A&E debate

Monday’s RTE’s Prime Time did a major undercover documentary on the state of A&E Departments in several hospitals. Some patients were featured who subsequently died, one within days, from their illness.

It was followed by a panel discussion on RTE’s Questions & Answers, which included representatives of the various medical groups, politicians and Professor David Drumm of the HSE.

Overall it was a fairly balanced and positive debate, but you could still detect the individual and powerful vested interests who work within the hospital system, notably the Consultants but the Nurses won’t be too far behind.

I detected a certain satisfied smugness among the consultants in the front row of the audience as the heat from the earlier Prime Time documentary was reflected onto Minister for Health Mary Harney and Professor Drumm. You get the sense that as more heat is generated by the media, the consultants (and the nurses) see the opportunity of catching more of the money that will be thrown at the problem. Professor Drumm revealed that the 4,000 Junior Hospital Doctor's earn, on average, €50k+ p.a. in overtime alone - so they have no financial interest in changing the system. They're not alone in being major financial beneficiaries from the additional money put into the Public Health System in recent years.

The reality is that none of the medical and nursing professional groups is willing to acknowledge that they themselves are a major part of the problem. Each tends to blame the other and/or the system. The internal politics in the hospitals would match anything you’d see on “Yes, Minister”. The inability of management to "hire & fire" allows individuals and groups to play silly games without fear of punishment. The wider public services must be riddled with and hamstrung by this type of nonsense.

It's also far too easy to blame hospital administrators for the problems in A&E. How can they reform a system where the various interest groups are so powerful and clearly refuse to co-operate or volunteer changes in their own work practices? If a succession of Government Ministers have failed to achieve movement with these powerful vested interests, how could we expect a lowly Hospital Manager to do so?

Footnote: An abbreviated version was read by Pat Kenny on his RTE radio programme.