An advocate for advocacy

The IHCA’s ‘Care Can’t Wait’ campaign is a good example of doctors advocating for patients

I am a strong believer in advocacy. And I’m an even greater proponent of doctors advocating on behalf of patients.

In my 20 years writing about health issues, I have seen doctor advocacy wax and wane. At its nadir, I remember attempts being made to include gagging clauses in consultant contracts. Thankfully, these undemocratic missives seem to have faded, with both individual medics and representative organisations stepping up to the advocacy plate.

For anyone concerned about the ethics of advocacy, the current Medical Council ethical guide is quite specific. It says:

“You should act as an advocate for your patients in two ways. You should speak on behalf of individual patients, to help make sure they receive appropriate healthcare. In addition, you should support all patients by promoting the fair distribution of limited resources and fair access to care.”

The ongoing campaign by the IHCA under the ‘Care Can’t Wait’ banner is a good example of patient advocacy by doctors. It launched the campaign earlier this year in a bid to highlight the growing number of people waiting long periods for outpatient appointments through the HSE. 

At its recent annual conference, the IHCA said that one million people are on a waiting list to be seen at an acute hospital, with almost 570,000 of these waiting to be seen by a consultant.

In a good illustration of patient advocacy, IHCA President Dr Donal O’Hanlon highlighted how these colossal waiting lists impacted on patients, speaking about how their condition may worsen and their suffering increase. And he made the valid point that the waiting lists were unfair on everyone who has paid for a public health service through their taxes.

The Association has now significantly escalated its campaign by passing a vote of no confidence in Minister for Health Simon Harris. This is what Dr O’Hanlon had to say:

“We do not believe that (the Minister) has the authority, understanding, inclination or experience to deliver timely, quality hospital care for patients. He has become increasingly complacent and deaf to the suffering of patients across Ireland.”

Presumably irked by the Minister’s failure to engage with the association and his ‘no-show’ at the recent annual conference, Dr O’Hanlon took the sheath off his scalpel when he said:

“After three years in the office, Minister Harris has presided over an unacceptable increase of 153,914 patients on the outpatient waiting list since he became Minister for Health. This amounts to a 37 per cent increase, or almost five additional patients every hour. While over the same period, the number of patients treated on trolleys has increased by 36 per cent since May 2016.”

While this statement can be seen as an uncompromising surgical strike against the Minister, it cleverly uses patient advocacy as its foundation. And it is timely, with unprecedented numbers of people on hospital trolleys over the summer, before we hit the annual winter surge.

The worst and most consistently affected hospital is University Hospital Limerick (UHL), where some 1,400 patients could not access a bed during the month of September. Recent figures from the Irish Nurses and Midwives Organisation (INMO) showed there were 47 patients without beds in UHL’s emergency department, with 35 in wards elsewhere in the hospital on a single day. This is the highest-ever trolley figure ever recorded in an Irish hospital.

We are unfortunately unique among developed countries when it comes to waiting times and trolley numbers. We are also unique in that we accept ministerial expressions of regret, couched in language suggesting they are observers rather than key players in the crisis. Having said that, the failure of health service management must also be highlighted by the IHCA as it expands its advocacy campaign.

While relatively quiet on the advocacy front of late, in 2013 the IMO published a useful guide, The Doctor as Advocate. It describes advocacy as playing a “significant role in medical professional life in Ireland, from patient advocacy through to more public advocacy roles”. The guide also suggests that advocacy as a physician encompasses individual patient care as well as lobbying for resources and services at a broader level, and for specific patient groups.

Now would be a good time for the IMO and INMO to back the IHCA advocacy campaign. In doing so, however, I suggest they broaden the target to include the HSE and the Department of Health.