says why don't you do such and such and everybody slaps their foreheads and says: "Of course! Why didn't we think of that?"
The present state of accident and emergency units in Ireland is a fine example of this state-the-obvious kind of thinking.
The Nenagh Hospital Action group asked why there is no backlog of patients in its casualty department. The answer was obvious. The casualty department sees victims of accidents and emergencies. If you cut yourself or fall off a ladder, you go to the casualty department.
If you have pneumonia or a stomach ache, you see your GP. If the GP decides you need to be admitted to hospital, he or she rings the matron. The matron knows where to find the beds in the wards and tells the GP where to send the patient. The system is clearly obvious and it is clearly working.
When I was training back in the 1980s, it was obvious that the system (if you could call it a system) of admission in the major hospitals was flawed.
As we students walked past casualty on our way to lunch, we would see forlorn figures in mucky football gear waiting to be seen. They were still there when we went for tea and, in most cases, would still be there if we headed down town for a late pint.
The reason they were waiting so long was that there was every kind of patient in the queue in front of them. Children with suspected meningitis, old people with bowel obstructions, pregnant women with urinary tract infections - the whole spectrum of human medicine sat and stared at a sign that ironically informed them that they were accidents and emergencies.
Nearly all of these people had seen a highly trained and experienced GP. But they were still expected to wait to see the casualty doctor.
The same casualty doctor was probably on a general practice scheme, in other ,words training to take his place with the GPs and have his decisions second guessed by doctors in training. Or the casualty doctor was a trauma specialist; just what you want if you've been shot, but maybe not the best person to decide what do about your painful gastroenteritis.
When I worked in the UK, the system was different; that is to say, they had one. If a GP decided that a patient should be admitted to, say, the medical ward, they rang the hospital and arranged it.
I found it incredible, and still do, that just about every ailment in Ireland gets sent to casualty.
The only change I can see from the 1980s is that the situation in most hospitals is actually much worse now.
I can vouch personally that the Nenagh system is downright civilised. If I drive to see an elderly patient and decide that they need admission, I make one phone call and we all know immediately where we stand. And your football injury gets seen fairly quickly too.
There is more in the Nenagh Hospital Action group proposal Small hospital, Big Service, which was launched last week, than direct admissions.
It also shows that 97 per cent of admissions can be treated in the small hospital.
The cost per day to treat a patient in Nenagh is €711 which compares favourably with €956 for Limerick Regional Hospital and €1,153 for Beaumont. For a modest outlay, such as creating an acute medical unit, the service could be made even better.
The whole proposal was commissioned as a response to the Hanly report. The Hanly report recommended downgrading Nenagh Hospital.
Tipperary people are famed for their ingenuity. When Nicky English, hurling for Tipp, found himself in front of the goal with the ball and no hurley, he kicked it in. When Nenagh Hospital was threatened, it came up with a template for the whole country.
Small Hospital, Big Service is an impressively clear and well-structured document. I hope the policymakers take note. Small is beautiful.
Dr Pat Harrold is a GP in Nenagh, Co Tipperary. (He was not a member of the Nenagh Hospital Group.)