Sunday November 11 2007
JUST because you're paranoid, doesn't mean they're not out to get you. In addition to the very worrying quality-of-care concerns which have been highlighted by the recent cancer scandals, concerns which have caused agonies for thousands of women, another troubling issue is emerging in relation to these events, namely the official reaction to them.
In particular, there is a frightening willingness and enthusiasm on the part of the Government and Department of Health to resort to blatant intimidation of those health professionals who dare to go off message, and to bring sincerely held concerns into the public domain.
An early warning of things to come came when questions about aspects of cancer care at Barrington's Hospital were aired. It emerged that Dr Raj Gupta had alerted the Department of Health two years before. They did nothing, and their reaction to subsequent reports of their inaction was to suggest darkly that Dr Gupta himself had a case to answer, because he had not notified the Medical Council. Infuriatingly, the same self-exculpatory Pontius Pilatism was used to answer the recent revelation that concerns about equipment in Portlaoise had been relayed to the minister in 2005.
A similar excuse was offered when the sad details of Suzie Long's delayed diagnosis of cancer, due to a seven-month wait for a colonoscopy (bowel test), came to light. It was suggested to me by a Department of Health doctor that the fault lay, not with the system, which allowed seven-month delays, but with the doctors who didn't move her up the queue ahead of other patients, patients who themselves might have had undiagnosed cancers. He wondered if the doctors shouldn't face some censure. Incidentally, a leading gastroenterologist from the Midlands told me this week that his waiting list for the same test is still seven months.
In my own hospital, it is approximately five months. Every patient waiting for a colonoscopy potentially has bowel cancer. Waiting lists of five or seven months are unacceptable, and attempts by those, who have the power to resource the system appropriately, to shift the blame are reprehensible.
The ultimate example came last week -- a week in which the organisation which runs the health service announced that it didn't know which of its constituent hospitals were safe venues for cancer treatment, a week when it was revealed that all of the mammograms in an entire medium-sized hospital were being recalled and it again emerged that a concerned doctor had previously notified the minister about his worries.
When challenged in the Dail about the health service by Labour leader Eamonn Gilmore, who used quotes from Maurice Neligan and myself, the Taoiseach elected to play the men and not the ball, making outrageous comments about Mr Neligan and suggesting that my right to have an opinion on the health service was somehow questionable, given my large private practice. Well, despite my best efforts (I only do private practice on my own hospital campus), I do have a large private practice. I also have a large public practice. That is what happens when you have very few doctors in your country -- they see lots of patients. When nearly two-thirds of the population indicate their level of trust in the public system by taking out private insurance, your doctors will have large incomes.
What came next chilled me to the bone. When Mr Gilmore suggested that the Taoiseach's replies were casting aspersions on the reputations of doctors, Mr Ahern replied that he was very careful not to cast aspersions on anyone, and that, furthermore, he hadn't even used his briefing notes.
I, for one, would like to know what was in these briefing notes. Who were they about? Was it about doctors who have been caught up in the quality-of-care scandals, or was it about those who spoke up? Was public money spent compiling McCarthy-esque dossiers for his privileged use in the Dail chamber?
I intended to discuss this on the Late Late Show, when I was invited to participate in a discussion on the health service. I was then informed that a high-level decision had been made by RTE management to remove me from the programme in the interest of balance, as the HSE and the department had refused to participate.
In effect, they were able to censor me by proxy. This is an increasingly used and highly anti-democratic tactic, but one which can be fought effectively. If the government attempts to sabotage debate by preventing the formation of balanced panels, then proceed with all the unbalanced ones. They'll soon come round and start sending spokespeople.
Younger readers may not remember the bad old Haughey days, when internal opponents of his corrupt and intimidatory rule faced mysterious late night calls and threats on the nights before leadership challenges. Isn't it sad and ironic to think that one of the brave, principled young politicians who refused to cave in to intimidation then was Mary Harney. She was actually a heroine of mine.
Professor John Crown is a consultant oncologist
Taxpayer forks out for Executive's four-star lifestyle
Mary Hearneys brainchild the" Health Service Executive" which is supposed to replace the infamously spendthrift, local health boards ( now in dissolution) with one efficient centralised authority has spent at least €4m on luxury hotel bills since the beginning of last year, according to new figures released under the Freedom of Information Act.
The use of four- and five-star hotels for conferences, meetings and accommodation cost the taxpayer €2.71m - and even more may be claimed if staff paid their bills directly and billed the HSE for expenses afterwards, according to the FOI figures obtained by the Irish Medical News.
Another €1.3m has been spent on hotel bills for the first nine months of this year, preliminary figures for 2006 expenditures revealed.
The four-star Tullamore Court Hotel received the largest single sum - €69,597 - from the Midlands branch of the HSE, followed by the four-star Mullingar Park Hotel, which billed the HSE for €29,971.
Others on a list of more than 100 hotels used around Ireland and abroad include the luxurious five-star Druids Glen Hotel and golf resort in Co Wicklow; the Atlantic Coast Hotel, a four-star converted mill overlooking Clew Bay in Westport, Co Mayo; the Barcelona Hilton in Spain; the plush five-star Westbury Hotel in Dublin; and the equally salubrious Fitzpatrick Castle Hotel in Killiney.
Kerry GP Dr Eamonn Shanahan questioned the need for the HSE to host meetings and events in luxury hotels instead of using its own facilities.
"While I do recognise the HSE has a need to meet with its staff and stakeholders, I think, like in other parts of government, they should look for value for money. Specifically, it might be worthwhile looking to see if there are appropriate venues other than hotels that they could use for meetings."
Dr Mary McCaffrey, president of the Irish Hospital Consultants Association, was more blunt, saying the money would have been better spent hiring medical staff.
"This is a real classic example of how the streamlining of the health services from 11 health boards to one HSE doesn't seem to be saving money," she said.
A HSE spokesman agreed that the bills were high but said this was due to the restructuring of the HSE, which resulted in a lot of meetings around the country during the first year of amalgamation. He said the department was now looking at implementing a "value-for-money initiative" aimed at cutting out unnecessary expense.
The HSE also spent €38,239 last year and €27,356 in the first six months of this year on air travel, public transport and mileage.
Lavish spending by the HSE also drew much criticism earlier this year when it was revealed that €1.7m in bonuses had been paid out to senior HSE staff since the board was set up over 18 months ago, including a €25,000 bonus paid to one former health board chief executive on top of his €130,000 basic salary, and €32,000 paid last summer to HSE chief Brendan Drumm, who received a €32,000 bonus on top of his €320,000 salary.
Allison Bray(Irish Independent)
The plan by the minister for health, Mary Harney, to start transferring 1,000 private beds in public hospitals into for profit private hospitals is quite clearly socially and economically regressive.
The first obvious question is why taxpayers should be asked to subsidise
private medicine to the tune of 42% of the cost of new hospitals. How can
the state afford to effectively give away tax payers money to private investors while at the same time it cannot provide enough money to take public patients off hospital trolleys?
Mary Harney’s answer is that this new system will be more cost effective
and she has decided to pursue it as a result. She has made her mind up on this, while stating that she has "asked the HSE to assess precisely the tax cost to the exchequer of competing proposals". The reason she has proceeded regardless of the HSE endorsement is probably because the Department of Health (now the HSE) strongly disapproved of tax subsidies for the development of private hospitals at the time of the launch of the National Health Strategy in 2001, and, unless a Pauline conversion has occurred, would be unlikely to support the current measures, given a proper choice.
However, the difference between then and now is that the Fianna Fail minister, Michael Martin had a vision for public sector not private sector solutions to the health needs of the Irish people. The original measure providing for tax breaks to private investors was quickly rushed through in the 2001 finance bill by minister McCreevy at a late stage against the recommendations of the Dept of Health and wasn’t in keeping with the views of the minister for health at the time.
Canada's restrictions on the role of private health insurance for publicly insured physician and hospital services are unique among countries with universal, publicly funded health care systems. Pressure is mounting in Canada, however, to loosen these restrictions and create a parallel system of private finance. Advocates argue that creation of a parallel system of private finance will ensure the sustainability of the public system (by reducing public cost pressures), improve access to the public system (e.g., by reducing wait times), and improve quality in the public system (through competition).
Opponents of parallel private finance argue that it will create "two-tiered" medicine, increase costs, compromise equity and reduce quality and access to publicly financed health care as those with the financial means (and often the strongest voice) exit to private insurance.
Australia provides a particularly promising case study for Canada regarding the dynamics of parallel systems of public and private finance. An international study by independent experts has examined Australia's experience with parallel finance for inpatient hospital services to provide insight regarding:
(a) the effectiveness of a parallel system of private finance in reducing costs and wait times in the public system;
(b) risk selection between the parallel public and private insurance sectors;
(c) the financial redistribution associated with the introduction and maintenance of a parallel system of finance; and
(d) the dynamics of the broader political economy associated with parallel systems of finance.
Australia's experience provides a number of lessons for Canada, including:
(1) the potential for cost savings through introduction or expansion of a parallel private sector is very limited;
(2)the introduction or expansion of a parallel private finance is unlikely to reduce wait times in the publicly financed system;
(3)there is no simple way to regulate private insurers to pursue public objectives;
(4) it is impossible to create an independent, isolated parallel system of private finance - interactions between the public and private insurance sectors are complex and unavoidable;
(5) quality plays a key role in driving the dynamics between the public and privately financed sectors; and (6) it is essential to articulate clear policy objectives for health care financing and to design public and private roles consistent with these objectives. Our overall conclusion is that the Australian experience provides a cautionary tale regarding the risks, costs and benefits of a parallel private system of health care finance.
DEVELOPERS are being allowed to bypass their obligation to set aside 20pc of new developments for social housing, it was claimed in August 2006.
Opposition leaders accused the Government of allowing builders with an inside track to Fianna Fail to 'neuter' their social housing commitments.
Labour leader Pat Rabbitte yesterday told the Parnell Summer School in Co Wicklow that a "new urban landlord" class was "funding their political favourites", and that apartments funded by tax-breaks were often sustained by tenants on housing rental supplements.
And Green Party leader Trevor Sargent also told the school that 'obscene' land prices continued to keep people out of the housing market, and that a "new type of landlordism" now permeated Irish society.
Many people had been "robbed" of their dignity and health by being forced to struggle with mounting debt and long commutes to work, he said, adding that landowners were making money on the back of the exchequer providing community facilities which pushed up the price of land.
He said the Government should immediately implement the 1973 Kenny Report, which recommended that land purchased by local authorities should cost no more than a 25pc premium on top of its existing use market value.
This would result in land zoned for residential use - but used as farmland - being bought on the agricultural value.
Addressing a symposium on 'Michael Davitt's Legacy for Contemporary Ireland', Mr Rabbitte said that "increasingly incoherent" development was taking place and that the Ireland of 2006 faced a "new land question".
"The landlord system of property which Davitt abhorred is long gone. However, we do today have a new land question," he said. "The population boom, immigration and sustained and rapid economic growth have created vast new pressures in our towns and cities.
"We have a new landlord, indeed speculative class, serious issues of affordability in housing (and) the emergence of estate management companies. The national spatial strategy is a joke and Fianna Fail never intended it to be anything else," he added.
On the same day that Pat Rabbite gave his speech, the Independent carried news of such wanton waste, as having an odour of corruption about it- in the Health Service Executive..
THE Health Service Executive has been spending €51,000 a year renting a building in Sligo which has been unoccupied for the past four years, it has been claimed.
A furious Cllr Declan Bree, who uncovered the scandal after an information request to the Health Forum West, has accused the HSE of squandering public funds.
He is demanding a full investigation into how the building could have been left lying vacant for so long.
Mr Bree, a member of the HSE's Health Forum West, had asked the forum to furnish him with details of each property rented by the HSE in Sligo, the purpose for which it was used and the annual rent paid.
It emerged from the reply that almost €1.5m was being paid in rental for an estimated 57 properties, among them, the former Medicentre premises in Kempten Parade, in Sligo city centre.
But on further examination, he discovered that the premises, which the HSE said was being used for the Orthopaedic fitting service and for the Down's Syndrome Association, had been lying vacant for the past four years.
"I visited the premises last week and discovered that contractors were now in the process of fitting it out for use and I also found that a single HSE staff member had moved in three days earlier and was in the process of preparing an office for the Orthopaedic fitting service.
"I have every reason to believe that if I had not asked the question, this building would still be lying empty," he said. "I think it is outrageous that the HSE could squander in excess of €200,000 on a premises that lies vacant. Given the needs and requirements of the health service in this area and given the number of people seeking improved services, there can be no excuse for such a wanton waste of taxpayers money," he said.
It also emerged that the HSE is paying €198,850 in annual rent for the national project offices for the controversial PPAR human resources information system of the Irish health service in Duck Street, Sligo, while, Markievicz House - a building owned by the HSE on Barrack Street - lies vacant a couple of hundred metres away.
"I find it difficult to comprehend why the HSE would spend such a large amount of money renting property.
"In my view, the HSE should be investing wisely and purchasing necessary property. Money spent on rent is a waste of resources and a waste of public funds," said Cllr Bree.
(Not for the Fianna Fail crony landlords it's not.!!)
The single biggest sum of money paid on rent by the HSE in Sligo is €316,165 per annum for offices at JFK House, which is located on Kennedy Parade in the town, which is mainly used for community services and health promotion.
A HSE spokesperson said that it would respond to the claims later in the week.
The report of Comptroller and Auditor General John Purcell on the implementation of the 1997 contract of the Medical Consultants was published in April 2007
It makes timely reading, especially in view of the ongoing dispute with the consultants.
The report, which examined the implementation of the previous contract over the past 10 years, uncovered a number of deficiencies suggesting a difference of understanding between management and consultants in a number of areas. There is, for instance, a dispute about the agreed working week for consultants.
The Health Service Executive (HSE) contended that consultants were supposed to work 39 hours per week, including six hours of unschedulable activities, but the consultants insisted that they were contracted for only 33 hours a week. Mr Purcell expressed an understandable disappointment that this issue had not been resolved in the 10 years since the contract was signed.
The consultants were contracted to provide work schedules, but those were not updated over the years. After 10 years some bore little relationship to reality. As a result there was a distinct absence of records on which hospital managers could determine whether consultants were discharging their contractual commitments.
Even where managers believed that particular consultants were performing above and beyond the call of duty, there was no way of verifying this. The Comptroller and Auditor General found the lack of proper records particularly disturbing in the matter of consultants treating private patients in public hospitals, because there was no meaningful attempt to monitor the level of private practice of consultants.
In public hospitals 20% of beds were designed as private beds, but the report found that the level of private patients exceeded the 20% ratio in all categories of clinical activity. This brought the equity of the system into question, because less resources than those for which the public was ultimately paying were being applied to the treatment of public patients.
Distinct deficiencies were also found in the matter of clinical review to ensure the kind of medical abuses that occurred in Drogheda are not allowed to happen again. No central guidance was accorded with the result that whatever arrangements exist are merely implemented at a local level to varying standards.
The advent of the State Claims Agency has brought about a greater awareness of the importance of risk management. Some hospitals have taken proactive measures, but it will take a further three to five years to implement a comprehensive national plan.
Consultants do not come out of this report very well, but this should not be allowed to obscure greater deficiencies. The consultants were essentially allowed to interpret their existing contract as they saw fit.
The real story of this report has been the persistent failures of management. The managers largely only managed to dodge their responsibilities. Ultimately the report is a blistering indictment of managerial incompetence and indifference.
I'M GOING TO DIE BECAUSE OF HOSPITAL WAITING LISTS
On RTE's Liveline (9th January 2007) programme, a young woman called Rosie spoke about her diagnosis of terminal bowel cancer -- and the delay she has experienced in getting the proper treatment. She had sent in an e-mail to the programme, the following is the full text.
I'm going to die because of hospital waiting lists
"Today I had my 12th session of chemo. I got to talking to the partner of a man who was also getting chemo. She told me that when her partner's GP requested a colonoscopy for him he was put on the waiting list. She then phoned the hospital and told them he had private health insurance and he was seen three days later. He had bowel cancer that was advanced, but had not broken through the bowel wall and spread to other organs. She said the tumour was the size of a fist and what made him go to the doctor (apart from her nagging) was he started to lose weight rapidly. Thank goodness they got it in time and he's going to recover.
I then came home, flicked on the tv and got into bed. The first ad on the tv was from the government telling people that bowel cancer can kill, but not if caught in time. If Bertie Ahern or Mary Harney or Michael McDowell were within reach I would have killed them. Literally. I'm not joking.
I don't have private health insurance. It's a long story, so I'll start at the beginning.
I've suffered from digestive complaints for years. It started out with being unable to eat in the mornings or when my stomach felt tense. I'd feel too queasy. Then I got heartburn after just about everything I ate. I lived on Rennies. Then, in 2005, I got a lot of diahrea and after a few months it became constant and blood accompanied some of my bowel movements. I went to my GP clinic in the Summer of 2005. Probably about 2 months after the blood started appearing. I look back now and feel stupid for delaying for 2 months, but I wasn't sure if the blood was caused by piles, which my late mother suffered from. I was 39 years old and had read in books and heard a doctor say on tv that bowel cancer doesn't affect people under 50. Anyway, my normal GP was on holiday, but I saw his colleague, and she immediately sent a letter to the local hospital requesting a sonogram and a colonoscopy. Within weeks I was called for a sonogram and was diagnosed with a gallstones. That explained the queasiness and the heartburn. I expected to soon be called for the colonoscopy. I waited through the autumn, then through the start of winter. No word on the colonoscopy and no word on when my gall bladder would be removed.
In November I started to get serious lower abdominal pain after eating. I phoned the consultants secretary and asked if I was on the waiting list. She assured me I was and would be called soon. In December I started to rapidly lose weight. This definitely wasn't like me! I love my food, Joe. I phoned the hospital again after Christmas. Again I was told that I was still on the list and would definitely be called soon. (I later found out that that consultant had retired and they had just hired a new one). Joe, from November to the end of February I was in agony. Apart from the pain and diahrea I was tired all the time. I'd literally got out of bed to go to work at 4.30 in the afternoon. Came home around 10.30pm, ate my dinner (I couldn't eat before work because it'd make me too sick to do my job), tidied the kitchen and went to bed again. I was miserable.
Finally, on February 28, 2006, four days after I turned 40, I was called for a colonoscopy.
I woke up in the middle of the procedure and saw on a large screen, them probing a blob on my colon. They were taking a biopsy. But I didn't have to wait for the results. I knew what I had. Soon after I met my wonderful consultant, Dr George Nassim. What a gem he is. Friendly, compassionate and funny on top of being a great surgeon. I felt like I was in good hands. I didn't panic for more than a few hours after I was told that I had cancer. They can do loads of things to save cancer patients these days. I was young and strong. I'd been a vegetarian since I was 16. I ate mostly healthy foods, although eating at night was a serious no no when it came to my weight. I went for walks a few times a week. I felt I could beat this.
I was booked in for surgery to remove the tumour. I was given a stoma, which means I'll have to poop in a bag for the rest of my life. I found that really difficult to handle. More difficult than the cancer sometimes. I was in St Lukes hospital for over 50 days last year. (I had to have a second surgery due to complications) Recovery was hard, but I did it. I shared a room with two lovely women who also had cancer. They have since died. In another ward I was in I was next to another woman who had cancer. She died too. The staff at St Lukes in Kilkenny are the most kind, hardworking people I've ever met. In March, in between surgeries, I was sent to the Mater in Dublin and had a porto-cath put in for putting the chemo through, and a PET Scan to see if the cancer had spread. If it hadn't, I'd live. If it had spread to other organs, I'd die. It had spread to my lungs.
I felt bad enough to go to the doctor. She did what she was supposed to do. She told them I had diahrea and blood from my rectum. But what could they do? So do lots of people. Should I have skipped the list ahead of those other people with the same symptoms? I don't think so. Should there be a list so long that it puts people at risk of dying? No. Definitely not.
I know in my heart and soul that when I started to feel really, really bad, especially in from December to February 2006, is when the cancer broke through the wall of my bowel. Of course I can't prove it. But I know. Because it broke through the bowel I have been given 2 to 4 years from diagnosis to live. The chemo is to prolong life, not to save it. I have 3 years, tops, to go. Despite that, I'm going to try my best to make it for 5 more til my youngest turns 18. He needs me too much now. My husband has suffered right along side of me in his own way knowing that the woman he loves will be dead soon. My 18 year old daughter has been told and has gone quiet and doesn't want to talk about it. But I know she's scared. I haven't told my 13 year old son yet. He's too young to handle it. The South East Cancer Foundation in Waterford have been very helpful and will help us when the time is right to do and say the "right" things.
I don't blame the wonderful people who work in St Lukes in Kilkenny. They work with what they are given. St. Lukes has the best A+E unit in the country. I had to use it three times in 2006 and twice with my son (nothing serious, thankfully). What did the government do? Threaten to shut it down. They also threatened to shut down the maternity unit AFTER spending millions to improve it!! That would mean Carlow women would have to travel to already overcrowded hospitals in Dublin and Kilkenny women would have to travel to Waterford, which is grand if you live in South Kilkenny. The rest could lump it and birth at the side of the road if necessary.
Twice I had to listen to two women die next to me in hospital because there's no place for people nearing death and their loved ones to go to die and grieve in dignity.
My time in the Mater was dreadful. I was terrified I'd pick up MRSA because it was filthy. I was put on a ward with cardiac patients, mostly men, who because of their ill health were unable aim too well when they went to the toilet. Once when I used the toilet my pajama bottoms soaked up urine up to my ankles. Even though I was still sick and weak I still tried to hover over the toilet so I wouldn't have to touch it. I wasn't able to hover and hold up my pajama legs at the same time. I had just given my sister-in-law two sets of pj's to take home and wash and had nothing to change into. I rinsed them out in the grimey sink and wore them damp until she returned the next day with clean ones.There was excrement stuck to the sides of the toilet for days at a time. Water flooded the shower room, soaked my clean pjs and towel that were on the floor outside the shower and ran out into the hall. After that happened the first time I learned to take a chair in to the shower room to put my stuff on. At least I knew THAT floor got water and soap put on it regularly. The man in the bed next to me, who had suffered a triple bi-pass was served up a greasy fry for tea when he had specifically ordered fish because it was healthier. On the third day he refused to eat it when they wouldn't give him what he had ordered and went without eating on principle. I was vegetarian and so was served cheese on crackers and cheese sandwiches (fake cheese slices on white bread) for all but two meals. They brought one of the two nicer meals when I was fasting and not allowed to eat it. My suspicion is that the catering has been privatised, although I could be wrong. The staff, apart from one really nasty nurse, were lovely.
Should I blame anyone for my hard luck? I've thought about it over the last year and have tried to be reasonable about it. After all, I waited to get Christmas over with before I phoned the hospital for a second time asking to be seen. But today, when I heard that a very nice man who was in the same, if not worse condition, than me when he went to his GP is going to live because he had private health insurance and I'm going to die because I didn't, I had to bite my tongue. I'm happy he's going to live. He deserves to live. But so do I. Then I came home and watched that ad which told people to hurry up and get checked out for bowel cancer because it will save their lives, and I fucking lost it.
I've finally reached the angry stage, I guess. Who am I angry at? I'll tell you, Joe. The health service has been in the hands of Fianna Fail and the PD's for years and all they can think to do is put resources into privatisation. They don't have the ability to change structures in the public sector that would put more resources toward patient care. But it's not just the politicians. I'm also angry at every single voter who voted for Fianna Fail and the PDs because they thought they'd get a few more shillings in their pockets but were too greedy and stupid to realise that that money they saved in wage taxes would be made up with stealth taxes. We all knew before the last election what their health policies were and the majority of people ignored this and voted for them anyway. Maybe they thought this would never happen to them. Or maybe because so many have private health insurance they just didn't care because they were alright, Jack.
I never dreamed I'd get cancer, let alone die from it. But I was wrong. My message to anyone with symptoms of bowel cancer is go to your GP immediately. If you, like me, don't have health insurance, pester them until they hate you, go to your politicians and beg them to help, go to the media, get a solicitor to threaten to sue the government and the hospital if they don't get you in soon for a colonoscopy. Otherwise, the people who love you might lose you and you'll not get to do all the things you planned in life.
I'm writing to you because the way this country is run leads me to believe that contacting a radio show is the only way to try to change things like this. I hope that when Ms SUV and Mr Builder goes into the voting booth, they'll think about me, my husband and especially my children. My husband is a decent man. He works full time in a good job and I worked part-time in a job I loved that helped people, but didn't pay well. It depended on government money to help women and children in crisis, so of course couldn't pay me well. We know what Bertie, Michael, Micheal and Mary's priorities are.
Despite 1 1/2 incomes we couldn't afford VHI or Bupa. But even if we could have we wouldn't have gotten it because we believed (and still do) that all people should get good care despite their incomes. We thought jumping queues was wrong. We're socialists...just like Bertie. Ha Ha. Now I feel like vomiting and it's not the chemo!"
From a Cancer Patient in Kilkenny.
Thursday October 18 2007
Susie Long died over the weekend from her colon cancer. Earlier this year, she told Joe Duffy that she waited seven months for her bowel test, while a patient with the same condition, who had private health insurance, waited three days. Subsequently, Joe Duffy gave me time on his show, during which I explained why insurance and other aspects of our health financing system create inequity in access to hospital care.
Research carried out internationally, by the Health Equity Research Group of the OECD and here in Ireland by the ESRI, has shown that one of the benefits of health insurance is that it encourages doctors to treat patients quickly.
Insurance remunerates doctors through fees and fees are a financial incentive to get patients into hospital.
Professor Eddy Van Doorslaer of the Health Equity Research Group studied 21 OECD countries' health systems in 2004 to ascertain which were pro poor or pro rich. He found that Ireland had the third most pro rich system in respect of access to hospital doctors.
Not surprisingly, he found that Private Health Insurance was one of the leading contributors to our system being pro rich and therefore, inequitable.
To his surprise, but not mine, he also found that having a medical card was one of the other major factors creating inequity.
He could not understand why a card, which entitled an individual to free hospital care contributed to inequity. Medical cards are an insurance system against the cost of medical care but they do not pay hospital doctors' fees and are therefore a financial disincentive to hospital access. It is a system that should be changed.
Our politicians have created this inequitable system and with some exceptions in the opposition seem content to continue with it. They have failed Susie Long and her family and many other patients.
Although politicians and the health system failed her and her family and despite their recognition of the inequitable value of private health insurance, Susie and her husband had great courage, decency and principle in retaining a belief that health care should be provided on the basis of need, not ability to pay.
Dr John Barton,
18 October 2007 Examiner newspaper
Susie Long’s legacy is a damning indictment of our lack of care
By Diarmaid Ferriter
THERE’S a justifiable anger in the air about the untimely and unnecessary death of Susie Long from bowel cancer due to the seven-month delay in getting a colonoscopy because she could not afford private healthcare.
There were pictures earlier this week of her dignified children Áine and Fergus and husband Conor as they laid her to rest. Tributes were paid to the courage she demonstrated in devoting so much of the limited time she had left to highlighting the crisis in our health services, hoping her personal tragedy could turn into a force for positive change.
At her funeral, her husband read a passage entitled "Not, how did she die, but how did she live?"
Of course the family want to remember her life, but the first question contained in that passage — how did she die? — is also one that warrants close attention.
Susie Long’s story is important not just because of the scandal of her untimely and unnecessary death, but because of the simplicity and clarity of her situation and what it tells us about Ireland in the 21st century.
Her bravery has encouraged others to write of their own experiences — some of which have happier endings and different contexts — but they all share one thing: a sense that the victims are invisible.
On Tuesday morning on Pat Kenny’s RTÉ radio show, a long email was read out containing yet another disturbing account of our rotten health system. It was written by a mother who could not sleep due to her distress and found herself at the computer at six o’clock in the morning writing in a dignified, yet angry, tone.
She recounted the experiences of her 17-year-old son who fell ill and, from the time of his first admission, had to wait 37 hours in A&E at the Mater Hospital in Dublin.
A few of those hours were spent at home, but most of them were endured on a hard chair in A&E before he was seen to, despite the fact he could not even swallow his own saliva and was chronically dehydrated.
Thankfully, he is now recovered, but his mother also mentioned that, having already buried her 21-year-old daughter, she was seriously considering leaving the country because she remains terrified at the prospect of remaining in Ireland in case any of her other family members fall ill. The most galling aspect of her experience was the fact that the bill from the Mater Hospital arrived in a shorter space of time than her son had been waiting in A&E.
Listening to these stories, it is difficult to believe they are accounts of Ireland in the 21st century.
Susie Long’s original email contained many of the elements of the health system that have been highlighted in the past few years — the waiting lists, the agony suffered at home, wonderful and friendly health staff fronting a chaotic and shambolic system, the stoic and dignified cancer patients, hospital units being threatened with closure even after money has been spent to improve them, and the terror of contracting MRSA.
In her original email, Susie Long wrote: "Once when I used the toilet, my pyjama bottoms soaked up urine up to my ankles. Even though I was sick and weak, I still tried to hover over the toilet so I wouldn’t have to touch it. I wasn’t able to hover and hold up my pyjama legs at the same time." She also explained the anger and frustration she felt on hearing that an individual with the same condition was going to live because he had private health insurance and she knew she was going to die because she did not.
She criticised politicians in charge of healthcare because "all they can think to do is put resources into privatisation", supported by an electorate who do not seem to want to confront the reality of what that means.
The initial response of Health Minister Mary Harney to Susie Long’s death was one that has been heard before in reaction to the other needless deaths that have occurred as a result of the failure of the politics of healthcare in this country.
The situation, she said, was "unacceptable to me". It was a meaningless response. She seems to be suggesting that she is outside of all this. It reminded me of the attitude to poverty that existed in the 1920s in the new Free State when Cumann na nGael minister Patrick McGilligan asserted, "people may have to die in this country, and die of starvation".
The early 21st century equivalent seems to be "people may have to die in this country, and die because of the two-tier health system".
The statement Ms Harney made on Tuesday night about the introduction of a common waiting list for private and public patients as part of the new consultants’ contract is a pious gesture and regarded by many working in the health system as a smokescreen to hide the fundamental structural weaknesses of the public system.
Ms Harney is the same minister who asserted in the Dáil in July: "As for trolleys, some people spend all their time, perhaps 24 hours, being observed on a trolley. Recently, a close friend of mine who would be known to many members had such an experience in a Dublin hospital. He told me it was a very pleasant experience. There will always be people on trolleys and many people are treated on them. The issue is the length of time someone must wait to be dealt with in an accident and emergency department."
When Fine Gael TD Charles Flanagan put it to her that she should not suggest the general experience of being on a trolley was pleasant, Ms Harney replied: "It is for many people".
YES, there will "always be people on trolleys", and while deaths as a result of the two-tier system she promotes are "unacceptable" to her on a personal level, she is not going to do anything to stop this madness because ultimately, according to her misguided ideology, healthcare is a marketable commodity and state funds will continue to be used to subsidise and promote private care while not enough is being done to improve access to primary care for those who cannot afford it.
When researching her book Unhealthy State five years ago, Maev Ann Wren observed: "There is a perception that the Irish healthcare system is so complex that remedying its problems is too daunting a task. In my research it became apparent that the complexity is superficial, the flaws are fundamentally simple and the remedies quite achievable."
There is no more fundamentally simple flaw than the two-tier approach to healthcare access that resulted in Susie Long’s unnecessary death at the age of 41.
It would be gratifying if there could be a return to the acceptance of the principle enunciated so clearly by Aneurin Bevan who, as health minister in Britain 60 years ago, established the National Health Service there with the support of his Labour colleagues: "No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means".
As bill hits almost €200m, payroll system remains in tatters
THE ailing PPARS system was branded "a sick joke" again in October 2006.
It emerged the beleaguered computer system cannot handle sick pay, annual leave, bank holidays or sick leave for 70,000 Health Service Executive staff, even though its total cost could exceed €200m.
PPARS - designed to cover 'personnel, payroll and related systems' - still cannot handle basic functions, despite a year of government promises to patch up and even cure the ailing health network.
With no system ability to apply bank holiday working bonuses or handle leave and sickness, the record-keeping in these areas is still having to be done manually.
Fine Gael leader Enda Kenny said the "sick joke" was that millions were still being poured into the black hole of PPARS while a host of basic health programmes went a-begging.
The roll-out of PPARS, which covers fewer than two-thirds of HSE workers, was 'paused' last year because of its accelerating cost and mountain of glitches in practical applications - with a series of workers being underpaid, overpaid or not paid at all.
One worker in the northwest was overpaid to the tune of €1m, but reported the error and repaid the money.
But at the time the brakes were slammed on the project, 10 key areas remained to be fixed, according to an unpublished consultants' report on the fiasco.
This "Top 10" list is now drastically behind schedule.
"The features still to be addressed include the treatment of public holidays, sick leave and multiple contracts," says the report from Astron Consulting.
It adds further: "There are still numerous manual work-arounds to support the PPARS payroll function."
The overall cost of PPARS will now reach €186m by the end of next year.
Astron Consulting also say the entire wheeze was designed for eight stand-alone Health Boards, but when they were abolished it could not reflect the new organisation. "The new HSE structures are not supported," it declares.
More shocking than the misspent millions is the fact that "there was no one in charge for the past year", said FG leader Mr Kenny, even though €21m was spent in that timeframe.
"The frontline of our health service could desperately use the funds thrown at the PPARS fiasco. Just over €4m could make all of Temple Street Children's Hospital's wishes come true. They are trying to raise funds for an Intensive Care Unit and a Catscan."
The government could have increased the budget of the National Suicide Prevention office to €5m from its current 'miserable' level of €1m, employed another 100 public health nurses and provided 650,000 additional home-help hours.
"They allowed the PPARS waste juggernaut to roll on and eat into valuable resources that could have made a real difference. That is the sick joke of the matter," he added.
When challenged last year, the Taoiseach said he would freeze the project, stop the rot and halt the waste, Mr Kenny claimed, but neither the Taoiseach nor the government honoured that pledge.
Mr Ahern responded that the system had already been implemented in six HSE areas and to unravel it now would waste money that was "effectively working". ! Indeed.
Senan Molony and Geraldine Collins(Irish Independent)
Tragically for those who embraced reform, the HSE has turned out to be the same old system, with the same people, in a different guise.
Professor Brendan Drumm, its chief executive, sits astride an organisation that recruited its staff from the defunct regional health boards and whose mentality reflects the bureaucracy of the civil service.
The Department of Health, which should now have a limited function as a director of health policy, retains hundreds of civil servants, not because they have a useful function to perform, but because the government did not have the courage to pay them off. Layers of bureaucracy upon bureaucracy and the good reforming intentions that brought us the HSE have been destroyed by the reality of the beast.
IRELAND'S nurses know when to go for the political jugular. Ten years ago they seized on the weakness of John Bruton's Rainbow Government, threatening strike action in what would prove to be an election year unless their pay demands were met. In February 1997 they were bought off by a Labour Court ruling that awarded them significant pay increases above the national wage deal of the time, and the threat was averted. Their timing was immaculate, and the result impressive. Four months later Bruton went to the country, unnerved by the pressure that was being exerted on his backbenchers by all comers in the public sector. And he lost.
This time, the pressure may be different, but it is no less painful. Bertie Ahern's government is nearing its sell-by date, but Ahern's style has been to eke out every last day in office before asking the people to vote again. His preference for full five-year term governments robs him of the element of surprise and his government is a sitting duck for the malcontents in the public service who want to wring concessions in the few months that he has left.
The certainty of full-term governments, which should provide political stability, can actually become counterproductive, as they replace the drama of a snap election campaign with a never-ending campaign. And the certainty of the election date, give or take afew weeks, gives pressure groups an easy timetable to plan theirattacks, and the nurses' timingis precise.
Already, they have won their first victory: Fianna Fail's backbenchers have panicked, and have tried to place distance between the two government parties. They know that the nurses - who, in Liam Doran and Des Kavanagh, the general secretaries of the Irish Nurses Organisation and the Psychiatric Nurses Association, are lucky to have two of the best union advocates in the business - can win public sympathy, and they know too that the state of the health service will be an unavoidable election issue. Their panic, though, reveals that Fianna Fail has no idea how to deal with it.
The nurses are undoubtedly guilty of political opportunism, but they have actually given the government a rare opening to show that it is serious about healthcare reform. Fianna Fail will want to sidestep that opening, but Mary Harney, the minister for health and former leader of the PDs, cannot afford to.
With her party's support dwindling to the point of obscurity in the polls, she has little time left to demonstrate that the PDs are an essential force in government, and that without them nothing decisive can happen.
Her showdown with the consultants - predictably weakened by Ahern but still on the cards - is an easy stunt, but an effective one. Hospital consultants are a soft target, unloved, however unfairly, by the public and easy to caricatureas fat cats who stand in the wayof reform.
The nurses, though, present a more complex problem, and not just for the government. By stepping outside the stifling confines of the national wage agreement, the nurses' stance creates as many problems for the trade union movement as it does for government. The panic of Fianna Fail's TDs has been mirrored by the panic at Impact, the large public service union that seems to have an unhealthily close relationship with government. Impact frets that it could be made look foolish to its own members by the actions of the INO and PNA, and stands accused of looking after the interest of its managerial ranks, rather than its foot soldiers in the health service. So it postures too, muddying the waters that the nurses want to keep clear.
That division in the ranks of the unions gives Harney a chance to shake the system. Doran and Kavanagh are clearly open to a deal. They have made a pay claim - and one that carries some legitimacy, because nurses were treated strangely in the first, secretive, benchmarking exercise - but they have also made it clear that they are prepared to negotiate on work practices. Which is just as well, because nurses have done well out of this government.
Since 1997, the maximum rate of pay for staff nurses has risen by more than 70 per cent, while at the top end of the scale, directors of nursing have enjoyed increases of more than 100 per cent. We employ about 40 per cent more nurses than we did in 1997, and no matter how you cut the statistics, we have more nurses per capita in this country than in most, if not all, developed countries. Productivity and efficiency are key issues, so the concession to negotiate on work practices cannot be ignored.
Since the work of nurses has an impact on so many areas of the health service, any concession on work practices is certain to affect a host of other workers from non consultant hospital doctors to radiographers, care assistants and the plethora of job descriptions and grades that pepper the system.
The negotiations, therefore, cannot take place - effectively - in isolation from a complete overhaul of the system. If nurses can prescribe drugs, or send patients for diagnostic tests, or change intravenous lines, then they will cut through the clutter of hospital accident and emergency units and ease the load on general practitioners, but each advance in nurses' efficiency and responsibility will carry costs and benefits for others.
That root and branch reform of the clinical procedures in hospitals should have been undertaken within months of the Health Service Executive coming into existence two years ago, but it has been delayed and delayed. Tragically for those who embraced reform, the HSE has turned out to be the same old system, with the same people, in a different guise.
Professor Brendan Drumm, its chief executive, sits astride an organisation that recruited its staff from the defunct regional health boards and whose mentality reflects the bureaucracy of the civil service.
The Department of Health, which should now have a limited function as a director of health policy, retains hundreds of civil servants, not because they have a useful function to perform, but because the government did not have the courage to pay them off. Layers of bureaucracy upon bureaucracy and the good reforming intentions that brought us the HSE have been destroyed by the reality of the beast. Administrative reform occurs, but much needed reform of the way our hospitals actually work is stalled.
The nurses, though, have given Harney a timely opportunity to jump-start that reform. She will not want to delay her confrontation with the consultants, but she now has the opportunity to bring all health service workers to the negotiating table and hammer out a reform of work practices that can make a radical difference to the efficient delivery of the Irish health service.
There will be inevitable pressure to cloak those negotiations as part of the reform-numbing social partnership process, but it is time to wake up to the reality that social partnership has delivered nothing for the health service.
Social partnership can only have a role if the process itself is turned on its head and becomes a vehicle for reform, not a vehicle that frustrates reform. There is precedent, too, for a special negotiation. There have been side deals with a number of special pleaders in the recent past, and there is no reason for a strong government to allow concessions to the health service spill over in the rest of the public sector. The days of relativity are gone.
Reforming work practices is just a start on the road to a better health service, but it is an essential one. If Harney is to have any hope of restoring her party's fortunes in the opinion polls, she has to show that she - and by extension the PDs - has the courage to take the tough decisions that all other parties would duck and she must grasp the opportunity that the nurses have offered.
Their claims - for a shorter working week, for higher pay, for the elimination of pay disparities with other health care workers - come with the promise of reform. They are also set against the reality that although we train 1,800 nurses a year, at enormous expense, we cannot retain them in our health service and are forced to spend yet more money recruiting abroad.
According to the INO, up to 70 per cent of our new, degree-standard nurses leave the country within two years of graduating. To replace them, we had to recruit 3,000 nurses last year from India, and now have about 11,000 non European Union nationals working as nurses here. They, too, will leave for the brighter lights of North America once their contracts expire and their English is honed, and the churn will continue.
Nurses, like consultants, represent part of the problem in the health service. As a group of organised labour, they are not the angels of public perception and their willingness to threaten strike action is an act of extreme opportunism. Yet they have offered a route to a solution. Harney knows that she can do business with Doran and Kavanagh, but she must now show that she has the conviction to force the other unions to come to the negotiating table. If she can, then the nurses' unions will have done us all a service by striking for the jugular.
Alan Ruddock (Sunday Independent)
17 November 2007 Examiner newspaper.
Why they feared me — an ordinary person with cancer
I WRITE in the wake of the uncertainty surrounding the exclusion of oncologist John Crown from the Late Late Show panel.
I had the honour of being a Late Late show guest more than a year ago.
My reason for being there was in part to highlight my book, If It Were Just Cancer, but also as a founder member of the lobby group Patients Together.
I am an ordinary person, a cancer patient who suffered the indignity of A&E, a filthy ward, the fear and terror of not getting a bed and, as a consequence, denied the right to avail of my urgently required chemotherapy.
From the day I was given the all-clear I vowed that on behalf of all the others not as blessed as me, I would highlight our suffering. Nothing more, nothing less. I wanted people to know what it meant to be seriously ill in modern Ireland.
I am not an academic. I am not a mover-and-shaker. I grew up in a close, loving family of eight in Finglas, Dublin, in what was known as a ‘corpo purchase house’.
I left school at 15 and had a son at 19. I worked in a tyre outlet and as a company rep and eventually started my own business in 1994.
My new-found position under the spotlight on the Late Late Show, in the papers and on the radio was terrifying and I lost many hours sleep with the worry of letting everybody down.
I never envisaged this would be where my cancer would take me. My mother believes I survived at God’s will to do this work. I am inclined to believe I am driven by those gone before me, goading me to stand up and be heard.
Where am I going with all this? The night I appeared on the Late Late was one of the most privileged in my life. My family, friends and supporters were dotted around the country watching and my heart was bursting with pride and fear. I wanted to say something that would touch people — to make them understand how we as patients are being failed. I was sick with nerves, but I knew the girls on the ward were with me in spirit.
I made it through the show, but fell into my son’s arms crying and shaking when it finished. It was all too much. The relief that it was over was immense. I remember one of the researchers coming to me and hugging me: "Well done, Janette, you were brilliant and you have caused such a fuss."
I was worried. What had I done? The researcher went on to explain that certain people had been screaming down the phones wanting to know who made the decision to put me on the show and why were they not told I would be on?
The researcher took much delight in their agitation because they apparently find it so hard to get any comments, returned calls, etc, from these people, and now they were hopping mad, phoning in more and more as I was speaking.
What in Gods’ name could make these people so irate? Little old me rattling on about the indignity of our health service? What was I saying that incited such fear and upset?
I have found the answer: I was telling the truth. I was an ordinary person telling how it is. I had nothing to gain and nothing to lose. Until that moment I had never realised how powerful the ordinary person who is willing to stand up and be heard can be. I find it so sad that we have a section of our community driven with desire to silence the truth.
Following the show and my naive decision to gate-crash a HSE press gathering, I received texts from a prominent health correspondent saying he had received calls questioning who I was? Who was funding Patients Together? Who was yanking my chain? How many members do we have, etc?
I will save these people any further time-wasting and stress worrying about me. I am a nobody, a taxpayer, an Irish citizen, an honest and loyal person who whispered a promise to the dead that I would be their voice until our overcrowded, under-funded, diseased health service learns to treat us with dignity and care. Really you have nothing to be afraid of.
82 Finglas Park