State to overthrow Boolean logic with cart and horse

Dr Mick Molloy argues that a reduction in bed capacity should not come before an improved health service is in place. It’s simple logic and a matter of putting the ‘IF’ before the ‘THEN’

George Boole was the first Professor of Mathematics at Queens College, Cork (now UCC) in the early 19th century, and inventor of what we now know as Boolean logic. This logic many of us have studied formally or informally in economic theory, mathematics, physics, applied mathematics and the switch logic derived from it forms the basis for modern digital computer logic.
Without knowing it we have been using these terms for most of our educational lives, and George Boole was the first to try and explain such mathematical constructs in English — and also to do the reverse to create mathematical constructs from simple sentences.
Those familiar with the TV show Numbers would realise what I mean here. Where would we be were it not for computer logic? Well where would we be were it not for logic? Many medical researchers use this without questioning when doing background research on the internet using PUBMED.
The terms used for searching ‘AND NOT and OR’ are Boolean search terms. The modern researchers — using reference manager packages and other databases for searching — are probably not as familiar with these terms as those who used PUBMED in the original format, but nonetheless Boolean logic is what we use whether we know it or not.
Accountants also use other forms of the logic, again possibly without even knowing the derivation, when they use ‘IF THEN’ conditional statements in Microsoft Excel.
They use such conditional statements within the programming language to calculate our taxes, for example. IF income is greater than €10,000 THEN tax is calculated using a certain formula and a certain value is returned.
The IF THEN rules
When a figure is entered which is lower than €10,000, for example, another formula is used to calculate income tax owing at lower levels of income. The piece of software — Microsoft Excel — is programmed to follow the ‘IF THEN’ rules correctly in every case as long as the person creating the statement understands how to create the basic construct.
I was pleasantly surprised to see a new ESRI report, Projecting the Impact of Demographic Change, which looks at the impact changing demographics will have on demand for health services. Within this ESRI report, reference is made to the PA consulting Group report on Acute Bed Capacity from 2007.
The PA report stated that if demand for health services continued as is, without any other change, there would be a requirement for an Acute Hospital Bed Capacity of 19,822 public beds in comparison to the 11,660 that apparently existed in 2007.
This data is not unfamiliar, as a previous Hospital Bed Capacity study suggested that with maximum efficiencies, reduced length of stay moving more to day-case surgical model, we would need an additional 3,000+ acute hospital beds.
This 2007 PA report must have slipped by me because the current ESRI report references other statemenets made suggesting that with a new ‘preferred health system’ (PHS) only 8,834 public hospital beds would be requird in 2020 – despite the population having increased to around 5 million at best estimates and a significantly larger group of people living longer with multiple co-morbidities.
I will have to dig out the 2007 report if I can find it to study the PHS but those figures both astound and worry me at the same time. They are slightly couched by the fact that the ESRI report mentions that the PHS is now government policy. The cycnic inside me now says that is OK, because it will never happen, but the scientist deeper inside me is questioning further and worried, and hence the reference to Boolean logic earlier in this text.
Preferred health system
Changes to acute hospital bed capacity in this context would seem to be an obvious IF THEN construct. IF we move to a PHS (where there are dramatically more long-term care facilities, day-care beds with appropriate staffing and diagnostics, significantly reduced average length of stay with concomitant increase in intensity of medical work done while the patient is in an acute bed, significantly enhanced care in the home strategies and considerable expansion and enhancement of primary care personnel and facilities) THEN we may eventually have a scenario where we can reduce the number of acute hospital beds.
Cart before the horse
My worry in reading all this and looking at the changes that have happened in recent years is that the HSE or Department of Health may be trying to disprove 170-year-old Boolean mathematical logic by moving from an IF THEN logical construct to a new THEN IF construct where little change will take place, or certainly the change required will not take place, but the biggest immediate money saver – a reduction in acute hospital beds – will happen in a cart before horse, or THEN before IF, situation.
An illogical construct
Someone may write a great mathematical logical paper out of this and may well receive awards as Professor Boole did, but I fear for the health service trying to prove such an illogical construct.
If one lives in a house and wishes to renovate or reconstruct, one doesn’t do that prior to finding somehwere new to live, and indeed there will be a time period in one’s life where both the dwellings exist as financial costs to be experienced before one moves back to the original dwelling.
The same will inevitably hold true in such a massive change in health policy. IF must proceed THEN and not the other way around.