Health is Wealth
It really is a question of priorities. As Chris Lyons, network chief of the HSE North Dublin, observed, ‘It takes a population of 200,000 to properly sustain a small hospital’ - as though a hospital were a medical fattening station, to be fed by the people living in its hinterland. In this topsy-turvy world, the patient exists to serve the hospital; and communities exist to provide the essential nutrients that medicine requires for its empires - the disorders and conditions that permit its specialties and sub-specialties to thrive.
Marie O’Connor, Emergency, Irish Hospitals in Crisis, 2007
Trying to get a handle on what’s going on in the health service I stumbled across Marie O’Connor’s book, Emergency, Irish Hospitals in Crisis. She is a journalist and a member of the anti-Hanly Health Services Action Group. The book provides a lot of food for thought , among the ideas explored are how the health system is run for the benefit of the medical profession rather than the people it is supposed to serve, the increased trend towards privatisation and market driven corporation solutions, and how the health service is less and less accountable to the democratic institutions of the state. It’s worth reading alone for the shocking insights into how maternity care works in this country.
She writes:
The Government’s plan to centralise our hospital services raises issues over the kind of society we are creating, and have created: the dominance of technocracy, the loss of social solidarity, the rise of a small, powerful, urban, academic, elite that has driven a particular agenda in medicine for forty years, or 400, resulting in a massive loss of equity for town and country alike. We now have a health system that actively discriminates against local communities, their hospitals and their staff. Consultants there (and elsewhere) practise a les prestigious, less careerist and more community-oriented form of medicine. There are different strands in medicine, different views; only one is in the ascendancy. Today, the untrammelled rise of the biomedical or technocratic model of health has all but snuffed out the flickering social model. With primary and community health systematically starved in recent decades, local communities are doubly in jeopardy.
Marie O’Connor, Emergency, Irish Hospitals in Crisis, 2007
Having a Health minister who is ‘closer to Boston than Berlin’ doesn’t fill me with confidence that this situation is going to change.
Mark Waters marked time at 6:58 pm on April 16th, 2007 .
I thinking someone is misreading Chris Lyons meaning in the first paragraph. What is is saying is that if you are a specialist in a particular area you need to be seeing/treating cases in your area reasonably regularly to remain competent. If the hospital catchment area is smaller than about 200k then for common illnesses there won’t be enough people there to ensure the level of care is adequate.
And the it would not be efficient use of that specialists time to have them idle or working on areas they are not competent in.
I would rather a consultant that is a specialist in their area and well practiced, that a “jack of all trades” who might only see my condition once in a blue moon.
It’s a nice theory and one that I nearly bought into myself. However in reality it doesn’t work like that. Specialisation requires centralisation and in a country with a dispersed population such as Ireland, centralisation of services has a detrimental effect in terms of patient access and patient outcomes. I agree that there is a place for specialisation but what we have now is specialisation gone mad with ever increasing divisions into new sub-specialities all of which seem to serve the needs of the medical profession and not those of the patient.
The vast majority of cases presenting at hospitals can be handled by generalists and do not require specialist treatment. It would be nice if we could have a ‘both-and’ rather than an ‘either-or’ situation where we had specialists at centralised units and generalists dispersed among the population. However, specialisation is coming at the expense of generalisation. We are not producing enough general surgeons anymore.
The creep of specialisation has now extended into services such as maternity and Accident and Emergency. I would not regard these as areas that should be centralised and specialised. For these services the most important thing is patient accessibility, that patients are within the so-called golden hour in terms of time to access.
My local hospital lost its maternity facility 15 years ago and almost lost its A-and-E in 2004. Only street protests prevented it. There has been a continual rundown of services in the hospital to the extent that pretty soon they will be able to justify its closure on safety grounds. I do not live in an isolated rural area. The catchment area for this hospital is around 100,000 people.
You say that you would rather a specialist than a ‘jack of all trades’. The reality is that unless you are lucky enough to live close to a so-called centre of excellence you have no choice, you have no service, and you will suffer as a result. People have died that would otherwise be alive due to this policy.