Suffer little children - while we sort the budget

HEART BEAT: Many years spent working in Crumlin hospital gives insights into the problems there, writes MAURICE NELIGAN

HEART BEAT:Many years spent working in Crumlin hospital gives insights into the problems there, writes MAURICE NELIGAN

Mary, Mary, quite contrary

How does your garden grow?

With administrators and lots of reports,

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And trolleys all in a row

I HAD the privilege of being a cardiac surgeon in Our Lady’s Hospital for Sick Children for almost 30 years. I have many friends still working there.

It is and always has been an outstanding institution. It is distressing to know that, despite the affluence of recent years, problems of access and funding still blight the capabilities of the hospital.

In all my time there, we never seemed to have enough money or staff. We functioned on the goodwill and dedication of carers at all levels within the hospital who were prepared to go the extra mile for the smallest and most vulnerable within our society.

This dedication was unspoken. It was everybody’s job and we understood that. But there were times when the cracks could not be papered over and when staff and beds were in such short supply that postponement of treatments and cancellations of operations became inevitable.

On many occasions in my later years on staff there, you might be told, “Sorry Mr Neligan, there are no intensive care beds” or “we don’t have enough nurses to cover the theatre list”. We are talking about cardiac surgery for small, even tiny children here. This was very distressing for the doctors and nurses.

How much worse was it for parents and families of the children concerned? This was occurring at the height of the so called “tiger” and yet we could not put in place a system then to look after the most helpless in our society.

The best we could do seemingly was to export our sick children and their worried families at great expense to England and indeed to the US. This was the philosophy that spawned the National Treatment Purchase Fund. There was no consideration given to fixing the problems of beds and facilities in our own hospitals; rather it was easier to fob the patients off abroad or, in the case of most adults, to private hospitals at home. Money and value didn’t seem to matter. That was then. Then however, in seamless transition became now. The only thing that has changed is that the situation has got worse. Community care, primary care, mental health – nothing has escaped the blight visited upon them by sheer incompetence. Now the money has run out.

There was something chilling in hearing our Minister insinuate that hospitals somehow targeted the most vulnerable in highlighting funding deficits.

The comments came during a debate on the problems in Crumlin hospital, particularly but not exclusively in spinal surgery. The leader of the Opposition rightly said the remarks were disgraceful and called for the Minister’s removal.

The Taoiseach then told us that the remarks were not intended to be read as plain English and that the Minister had meant that the paediatric hospitals should co-operate with one other and that savings from this would stop the need for ward and theatre closures.

The Minister herself then told us that the episode(s) showed the need for amalgamating all the Dublin paediatric hospitals on one site. Apropos this little controversy, it is worth remembering that this Minister and the HSE attempted to insert a gagging clause into the consultant contract to stop the doctors from highlighting deficiencies.

Such issues had to be first referred to their “line manager”. Wouldn’t it make for a nicer life for the Minister and her faceless bureaucracy if such issues could remain hidden and doctors and nurses could be blamed as usual?

It is also interesting that despite the uncertainty of when and possibly even where this new paediatric hospital will be built there is already a paid staff manning this “virtual hospital” and planning for the future. This won’t do. John F Kennedy said to Congress on “The Nation’s Youth” in 1963, “the needs of children should not be made to wait”.

There is a different attitude here and sometimes it can be breathtaking in its ignorance of how hospitals work. With disbelief I heard a woman from the HSE assert that Crumlin would apparently exceed its approved hospital plan for the year and hence would come in over budget and so cuts (savings) were inevitable.

The fact that this is not a grocery store seemed to pass her by. But for her information – and anybody else interested enough to listen – hospitals deal with whatever patients are referred to them and whatever comes through their doors as best they can. They deal with patients who need treating and, lacking the gift of prophesy, they can’t exactly tell how many there will be.

Hippocrates wrote “I hold that it is better to give children only the most diluted wine”. Maybe Crumlin could save on the wine bill?

Maurice Neligan is a cardiac surgeon