Who decides the health agenda?

Shocked by the scandal at Tallaght, Dr Ruairi Hanley laments that our healthcare priorities seem to be decided not by clinical experts, but by the subjective, random outrage of the media

You really have to admire the HSE. In the glorious history of the Irish public sector, no one organisation has managed so many magnificent cock-ups as those charged with running our health service.
What is most impressive about the latest fiasco concerning Tallaght Hospital is its sheer scale: 58,000 worried people is an achievement that would put even the most incompetent bureaucrat to shame.
Of course, some would say it is too easy to put the boot into health service administrators. I beg to differ. The HSE is a disgrace to this nation. Troubled children have died under its supposed social care, patients continue to die in our hospitals because of its incompetence and hundreds of our fellow citizens scream in pain on trolleys every week. The people responsible for this deserve every criticism that I can throw at them.
Acknowledged
Perhaps the only positive development in the Tallaght scandal has been the re-emergence of national medical advocacy. At this point, I think the pivotal role of Prof Tom O’Dowd should be acknowledged and applauded.
I have had my fair share of beefs with those running Irish general practice. I remain extremely angry at the manner in which ICGP training schemes have treated experienced young doctors. This does not mean, however, that I am incapable of recognising when a senior academic GP has done this State some service.
The actions of Prof O’Dowd effectively exposed a culture of incompetence and disregard for patient safety that existed in Tallaght Hospital. Were it not for his very public advocacy, I strongly suspect that this scandal might have been quietly swept under the carpet by the authorities.
Dr O’Dowd appears to have grasped something that I learned a few years ago. Negative publicity is the only language that HSE administrators understand and fear. It remains the only stimulus that will force them to act.
In contrast, written protests by doctors to those in authority are routinely ignored. In the case of Tallaght Hospital, consultants had sent more than 40 letters to management expressing their concern about radiology services. In response, very little action appears to have been taken.
In my opinion, my esteemed senior colleagues would have achieved far more by making one phone call to Joe Duffy on Liveline on RTE Radio 1. Had they done so, I believe the x-ray backlog would have been dealt with a long time ago. Instead, it was apparently allowed to slide down the agenda alongside the growing mountain of unopened GP letters.
There may be those readers who feel I am being a little harsh here. They would do well to remember the cancer misdiagnosis scandals of the past two years.
For decades, senior physicians in this State had written to administrators and politicians protesting at the appalling standards of cancer care in this country. Their pleas for additional resources fell on deaf, condescending ears.
Media influence
After years of neglect, a number of brave, misdiagnosed patients went public with their experiences. Joe Duffy led the charge, and the media belatedly developed interest in the subject.
Within a matter of weeks, we had a shiny new national cancer strategy and a cancer ‘czar’ brought over from Canada. The failings of the previous two decades were quickly forgotten. I believe that Joe Duffy achieved more on this issue in a few days than every doctor in this country had in our nation’s history.
Like it or not
Whether we like it or not (and I do not), this is the type of Republic we live in: a country where the healthcare priorities of the State are decided not by clinical experts, but by the subjective, random outrage of a handful of unelected, powerful media figures.
Thus, when 500 people lay on trolleys on January 20, this grim milestone was largely ignored by our national press who, three years earlier, had gone collectively ballistic when the figure was a mere 300. It appears much of our media believes ‘trolleys are soooo 2008’.
As doctors, we have a choice. We can ignore this sick game and try to improve the lot of our patients through the existing, failed administrative structures. Alternatively, we can fight dirty and hit the HSE where it hurts — in the papers, on the airwaves and on our television screens.
Tom O’Dowd eventually chose the latter option and I salute him for doing so.
IMO silence
Unfortunately, I believe his actions have also once again highlighted a very serious leadership deficit at the heart of Irish medicine. Up until the time of writing, and throughout the emergence of this entire fiasco, the nation has heard nothing from the Irish Medical Organisation.
I cannot understand the reasons for this. While groups as diverse as the Irish Hospital Consultants Association, the Irish Patients Association, the Faculty of Radiologists and the Irish College of General Practitioners have all made their views known, the IMO has apparently taken a vow of silence.
‘Trolley watch’
This is hardly a new phenomenon. Over the past decade, the Irish Nurses Organisation has become identified with ‘trolley watch’ — the daily monitoring of the appalling suffering of people throughout the country.
Meanwhile, the IMO has chosen to say comparatively little on this subject. In my opinion, this reticence and apparent inability to publicly protest on behalf of our patients is a poor reflection on our entire profession.
It should be noted that the IMO appears well capable of expressing itself in other areas. Its public health division, for example, regularly calls for restrictions on alcohol sales. While this might be laudable in its own way, it is little comfort to those sharing a portable commode on the trolley-filled corridors of our overcrowded hospitals.
Maoist-style tirades
Other senior colleagues apparently enjoy launching into Maoist-style tirades against private hospitals. In my experience, these institutions generally answer their GP letters and report x-rays on time. Nonetheless, they appear to have been far more worthy of public expressions of medical outrage than the sufferings of the 500 people who lay on trolleys on January 20 last.
This profession needs to learn the lessons of the Tallaght debacle. We must fight the HSE in the only forum that will bring about the change we all desire — the court of public opinion, which unfortunately remains under the control of a fickle national media.
Prof Tom O’Dowd made the right call on this one. For that, he deserves our eternal gratitude.