Health by numbers: 8,834 is mark of the beast

Minister for Health Simon Harris was “ashamed and heartbroken” after watching RTÉ’s programme on waiting lists. In January, the Minister said the record number of trolley patients couldn’t have been predicted.

He’s been in the job since May. What does he believe? What’s the plan?

I’ve found a clue and it’s very troubling.

A couple of months ago, Minister Harris told the Dáil, “if we shifted care from hospitals to the community, the projected number of acute hospital beds could fall to 8,834” — 8,834? My blood ran cold. I recognise that number.

I trawled through my stash of health reports and found it. Yes, it’s Appendix K from the 2007 report by PA Consulting. I’ve written about it before (<em>Lies, damn lies and statistics</em>, <strong><em>Medical Independent</em></strong>, 18 March 2010)… 8,834 is the Mark of the Beast.

The report is really soothing for a rattled health minister or Department of Health (DoH) stalwarts. It (supposedly) maps the inappropriate use of acute hospital beds and provides solutions.

Even better, the report puts numbers on these items.

A 25 per cent increase in diagnostics will yield an amazing 33,000 extra discharges. Admitting patients on the day of their surgery will save a fantastic 140,000 bed days. Increased discharges on Friday and Saturday will give a whopping 135,000 extra discharges (no wonder there’s such a push towards weekend working).

There’s a focus on reduced length of stay, discharge planning and non-acute care.

The key message is that the hospital system is grossly inefficient. There absolutely isn’t a shortage of beds. New contracts are needed to change work practice.

I reckon that’s why there’s plenty of maudlin reaction from on-high to the plight of patients on waiting lists or on trolleys, but zero action.

And it explains why the finger of blame points at everyone except the Minister and the Department of Health.

<em>Ochón</em>! Patients are wasting ambulances and hospital time with minor problems; families refuse nursing home care to protect their inheritance; HSE managers don’t do something or other. That’s why there are trolley crises and waiting lists!

It’s lovely for us doctors not to be blamed for a change, so we don’t pay much attention.

But all those media stories are just distraction. The scary truth is that patients on trolleys are sicker than ever.

People close to me have been admitted with heart arrhythmia, severe abdominal pain, stroke with grand mal seizures. They were all referred by GPs. New contracts or extra diagnostics would not have changed the situation.

None of them got ward beds, so the HSE pretends the admissions did not happen. It’s yet another hidden list.

This is the real world.

Where did the numbers in the PA report come from? There’s 100,000 elective admissions: How can admitting on the day of surgery save so many beds?

I’ve read the report — all four volumes and all the appendices. As the research methods are vague, I spoke to colleagues who were involved.

And I found myself in a world of ‘alternative facts’.

Inpatients were surveyed using a tool called the Appropriateness Evaluation Protocol (AEP). I’ve used it. Patients can be very ill but be outside AEP. Forty per cent were found to be outside the criteria. The report explains that this compares very favourably with other countries — but that discussion is hidden in an Appendix.

Instead, the main report decided (bizarrely) that the 40 per cent did not need hospital care. A second survey looked at these cases.

This is how it was done: My colleagues sat in offices and looked at files. They did not have vital signs, or medication records, or any nursing notes. They did not speak to patient or family, nurse or doctor.

Based solely on the medical file, they decided what each patient needed to be discharged, or avoid hospital altogether.

That’s ‘La-La Land’.

There are very few hospital consultants who could decide what a patient needs just by looking at the medical file.

But management consultants are braver than us doctors. They turned soft opinion and guesswork into hard numbers, then they predicted future bed requirements and arrived at Appendix K.

You can Google it. ‘Appendix K: Beds by Specialty Group’. But be prepared for a shock. The recommended total of 8,834 beds includes over 3,000 day beds. Yes. The PA Consulting report concludes that our hospitals need only half the current number of beds.

That’s the report the Minister has such faith in, and DoH too. It is my duty to inform them it’s ‘Fake News’ based on rubbish data.

8,834 truly is the Mark of the Beast.