Time to take stock

Schools are back, colleges open, politicians return. Another year begins: Time to take stock.

There’s no doubt the number one problem right now is housing and homelessness. I am a health service obsessive, but people are dying on the streets, not in the cold of winter but in summertime. We even had a shocking death in Nenagh this year. I gave him money ‘for coffee’ a few days before he died.

On the radio, a distressed teenager said it took a long time to “come out” to her teacher – to explain her family are living in a hotel room for a year.

How can I shout about hospitals, and the problems of my friends and family in getting hospital care? After all, no one died.

But it’s the same problem. During the lost decade of the financial crisis, no houses were built, but the population went up. No hospitals were built either.

The next big problem (obviously) is the gardaí. The Commissioner is gone but I hope that doesn’t distract from the issues.

There is a genuine crime scene in the fixed charge penalty notice (FCPN) scandal. Innocent people were hauled before judges and suggestions of perjury made against them. True offenders got no summons – all in a random manner.

In contrast, I can’t get excited about breath tests. That’s just a big meaningless number. No one was wrongly convicted. No one died. Okay, it raises questions about the truthfulness of Garda information. But there’s a major difference between admin data, to keep the computers happy, versus real information such as evidence of crime. When everyone inflates breath test figures, everyone else must do the same.

Mind you, it gives a fascinating insight into a dysfunctional public bureaucracy. If Garda management are foolish enough to sit in offices and believe woolly computer data, so what? If they use that data to judge the quality of policing in Ireland, it’s very serious indeed.

In the health service, competitive falsification of admin data is a way of life. It has to be. Hospitals are penalised if they breach targets, so there’s less money to look after patients. People suffer, someone could die. It could be my friends or family.

It doesn’t matter how bad the hospital numbers are. The aim is to look better than the rest and never, ever be the worst.

Here’s a real life example.

A 90-year-old suffered a fall and nasty head injury and was treated on a trolley overnight. At 9am the doctors said she didn’t need ‘admission’. Instead they kept her on her trolley for the rest of the day.

Here’s the trick: She’s not a trolley patient. Yes, really. The daily trolleywatch count only includes patients who have been ‘admitted’ under a specialty team. Really, truly. If you’re not ‘admitted’, the hospital doesn’t have to count your trolley. Whew!

It’s no wonder journalists say that some hospitals have cracked the problem, while people I know suffered in those same hospitals.

In a further twist – and this is the honours course – even if she was ‘admitted’ under a specialty team, the HSE computer refuses to record her, unless she gets a bed on a ward.

The result is bizarre data from our hospitals, which bears limited resemblance to reality, but people sitting in offices believe it all.

It matters. Health will join the back of the queue until the problems are understood.

Clever people assure us that health has too much money, too many nurses, too many hospitals. That’s all pretty scary. I don’t see how to solve a problem that way. Maybe they’re confused by woolly data.

Then there’s the Oireachtas <em>Sláintecare Report</em>. The reaction from both GPs and consultants seems to be ‘meh’ and mostly because of bad data.

This autumn there’ll be two more reports. PA Consulting are back to look at bed numbers. The first chapter should explain how they got it so wrong in 2007, when they recommended 9,000 hospital beds, including all day wards.

In December we’ll get the results of  the National Patient Experience Survey, based on the views of patients discharged in May 2017.

Of course, to be ‘discharged’ presumes you have been ‘admitted’, and that would exclude all my friends and family in their recent hospital travails. Not one of them managed to get to a ward.

I’m just back from Cardiff. I drove Annie over to start her stage management degree, along with her mum and the kitchen sink. There were storms on the Irish Sea on the way over, emotional storms on the way back.

Another year begins.