Why the silence of 10,000 surgical postponements

Cancelled operations up 10% to 18,000 in 2009

This is not surprising. The population gets older. The number of surgical
beds shrinks and the speed of turnover increases, the effects on case
cancellations will multiply. There is also the unresolved problem of A&E
trolley occupants having priority over elective admissions virtually
irrespective of the reason for elective surgery. Probably, the only way to
deal with this problem in the short-term is to have whole secondary and
tertiary care hospitals with no A&E service.

What is most interesting here is the absence of a loud cacophony coming
from surgeons and anaesthetists all over the country. To-day I heard of a
surgeon going from Beaumont to Connolly to operate under the terms of the
share out agreement between the surgeons in the two hospitals. The theatre
session was ok on day 1. then there was only one case on the next occasion
and then no case the following day because of a lack of admission beds.

I did not notice a picket on the gates of Connolly Hospital protesting at
this waste of time and money. Joe Public is paying for this in terms of
contracted surgeons and anaesthetists.

Why the medical silence?

Firstly, self preservation by consultants because of gagging clauses in
contacts and the rein of administrative terror in the hospitals is
pervasive. Read the new 2008 contract and it is there for all to see.
Remember, the culture of silent conspiracy that is endemic in medicine. I
find it amazing that journalists do not seek out the gagging clauses
introduced by public hospitals like Beaumont to protect their corporate
image. You might think that somehow Beaumont is a private commercial
enterprise and not a publicly funded and managed hospital.

Financial interests are second. No clinical consultant loses any money
through cancellation of operations on public patients in public hospitals.
Because of “nothing to do”, it is perfectly logical to whistle-up your
tipstaff and head for a private hospital. There you will be rewarded for
your enterprise and still collect your public bank transfer at the end of
the month.

It is even feasible in this state to own your own private hospital and hope
that there is never a bed to admit any elective patient.

The other downside of this is the requirement for surgical and anaesthetic
accreditation and training. How can a consultant who has very limited
access to theatre time in a public hospital train publicly funded
registrars on training programmes. I know that accreditation for training
in private hospitals is now on the agenda. But……………..

I will be impressed when I hear that then surgical and/or medical division
of any public hospital calls a press conference to expose what is going on.

At the HSE Forum for Dublin Northeast last month, I proposed a motion which was unanimously carried to call on the Board of the HSE to order Lean
Studies on the administration of the big hospitals in this area starting at
the CEO level and heading down several grades – Mater, Beaumont, Connolly,
Drogheda, Cavan -. The purpose is to focus services on patients and not
close wards. I have experienced administrative malfunctions throughout my
career in Beaumont and Connolly. The Croke Park agreement allows for change that should have been already been lead from the front. My guess is that the top of the HSE management would prefer a silent go-for as CEO than a
patient advocate in the same mode as John Lonergan in his time as Governor
of Mountjoy Prison.