Heart Beat/Maurice Neligan:I have been asked in the past few days to explain what I meant when I pointed out to the Minister for Health that criticism was a two-edged sword.
My meaning was that as the Minister has criticised hygiene within our hospitals, particularly among front-line staff, she must then face the consequences of such criticism. The inevitable sequel, of course, is litigation by patients who have acquired in-hospital infection.
The domino effect of this is that money destined to remedy this problem and for patient care, is diverted into expensive lawsuits, and the situation simply becomes worse for patients, doctors, nurses, etc. Less money is available to remedy the infrastructural defects that contribute so largely to the problem of hospital infection. It is a vicious circle.
The results of the survey into such infection deserve the most serious consideration. In making this point, I would be interested in seeing the results of similar surveys carried out by this team in similar hospital groups. What is of particular concern is that some of the hospitals with the worst results are among the newest in the State, eg Beaumont, Kerry and Waterford.
A bad night in the A&E department of one of these hospitals is unforgettable to the transient, sentient patient and their relatives. It is a matter of despairing inevitability for the staff. This ultimately pressurises the whole hospital and standards may slip.
Acute Irish hospitals run at bed occupancy rates often in excess of 100 per cent (hence the trolleys). International best practice suggests 80-85 per cent should be the norm. Hence my interest in similar surveys in such stressed hospitals. I suspect there may be very few.
I have repeatedly said that to portray the problem as one of simple hand-washing and hygiene is facile and unproductive. There are huge infrastructural deficits to be met before the tide turns and the challenge of MRSA and similar organisms is met within and without the hospitals. This will take time and money and regrettably will never be completely successful.
I do not think that it is sustainable that every hospital infection in the future should be a source of litigation. A hospital will never become a sterile air bubble, desirable though that may be.
Before such pronouncements are made in the future I would suggest that the Minister spend one week of night duty in the A&E department of Beaumont, James Connolly or the Mater and hence get a glimpse of the real world.
Two other seemingly unrelated items came to my attention during the past week. The first was that planning permission has been granted for a new private hospital in Limerick. This apparently is not the one envisaged by the Minister to be built in the grounds of Limerick Regional Hospital, nor is it the new private hospital postulated for Adare. In theory, at least, Limerick could wind up with three new private hospitals within a 15-mile radius. Does anybody really think such development is either practical or desirable?
The second item that I noted was that there are now 1,100 unfilled nursing vacancies throughout the State. While not getting into the reasons for this now, I would point out yet again that the private sector which currently makes no contribution towards nursing or medical teaching and training is not hesitant to avail of the services of those trained at the expense of the State.
By any standards this is at least unfair and indeed a stronger description is probably justified. These three postulated units for Limerick and those planned for elsewhere must inevitably make the overall manpower situation worse.
My own personal surgical odyssey has again been interrupted by the problems of today and, at this rate, my career will span a century or more. I feel, however, that I must articulate an informed medical viewpoint about our current situation.
The views expressed are personal, formed by my own experience but augmented daily by disenchanted colleagues, medical and otherwise. There are so many dichotomies, inconsistencies and downright contradictions in our service today that one can only suppose that it is organised and run on a purely ad hoc basis.