What a difference a pandemic makes

The Covid-19 crisis has highlighted the value of a properly resourced public health service

At the end of last year, on Broadsheet.ie, they were talking about cuts to hospital bed numbers despite our rising population. Journal.ie had an eye-catching headline: “Kelly says Government should have bought some private hospitals outright last year [2020].” Wow! I don’t agree with Alan Kelly, but oh my goodness, it’s such a world away from co-located private hospitals. That was like handing public hospitals over to the private sector. On the RTÉ website, there was a paper by Brian Turner, Health Economist, about Ireland’s lack of hospital beds and ICU beds. Brian
had previously told an IMO AGM that (for our population) we would need 8,000 extra to catch up with Germany. No wonder the Germans are coping with Covid better than most, along with their large number of ICU beds.

These are all my sort of arguments. Maybe I can retire – my job is done!

It’s amazing how long a wrong idea can persist. Back in 2007 the PA Report used bizarre calculations and arrived at a daft conclusion – that Ireland needed only 9,000 hospital beds. From that point on, shutting down hospital wards became a major HSE pastime. They ignored our rapidly rising population and squeezed the hospitals down to a scary 10,500 inpatient beds. We and our patients have suffered the consequences ever since. The mid-west has suffered more than most as reconfiguration of services inflicted wave after wave of damage. I can map the
inexorable rise in trolley numbers in University Hospital Limerick against the whittling away of emergency services in Nenagh and Ennis Hospitals.

Our hospitals were not large, but we were busy.

Until Covid struck, it was as if we were living in a post inpatient world. Day beds were supposed to replace inpatient wards, and private hospitals would substitute for public. But Covid patients need wards and ICU and they need them in public hospitals, not private. I’d say there’s been a pretty intense learning curve within both the HSE and Department of Health about the relative weighting of public hospitals versus private and about day case beds versus inpatient wards.

I think people get it too about trolleys. If there are 40 people on trolleys in a hospital, it means the wards are overflowing and simply can’t fit in 40 extra sick people. It’d be nice if the pandemic got rid of the notion that trolleys are because of consultants’ private practice. Hmm, there are limits to people’s understanding. It’s funny to think that Paul Reid came in as HSE CEO with a reputation for cutting costs.

The pandemic changed all that. When my eyesight forced me out of healthcare, I didn’t know who the CEO was. The structure of the HSE was befuddling, and seemed almost deliberately so. There were layers of opaque committees, whose job was to stop anyone employing a nurse or a doctor, and to stop anyone spending money. Now there’s been two years of spend, spend, spend, and constant recruiting of staff. I’m sure there were plenty of mistakes made. We’ll hear all about them when/if the pandemic ends.

I like that we all know who the CEO of the HSE is now. I think it’s great that the new Sláintecare group will be co-chaired by Paul Reid along with Robert Watt, Secretary General of the Department of Health. It makes much more sense to me than creating another new structure. The roles of the HSE and the Department of Health have never been made clear. They don’t have to like each other, but I reckon there’s some chance of a more coherent approach to health.

In other news, my delightful stepdaughter Annie has got her first job. Annie graduated as a stage manager
when every theatre in the world was dark. But now she’s working on a pantomime – and it’s no ordinary panto, it’s
the Gaiety panto! Her Dad would be so proud of her. It’s a mad job and intense, with long hours and weekends – it
reminds me of my intern year. Just like my intern year, all Annie does in her time off is sleep. And the whole show is
so vulnerable (Oh yes, it is!) to a further change in Government restrictions, or a positive test (Oh no, please not!)
among cast or crew.

Last year, during the dark days of January, I read that pandemics usually last three years. I decided to ignore that ugly fact. Well, here we are facing into year three. But this year, the family get-together in Scotland for New Year is on again. We had to miss it last year. And the ski holiday I cancelled in March 2020 has been re-booked for March 2022. Covid willing, of course.