Fragmented system, fragmented lives

Fragmented, poorly developed and unfair,” are the words used to describe the current health system in the recently published report, <em>A Future together: Building a Better GP and Primary Care Service</em>. We have a health service that is somehow disconnected, incomplete and unjust. But the health service is made up of people. So, if this is true, then it is really all of us involved in the planning and delivery of care who are disconnected, lack unity and behave unjustly. We may have our own version of why this is so, but while we are deciding who is most responsible and what changes are necessary, what does this system actually look like for those unfortunate enough to need the care that we are not providing?

While on a house call to Seamus, a 39-year-old man with lower limb paralysis, following a car accident two years ago, I recommended that he go to hospital for assessment. He had a persistent pressure sore that had confined him to bed for over six weeks as sitting up was impossible. His public health nurse had provided excellent care but this wound was not healing. At the mention of hospital, both he and his wife looked at me as if I had just suggested they enter the TV show <em>Ireland’s Fittest Family</em>. Seamus rarely left his house and hardly ever to go to hospital.

“Do you not remember the fun and games we had the last time you sent him in?,”exclaimed, Margaret, his wife. I could indeed remember, but without waiting for an answer she proceeded to recount the story, still fresh in her mind. “We couldn’t get an ambulance to take him because it was not an emergency appointment. Do you not remember, we had to ring the head office and explain that he couldn’t go in the car, but they have that policy of only taking emergency cases. Only for the Order of Malta being so good as to send an ambulance he would never have got in. It was a disaster from start to finish. Remember, I told you, we had to wait for hours in the casualty even though you specifically asked that he be seen quickly. They had no air mattress for him and I was so worried all day about him getting another pressure sore. By the time the doctor came, we were both so stressed that we just wanted to get out of there. Is there nothing else we can do? I have terrible memories of that day.”

Seamus lay propped up in his bed, on his air mattress, medical equipment casually intermingled with the soft furnishings of a regular bedroom, the dedication and care of his wife almost palpable between them. He had been watching us closely. I thought how much easier it would be for him if someone could come to him rather than he having to travel the 20 miles to hospital. I thought how unfortunate it was that the wound specialist community nurse had retired and was not being replaced. She may have had something up her sleeve that would keep him at home. As it stood, I had no option but to refer him.

“You have your work cut out for you today, doctor,” Seamus said smiling, as if he was reading my mind. “Are you sure you want to do this?”

I smiled back, appreciating his sense of humour. “Are you up to it?,” I asked, “because if you are, then so am I.”

We both looked at Margaret. “Okay so, she said, with a sigh of resignation, I better get on to the Order of Malta. I am not ringing the HSE ambulances after the run-around they gave me last time. Can you hang on before getting on to the hospital, doctor, as they may not have a free ambulance today.”  “Of course,” I replied. “You see what you can do about the ambulance and I will see about an assessment. Hopefully, you won’t have to wait as long as last time.”

“I wouldn’t bank on that, doctor,” said Seamus, “but luckily, I don’t have a whole lot else on my agenda for today.”

This is what a “fragmented, poorly developed and unfair” health system looks like from the inside. An incapacitated man relying on a voluntary organisation for transport to hospital. A public health nurse with no specialist community support. An emergency department that does not have an air mattress. A GP who feels guilty for suggesting hospital referral because of the unnecessary stress and risk to health that this incurs.

We can gather data and write reports that diagnose the health service but this is not worth the paper it is written on if it is not accompanied by a concerted effort to help people cope with their fragmented lives, one patient at a time.