Monday, February 25, 2008

The HSE needs to go to war.

there was an article in my local paper last week. It exposed a directive issued by the HSE that ambulance drivers in "some cases" (read most) have to bypass the A&E unit in Nenagh hospital and bring patients to the A&E facilities in Limerick, Laois or even Kilkenny hospitals. This would all require a traveling time of well over an hour. Now any person with half a bit knowledge of trauma medicine knows of the so-called "golden hour". Experience has proven that a patients chances of survival greatly increase if he/she receives treatment within the first 60 minutes after receiving the injuries. If treatment occurs outside these 60 minutes the chances of survival decrease rapidly no matter how experienced and well equipped the ambulance crews are. So this decision clearly diminishes the survival chances of any person requiring A&E treatment in the Nenagh catchment area. This is again a decision that typifies HSE policy.
Operational and management decision are made by bean-counters without any regard for the patients.
We now have a healthcare system in Ireland that drives trauma victims around the country for over an hour, has people on trolleys in hallways for days on end and can't even do a simple thing such a process and analyse an X-ray immediately.
This is ridiculous and unacceptable. In Iraq and Afghanistan injured soldiers who have their limbs blown of by an IED have a better chance of survival than a victim of a road traffic accident in Ireland. I strongly suggest that we scrap the whole system of healthcare currently in place and replace it by something along the lines of what the US military currently has deployed in the various theatres of operations. We need to setup a number of primary/trauma care facilities across this country so that any sick or injured person is never more than a 30 minute ride away from one of these. Structure these facilities along the lines of the Combat Support Hospitals. Anyone coming in to these will be subjected to triage and treated accordingly. Once a patient has been diagnosed and stabilised they will be either discharged or "passed up the chain" to a more specialised treatment facility/hospital.
These primary care units make more sense than a full hospital facility in every county and are a lot more cost effective. Staff them with a mix of trauma surgeons & nurses and assign no more than 2 administrators. Have all primary care units managed from a central facility located somewhere else in the country but staff this central management office with medical staff re-trained to management duties and not just bean-counters.
You can then close all the general hospitals and replace them with a number of specialised treatment centres across the country. All cancer patients go to centre X, all paediatrics go to centre Y etc...
A system along these lines will be patient-centric and ensure (for as far as this is possible) that any patient will receive the best medical care possible.
I know that with the way the system is structured at the moment that if any member of my family develops a serious illness that I will put them on the first flight out of this country...


topgold said...

1. The Irish health care system administers wage packets first and patient care at some point later. As is obvious from the HSE wiring diagrams, there are too many administrators. Those jobs remain intact as the natural fall-out of regional health boards consolidating. No one has the tenacity to pare back the fat in middle management.

2. So you take your paring knife to the front door of hospitals and stave off anyone trying to enter. That's relatively easy when you tell the ambulances where to park or when you don't open wards.

For what it's worth, I spent three years living in northeast Oklahoma where those involved in a motor vehicle accident on the interstate were collected by the county hearse. An EMT crew, equipped with rescue equipment, drove the hearse more than 80 miles to Oklahoma City for critical care cases. Ireland is not the only developed country in the world with limited health care assets.

Caoimhin said...

Great post! Fine Gael were talking about Primary Care facilities before the election, it makes sense and you've expressed some good ideas. Why is this not as obvious to Brendan Drumm? He's on a thousand a day, you'd think he could come up with an idea or two on his own?