Comment: Health Service Broken – Is It Beyond Repair?

This week it was reported that 350 people were on trolleys in accident and emergency departments in Northern Ireland waiting for a hospital bed. When one sees elderly patients waiting for 36 hours, when one sees staff in casualty juggling multiple patient conditions, when one sees ward staff desperately free up space it is clear that the health and care sector is broken.

The number of workers is below what it should be. The number of hospital beds is too low. As to the residential and nursing homes there are too few.

What this means is that Northern Ireland can no longer have a health and social care sector that caters for all of the population.

For decades it has been clear that there is an aging population. The demographics are clear, have been clear for all professionals and casual observers alike. It is almost right years since Professor Rafael Bengoa published the report Systems not Structures. The report pointed to a series of reforms and ways forward.

A quick glance at the Department of Health reporting on progress reveals that there are transformation boards, groups, conferences and such like.

However, one thing it does not show is a 93-year-old man on a trolley in a packed area waiting for 36 hours for a bed on a ward. What it does not show is the bay he is in, normally equipped for six trolleys, packed with eight and no space for relatives to attend for more than a few moments. Nor is it likely to, as figures, statistics, pushing ‘modelling’ of the system around a table are easier. Especially if there is no one pushing the buttons; no minister ready to kick the bureaucracy into tomorrow in favour of action.

Not that MLAs have been proactive over the periods when they have been sitting. In his conclusion Prof Bengoa said:

“The stark options facing the HSC system are either to resist change and see services deteriorate to the point of collapse over time, or to embrace transformation and work to create a modern, sustainable service.”

The drive for ’Care in the Community’ contributes to the ethos that moves patients back into their homes. The principle is sound; with the right care package people want to stay in their homes as long as possible. When they suffer from an illness or an accident then they too often fall through the cracks or are shunted back to home before it is appropriate. If it is deemed to be appropriate to have a respite space in a residential or nursing home they may as well whistle in the wind.

It is cracked so much that it may be the case that staff at all levels have come to accept the situation and have neither the will nor the fight left to battle the monolith they seem to face.

It is also worth noting that catering for someone at home is cheaper than a place in a nursing or residential home, once private patients are discounted. They will maybe have to have sold their house to pay, but there is no willingness to avoid stripping someone’s inheritance.

For those readers of a certain age there once was a time when the health and social care system provided these homes, but it was deemed too expensive.

Fingers can be pointed, statements can be issued, monies can be spent, but there needs to be a fundamental re-think of what the health and care system should be.

It should be about the health and care of every member of the populace. It should be about protecting their dignity and afford them the life they deserve from their earliest years to the fading days of their lives.

It is not about counting the pounds and pence; it is about shaking up the system, but more importantly focusing on every person’s care.

Not that there seems to be action from the political classes nor senior civil servants. Better to talk, shuffle the papers and issue statements.

And, to remember that behind every statistic is a person. A human being.

Northern Ireland’s health and social care system is broken right now. To not have the will to fix it completely represents the willingness to forget that the human being.

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