IT WAS ANNOUNCED this week that all elective surgery in public hospitals in Cork and Kerry, an area with a population of almost 700,000 people, would be cancelled until further notice due to unprecedented levels of overcrowding in the region’s emergency departments.
Elective surgery is a term that encompasses all non-emergency, planned procedures.
These are not trivial entities and may include cancer surgeries, repair of blood vessels that are at risk of rupture, joint replacements for patients in chronic pain, among others.
It was therefore no surprise to hear several senior politicians on the airwaves in recent days discussing the important issues of the day.
Except they weren’t discussing the situation in our hospitals, rather the proposed commemoration of officers of the Royal Irish Constabulary.
For me, the juxtaposition of these two news stories summed up the way civic Ireland, once so outraged about healthcare, now merely shrugs its shoulders at the perpetual overcrowding crisis in our hospitals.
A shameful record smashed
Today’s figures from the Irish Nurses and Midwives Organisation (INMO) show there are 621 patients on trolleys in Ireland’s hospitals.
On Monday, 760 patients were on trolleys, a new all-time high.
There was a time when this would have dominated the airwaves, and the major TV current affairs shows.
No longer.
What did Liveline and the Claire Byrne shows lead with on Monday?
The Black and Tans.
If it is to be our lot as Irish people to be, in the words of the great Strabane songwriter Paul Brady “still trying to reach the future through the past”, is there anything we can learn from revolutionary times that could help our crisis-stricken hospitals?
I argue yes.
This was not part of the plan
Ostensibly, what the RIC and the Irish Volunteers were fighting about 100 years ago was the right of the Irish nation to constitute itself as a republic, in line with the Democratic Programme of the first Dáil, drafted by the then leader of the Labour Party, Tom Johnson.
This document states that ”The Nation’s aged and infirm…shall not be regarded as a burden, but rather entitled to the Nation’s gratitude and consideration…it shall be the duty of the Republic to take such measures as will safeguard the health of the people and ensure the physical as well as the moral well-being of the Nation.”
If those who wrote the Democratic Programme, and gave their lives in those tumultuous days were to come back and revisit us, I would be confident that they would concern themselves more with the welfare of Irish children in their infirmity than the re-telling of battles fought and atrocities perpetrated a century ago.
More boldly again, the Democratic Programme affirms “that all right to private property must be subordinated to the public right and welfare”.
A two-tier system
Ireland operates two parallel, yet intertwined healthcare systems, one public and one private.
The private system provides modern, comfortable facilities, and timely, efficient, high-quality access for a reasonable range of medical conditions, which eases the pressure on the public one.
For its part, the republic provides massive direct and indirect subsidises to the private sector.
Directly, the National Treatment Purchase Fund spent €75 million in 2019 purchasing services from the private sector.
Many of the private hospitals in the state availed of generous tax breaks for their construction in the early part of the 21st century.
Indirectly, the private sector benefits greatly from the publicly-delivered training of healthcare staff.
In addition, when patients experience complications in private hospitals, or when those hospitals are full, the patients are transferred across to public hospitals, at no charge to the private hospital.
Also, most private hospitals, particularly those in Dublin have rarely had to worry about recruiting and retaining consultant staff.
They have simply been able to piggyback on the recruitment of high-quality doctors by neighbouring public hospitals and been able to offer them increased earning potential without inconveniences, such as having to provide for their pensions, for example.
Not a bad set of subsidies for these hospitals, all things considered.
Some private hospitals are financially thriving, others are finding the going more difficult, with the Mater Private group for example being reported as having recorded a €23 million loss last year.
Unsurprisingly, elective surgery is not cancelled in private hospitals at the moment.
In spite of what some of my more excitable colleagues may think, nobody is talking about sending in the tanks to seize private hospitals, but could the nationalisation of some or part of these facilities be an option to alleviate our crisis?
This is not without precedent.
Mount Carmel hospital in South Dublin had previously been best-known as the place where the babies of Ireland’s rich and famous came into the world.
However, in 2014, liquidators were appointed by the High Court and the hospital closed its doors.
The minister of the day, James Reilly told the Oireachtas at the time that nationalising the facility would not be workable, yet 6 months later the state did exactly that with the HSE purchasing it from the liquidators for €11 million.
The hospital is now a thriving public facility providing Step Down/Step Up Beds, Transitional Care Beds and Rehabilitation Beds, staffed in partnership with private sector agency Mowlam Healthcare.
Few would argue that the people of the community are not better served by what is there now than what was there before.
Many will argue that the state has proven itself unworthy to run hospitals, but the state is the only game in town when it comes to full-service hospital care.
There are no private maternity hospitals, rehabilitation hospitals, stroke units, hospices, or crucially, emergency departments that open 24/7.
Others will baulk at giving the state more hospitals to run when it struggles with the ones it already has, but the truth is the state is planning to build several new elective-care hospitals around the country anyway.
The answer could be simpler
Given our experience with the children’s hospital, would it really be that terrible an idea to think about buying ready-made, currently operational facilities instead as a faster and more efficient means of improving the service?
It may seem unthinkably complicated now, but nationalising the banks was unthinkable once too until we woke up one morning at a time of crisis and it had happened.
The most dangerous thing I see at the moment is the apathy with which we have greeted 760 people on trolleys waiting for beds.
And it is ineffably depressing that we, as a people, are more interested in fighting the battles of the past, rather than honouring the ideals of a republic that were fought for.
James Connolly exhorted us to “draw inspiration not from the mouldering records of the past, but from the glowing hopes of the living present, the vast possibilities of the mighty future”.
We owe it to all of our antecedents, regardless of who they fought with to do better. Radical change is needed.
Dr Anthony O’Connor MD, MRCPI is a Consultant Gastroenterologist at Tallaght Hospital.
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