De-Socialising Medicine
Why is the Co-Located Hospital project so evil?
Yeah, OK, so that's not the most open-ended phraseology ever; a bit like asking someone if they're still beating their wife. It's a bit hypothetical in any case, since the Co-Located Hospitals are, to my knowledge, residing somewhere in limbo. The agreements stipulated that, if the companies running the things go out of business, the hospitals revert to the government. As you might imagine, the banks loaning the companies the money weren't wildly keen about that prospect*, even before they discovered that they owed 64 trillion non-existent quid to each other.
But anyway, let's put all that to one side, and ask ourselves; what is/was so bad about the idea?
The theory was simple; give away chunks of land to a private developer, and get them to build a private hospital on the thing. Firstly, let's put the ideological objections to two-tier health systems to one side, just for a moment. There's a lot of denial about this, but we already live in a two-tier health system. VHI relief has been available on income tax for decades; once the government did this, it accepted that private health insurance was not a frivolous luxury but something people should be encouraged to have. It's shit, and it weakens the very notion of a health service, and it effectively says that the best care should only go to people who can afford it. However, the Co-Located Hospital project is a product of that climate; it didn't generate it.
The general tone of the objections, back when this was being widely discussed, was that we were giving away public land / money to private developers, in order that they could provide top-class care to the wealthiest members of society. And... yes. That was exactly what we were doing. However, it's not exactly that simple; the Co-Located Hospitals would have taken private patients out of the public hospitals, freeing up more and more public beds, and stopping the situation where the state was more or less subsidising privately provided healthcare. Yes, there would be an initial cost, and the thought of giving away public land to companies like Beacon remains unconscionably ugly. However, the maths do add up. Whatever the government give away, it's dwarfed by the interest payments they would be looking at for building a new hospital. It makes accountancy sense to stop wasting electricity on private patients.
So, my objection is this, and it's very basic.
Our hospitals are shit.
This sounds like a truism, but think about it for a moment. At a rough guess, about 85% of the hospital buildings in the country are dumps. That's no reflection on the people who work there, or the efficiency of the HSE, or any manner of professional healthcare stuff about which I know bugger-all. It's a simple statement that our hospitals are dated, outmoded, miserable, grim, and painted in that shade of green that makes you want to gnaw your own arms off. I don't even care about MRSA or how well-equipped they are, I just know that I've never been in a hospital building that wasn't crap. James'; dump. Vincent's; shithole. Beaumont; miserable. The Mater; actually worse than all the others combined, which takes some doing.
If that sounds frivolous, it isn't. Hospitals don't have to be shitholes, we've just been conditioned into expecting them to be like that. They're places where people go to be healed. This isn't happy-clappy artschool bollocks; there's been several studies carried out that show that the quality of the environment is a huge factor in patient health. Once you read anything about placebos this seems obvious, but the magnitude of the effect is astonishing. Patient recovery times in decent environments fall by 80%, and drug use falls by a half**. If a ward is looking over a flat roof, then it even has a huge effect to plant it.
I could get it into all sorts of technical chat about hospital design, if I was so inclined. I could talk about how hospital design is constantly changing for the better, and how the designs of twenty years ago are already outmoded. But suffice it to say that we don't have many hospitals in Ireland that look like this or this. Our hospitals look the way they do because, when they were built, there wasn't really an alternative to 98 miles of corridor. If you don't believe that it might be a culturally great thing to actually have hospitals that aren't mazes of linoed corridors, or that it might effect our perception of the health service in all sorts of beneficial ways, then here's a basic one; patients will be there for less time, and will need less drugs. It will save money.
And yet we keep modifying the same old buildings, adding extensions to buildings that no longer work, and expecting people to get treated in crap, crap buildings. People in hospitals are, in a very way, as vulnerable as a member of our society can be. Stop pissing about with the old hospitals, stop pouring money into modifications to shit buildings, and build something new***.
We didn't. We could afford it, of course, but it was too much bother.
When the Co-Located Hospitals project finally happens - when, if - the government can point to state of the art facilities. They can point to the increased efficiency of the new hospitals, and use it to justify more private sector involvement. And people who can afford health insurance can go to good quality buildings, while the rest get treated in outmoded facilities and portacabins. And they'll know, just as they've always known, how little we really care about them.
*Important note: this information is based on something I heard someone say that they thought they'd heard someone else say. I make no apologies for the possibility that it could all be lies.
**There's a report here, if you're so inclined. Or, actually, even if you're not. I read it, plus another even longer that I can't find again on google.
***Some maths, for those who care. A hospital would cost maybe €300m, at the very most. Given that there's a recession on, all the employment this generates (increased tax take, people not on the dole etc) means that you can probably cut that figure in half. That's €150m, split over two years. In other words, slightly less than John O'Donoghue's expenses.
Yeah, OK, so that's not the most open-ended phraseology ever; a bit like asking someone if they're still beating their wife. It's a bit hypothetical in any case, since the Co-Located Hospitals are, to my knowledge, residing somewhere in limbo. The agreements stipulated that, if the companies running the things go out of business, the hospitals revert to the government. As you might imagine, the banks loaning the companies the money weren't wildly keen about that prospect*, even before they discovered that they owed 64 trillion non-existent quid to each other.
But anyway, let's put all that to one side, and ask ourselves; what is/was so bad about the idea?
The theory was simple; give away chunks of land to a private developer, and get them to build a private hospital on the thing. Firstly, let's put the ideological objections to two-tier health systems to one side, just for a moment. There's a lot of denial about this, but we already live in a two-tier health system. VHI relief has been available on income tax for decades; once the government did this, it accepted that private health insurance was not a frivolous luxury but something people should be encouraged to have. It's shit, and it weakens the very notion of a health service, and it effectively says that the best care should only go to people who can afford it. However, the Co-Located Hospital project is a product of that climate; it didn't generate it.
The general tone of the objections, back when this was being widely discussed, was that we were giving away public land / money to private developers, in order that they could provide top-class care to the wealthiest members of society. And... yes. That was exactly what we were doing. However, it's not exactly that simple; the Co-Located Hospitals would have taken private patients out of the public hospitals, freeing up more and more public beds, and stopping the situation where the state was more or less subsidising privately provided healthcare. Yes, there would be an initial cost, and the thought of giving away public land to companies like Beacon remains unconscionably ugly. However, the maths do add up. Whatever the government give away, it's dwarfed by the interest payments they would be looking at for building a new hospital. It makes accountancy sense to stop wasting electricity on private patients.
So, my objection is this, and it's very basic.
Our hospitals are shit.
This sounds like a truism, but think about it for a moment. At a rough guess, about 85% of the hospital buildings in the country are dumps. That's no reflection on the people who work there, or the efficiency of the HSE, or any manner of professional healthcare stuff about which I know bugger-all. It's a simple statement that our hospitals are dated, outmoded, miserable, grim, and painted in that shade of green that makes you want to gnaw your own arms off. I don't even care about MRSA or how well-equipped they are, I just know that I've never been in a hospital building that wasn't crap. James'; dump. Vincent's; shithole. Beaumont; miserable. The Mater; actually worse than all the others combined, which takes some doing.
If that sounds frivolous, it isn't. Hospitals don't have to be shitholes, we've just been conditioned into expecting them to be like that. They're places where people go to be healed. This isn't happy-clappy artschool bollocks; there's been several studies carried out that show that the quality of the environment is a huge factor in patient health. Once you read anything about placebos this seems obvious, but the magnitude of the effect is astonishing. Patient recovery times in decent environments fall by 80%, and drug use falls by a half**. If a ward is looking over a flat roof, then it even has a huge effect to plant it.
I could get it into all sorts of technical chat about hospital design, if I was so inclined. I could talk about how hospital design is constantly changing for the better, and how the designs of twenty years ago are already outmoded. But suffice it to say that we don't have many hospitals in Ireland that look like this or this. Our hospitals look the way they do because, when they were built, there wasn't really an alternative to 98 miles of corridor. If you don't believe that it might be a culturally great thing to actually have hospitals that aren't mazes of linoed corridors, or that it might effect our perception of the health service in all sorts of beneficial ways, then here's a basic one; patients will be there for less time, and will need less drugs. It will save money.
And yet we keep modifying the same old buildings, adding extensions to buildings that no longer work, and expecting people to get treated in crap, crap buildings. People in hospitals are, in a very way, as vulnerable as a member of our society can be. Stop pissing about with the old hospitals, stop pouring money into modifications to shit buildings, and build something new***.
We didn't. We could afford it, of course, but it was too much bother.
When the Co-Located Hospitals project finally happens - when, if - the government can point to state of the art facilities. They can point to the increased efficiency of the new hospitals, and use it to justify more private sector involvement. And people who can afford health insurance can go to good quality buildings, while the rest get treated in outmoded facilities and portacabins. And they'll know, just as they've always known, how little we really care about them.
*Important note: this information is based on something I heard someone say that they thought they'd heard someone else say. I make no apologies for the possibility that it could all be lies.
**There's a report here, if you're so inclined. Or, actually, even if you're not. I read it, plus another even longer that I can't find again on google.
***Some maths, for those who care. A hospital would cost maybe €300m, at the very most. Given that there's a recession on, all the employment this generates (increased tax take, people not on the dole etc) means that you can probably cut that figure in half. That's €150m, split over two years. In other words, slightly less than John O'Donoghue's expenses.
Labels: In case you're wondering I've been watching a lot of House lately
posted by Nyder O'Leary at
22:25
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