Thursday, January 12, 2023

The national news has been replete of late with stories about people on trolleys in hospitals all around the country. Covid, seasonal flu and other illnesses are creating perfect storm for our health services. The lists from hospitals all around the country of numbers on trolleys are terrifying.

Except, that is, in UHW, which despite horrendous pressure on our Model 4 hospital, there were, at the time of writing, none!

In an article in The Irish Times on January 4, Paul Cullen wrote that there were two answers to the hospital trolley crisis.

“The first is more hospital beds. The second answer to the problem of overcrowding lies in the system itself. A system weighed down by vested interest is averse to change. Yesterday 3rd Jan UH Limerick had 97 patients on trolleys. UHW had none. There is a consistent and huge disparity between the best and the worst performers, go figure!”

In a WLR interview later that day, UHW hospital manager Grace Rothwell said quite emphatically:  “We do not do trolleys at UHW!”

It is quite difficult to understand what is happening when you examine the list of this country’s 32 or so, acute hospitals and see that UHW has a long history of no patients on trolleys, while every other hospital seems stricken with the problem.

What is our hospital doing right that others are not? Health Minister Stephen Donnelly (FF) was in UHW before Christmas to see for himself.  Why is UHW practice not being replicated elsewhere?

In the weeks before Christmas, this issue was aired by The Examiner and was picked up by Newstalk and RTE Radio 1.

Ms Rothwell was interviewed at length and explained how every resource available to UHW was utilised to keep people off trolleys, including sending people off-site to UPMC and other facilities.

One must presume that the same latitude is available to hospital managers in other areas but is not being used.

Again, on the day Ms Rothwell was interviewed, Sinn Féin health spokesman David Cullinane was interviewed on national radio and seemed to me to be dismissive of UHW’s success, and concentrated on the needs of hospitals in Limerick, Cork and Galway. I don’t think he mentioned UHW’s long list of needs.

Maybe he prefers, in the interests of politics and his own party political ambitions, to confine himself to the national picture and is reluctant to mention his home town for fear of being labelled “provincial”?

Ms Rothwell, by the way, has lobbied trenchantly for extra beds and extra resources (extra everything, actually!) at UHW.

“Why is UHW’s trolley practice not being replicated elsewhere?”

There is a consensus that extra hospital beds are needed in Ireland. OECD says we have fewer than three beds per 1000 people compared with the average international figure of five. Between 2012 and 2021, 1000 beds (a 10% increase) were added to the HSE system. More are needed and will be developed by government. The Waterford worry is that those who shout loudest get the most attention while those who work away with available resources to look after patients get a pat on the head.

“Great work, guys” as the capital investment goes elsewhere. Is effort ever fairly rewarded in Ireland? Those of us who remember WRH (as UHW then was) between 2011 and 2014 confining itself to working within a Cork imposed budget while hospitals in the latter city and everywhere else across the country blew their budgets, recall what happened.

Cork and other hospitals had their over spending recouped without demur while UHW’s budget literally stood still, with a budgetary increase which failed to even keep pace with inflation.

The budget busters were rewarded, while the Waterford budget keepers got a sh*t kicking for their efforts!

Waterford is politically weak at present. Cork has always been screaming about extra medical resources and has been plastered with investment to an extraordinary level, by its political representatives.

How likely is UHW success at Emergency Department trolley management, the national metric for “hospital under pressure”, to be rewarded when the next HSE Capital Plan emerges? Mary Butler (FF) is Minister of State in the Department of Health. Has she the grit and stamina to demand a fair allocation of resources for UHW to reward good management, excellent staff and sheer hard work?

Will we be fobbed off as ever, with “the demands were greater elsewhere?” It’s an extremely difficult call and a calculated gamble. Would we be better off with 50 people on trolleys every day? Is that Ireland’s reality?

UHW has three projects with full planning: a vertical extension of the Outpatient’s Department, an extension of the laboratory and a redevelopment of a store as an oncology facility. When will they commence?

A massive refurbishment at St Otteran’s, allowing community specialties be decanted from UHW, thus creating extra space, has planning (since July 2021) and was tendered in Dec 2021. Work has not started.

The proposed new UHW psychiatric unit, a pet project of Ms Butler, has been utterly long-fingered over the past two years with paltry (miserly actually) funding committed to its progress. It is unlikely to advance to construction before the next election.

UPMC’s Chief Executive was in Waterford some years ago and said that the future of the city lay in “Eds and Meds”, education and medicine.

He even floated the notion of a medical school co-operation between UPMC and SETU (WIT).  No-one needs a crystal ball to understand why WRH was nearly crippled when tied to Cork in 2014, or why WIT had its future deeply compromised by linkage with Carlow IT. Politicians in other parts of the south east can see the future just as we can and have been adept and willing to do anything to undermine developments in Waterford in the two fields mentioned.

It is self-evident that had the old South Eastern Health Board (SEHB) hospital network survived that UHW would have developed much more quickly.

It is equally evident that a stand-alone university in Waterford and a TU across Carlow, Kilkenny and Wexford would have hugely benefited the South East region.

Suffice it to say, since Interventional Cardiology was first provided at UHW, that St Luke’s Hospital (Kilkenny) has sent only one patient there for cath lab treatment. That attitude speaks volumes. Hopefully 2023 will be better!

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