The health board funding crisis will affect patients adversely, as healthcare involves a team approach, writes Dr Muiris Houston, Medical Correspondent
Two health boards - the North Eastern and the Western - are now directly at odds with the Department of Health over staff cutbacks, and other boards are suggesting they may not make targeted savings by not filling vacant posts. What are the implications for patient care?
Take the Government cost-cutting plan of 800 job cuts announced in July. Although cushioned in language which said the cuts were not to be in "front-line services" and were to be achieved by the "non-filling" of existing vacancies, this level of staff reduction was always going to affect patient care.
Mr Hugh Bredin, consultant urologist at University College Hospital Galway and a past president of the Irish Medical Organisation, has said the loss of administrative staff like ward clerks and medical secretaries "will have an effect on patients".
So what would happen if a busy surgical ward in an acute hospital lost its clerk?
This team member who gets a patient ready for surgery by ensuring that charts and X-rays arrive at the operating theatre with the patient will no longer be there. Essential laboratory reports - needed by the surgeon or the anaesthetist for reference during the patient's operation - will not have been filed. Or worse, they may be lost in the system because the ward clerk is not there to chase them up. And like any system which loses an efficient cog, it is conceivable that a person's operation might be delayed for days because of the false economy of not replacing a ward clerk.
Next, both nurses and junior hospital doctors will feel the knock-on effect. They will be diverted from direct patient care to take on the secretarial and filing work. As a result other duties will be rushed, they will feel stressed and the likelihood of making a mistake in the clinical care of a patient increases. Certainly, the throughput of patients through the surgical unit is likely to be decreased.
In another scenario, how might the non-replacement of a consultant's secretary impact on patients?
As an essential member of a team, the loss of a key person such as a unit secretary could seriously impinge on patient care. Working to strict clinical protocols, it is she who controls and prioritises waiting lists for both outpatients and the operating theatre. She liaises with patients and their families and ensures that time is set aside for relatives to discuss their concerns with the consultants. After each outpatient session, it is the secretary who types up letters outlining the patients diagnosis, investigations and future treatment plans. If these are not completed in a timely fashion then both the patient and the GP will be left in limbo and the whole process of "consulting" a specialist for an expert opinion will be for nought.
In a similar way, the early dispatch of a letter following a patient's discharge from hospital is essential if care in the community is to follow the seamless pathway outlined in the National Health Strategy.
Mr Bredin makes a valid point when he says patients are doubly at risk. Their primary risk is that they are sick and have sought help from a healthcare professional. Being on a lengthening waiting list without treatment makes it likely a patient's medical condition will worsen and is another risk to their health.
And that risk is increasing as the situation unfolds. At the weekend the North Eastern Health Board confirmed that elective surgery in the region has been severely curtailed. So people due to receive a new hip, a hernia repair or have a gallbladder removed this month must now wait longer, with a consequent knock-on effect for those patients originally earmarked for surgery later in the year.
The use of agency nurses has also been banned in the North East board area. If a staff nurse goes sick while on night duty, then presumably she won't be replaced by a locum from an agency. In a ward full of older patients with a high nursing dependency, such a development could certainly affect patient care and safety.
According to the Irish Nurses Organisation, hospital managers are ending temporary contracts in all health board areas. Coming on top of a nationwide shortage of nurses, how can such a move but impact on patients?
Take yet another scenario. The stroke unit in an acute public hospital has finally secured the services of an Australian occupational therapist after many months of advertising. As is usual with contracts, she must serve out a probationary period as a temporary member of staff. Unfortunately for her, the axe falls on all temporary posts. While she wings her way back down under, the rehabilitation and even the very survival of people with strokes within the specialised unit is jeopardised immediately.
No matter how you examine the health board funding crisis, one thing is clear. Patients will be affected because essentially healthcare embraces a team approach. Using aspirational language like "front-line services" and "non-filling of posts" will not disguise this fact. Now that cuts in planned surgery have been confirmed and temporary contracts not renewed the direct effects are also there for all to see.
Where does this leave the much hyped health strategy and would the money and effort that went into it not have been better spent in continuing to employ essential staff?
How long will patients have to suffer before the Government tells it like it is?
And more importantly, when will it take action to adequately fund our rapidly unravelling public health service?
Dr Muiris Houston is Medical Correspondent of The Irish Times