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The health service

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The health service



Liamy MacNally The last ‘family’ hospital experience was over two years ago when my father was hospitalised. Last week was one of those weeks, with three relations in hospital. The hospital experience, even for the visitor, reveals, first-hand, how staff work in such difficult conditions. Like the present incumbents, my father’s hospital stay was made tolerable by efficient and dedicated staff. One can marvel at the small gestures for patients that still permeate the busy days of over-worked, exhausted hospital staff. Only last week, a man in his late seventies, was stretchered in and stretched out in Trolleytown in the A&E Department in the Mayo General in Castlebar. Yet, someone was conscious that he was to be one of over a dozen patients who would have to spend the night there, amidst the noise, hustle and bustle and those bright lights of the A&E. Along with two other patients he was placed in what he described as a ‘store room,’ where all three slept like babes for a couple of hours. It was a small gesture of kindness by an alert and caring staff member amid a world of turmoil, mismanagement and chaos.  Front-line staff
Blame cannot be left at the feet of the front-line staff. They do their jobs with such efficiency and energy that it would make one wonder why or how they carry on day after day working in a system that is blatantly mismanaged from the top. It is amazing that the only results we seem to see emerge from various restructuring of the health service are a new name and new titles for an even bigger department of middle management. Windscale became Sellafield. Same thing, only the name was changed. It is just like the health service, only the name has changed, from regional health boards to the Health Service Executive. New packaging but the contents are the same! It impresses nobody. For all their faults, the health boards had some semblance of accountability. Local politicians sat on the boards and they asked questions when they needed to be asked. The new HSE, like the Better Local Government of local authorities, has become less accountable and more bureaucratic.
Press queries
One thing the HSE excels in is a lack of clarity. Many press queries have to be submitted several times before one elicits an answer to a particular question. Then some of those responsible for dealing with the question have the audacity to say that the wrong question was asked! It is like British Rail and the wrong type of snow falling on the tracks or the wrong kind of leaves falling on the lines!
This shows up the main weakness of the HSE – people who do not have to publicly account for their stewardship control it. They are unelected and not answerable to an electorate. In one case last week, a question had to be submitted three times to the HSE regarding the cutting of services at the Sacred Heart Hospital in Castlebar before they eventually admitted that services were being curtailed. The people at fault are not the people who take the call in the Communications’ Department of the HSE but those to whom the query is passed on. It seems to be a bit of a misnomer to call it a Communications’ Department when one can be dealt such a barrage of insolence. It is as much an insult to those of us who are trying to find answers to questions raised by people who are genuinely concerned as it is a betrayal of those who man the phone lines in the Communications’ Department of the HSE. Allowing faceless people to make meaningless remarks to serious questions is not the way to provide a service to the public. 
Who is responsible?
The big flaw in the revamped HSE is the lack of accountability. The only winners are middle management – managers for beds, managers for wards, managers for hospitals, and now, network managers for groups of hospitals. And yet, no one seems to be able to take any responsibility! Title, titles, titles! If only we could live on them. They are only meaningful if they do what they say on the tin. In HSE experience, they do not. That is why we have A&E Departments renamed Trolleytowns. It is difficult not to get angry when you visit a relative on a trolley in this so-called Celtic tiger-fuelled democratic economy.
In health service terms all it seems to have spawned is arrogance and the evasion of responsibility. Try making sense of the fact that a man in his late seventies can be admitted to hospital with chest pains and be forced to lie on a trolley all night. This is the 21st century, for God’s sake. It is time those in charge of the health services woke up to that fact. Peter will blame Paul and Billy will pass it on to Jack and all along the patient just continues to suffer. Mary Harney, whom many of us hoped would genuinely tackle the A&E crisis, has leapt from one crisis to another in the health service. Her ten or 12-point plan has got lost along the highway of good intentions, Government spin and time-honoured cynicism.
The bottom line is that since she took over the A&E crisis still exists. It is a testament to bad management at so many levels in the health service. And yet, despite such ineptitude, arrogance and pride, front-line staff can still deliver a service with a smile. The Maeve Morans and Vera Byrnes of front-line staff are a testament to a depth of commitment to their jobs that it restores faith in human nature. Their professionalism and hard work are equalled by their good humour and effectiveness. They personify all that we hold dear about the health service. They stand as the last refuge between the betrayal we experience from management and our own sense of powerlessness when facing the great unknown.  When the history books are written about the great health betrayal of the early part of the 21st century, let there be someone who will record the heroes and heroines who battled against staid leadership and a lack of vision. Let there be someone who can shout from the mountaintops that not even the combined efforts of lacklustre management and weak government could prevail against the goodness of the human heart of front-line staff in so many hospitals. These staff battle the odds, like the patients, but on a different plain. Unfortunately, the provision of a proper health service has become lost in the fog of titles and management catchphrases. Management should know that we are dealing with people, not statistics or concepts or management theories. People require other people, not textbook answers or bullet-points. 
A patient patient
Six months after my father left hospital we discovered that certain monitoring tests requiring a ‘halter’ had not been carried out. A halter monitor was arranged two years ago. He attended the Mayo General as an outpatient at that stage. The halter was returned. Two years later, we are still awaiting the results! Health service, how are ya!