Susie Long: A link and a transcript

There’s little to add to the discussion of Susie Long, RIP, dead from a late diagnosed case of bowel cancer after a 7 month wait for a colonoscopy as a public patient. Here’s a link to her letter to Joe Duffy (which is as revealing about hospital-acquired infections as her own case), and then below, the text of yesterday’s discussion in the Dail during Leaders Questions. Bertie’s passive voice approach and his refusal to see anything systematic in her case make for very irritating reading. In particular, note that Bertie never actually admits that Susie got worse treatment because she was a public patient.

The Taoiseach: … I know there are problems. Deputy Kenny mentioned the death of Susie Long last Friday, and how she fought her case and obviously felt let down by the system.
Deputy Jim O’Keeffe: She was entitled to feel so.
The Taoiseach: I followed what she said about how her diagnosis was handled given that she was a public patient and not a private patient, an issue about which she felt strongly. It is regrettable that the system did not live up to the standards in that case, as has been clearly put forward.
Deputy Pádraic McCormack: There are thousands more such cases.
The Taoiseach: I extend my sympathy to the family of Susie Long on her death.
Deputy Jim O’Keeffe: She was kept waiting seven months for a colonoscopy ….

Deputy Pádraic McCormack: Is the HSE working?

The Taoiseach: I am not involved in individual cases but, at times, people look around to find the emotive angle rather than any other. We are talking about the HSE being 1% over budget. With the small amount of resources involved, for a short period in the year, everybody should do their best to ensure sensitive services, of which cancer is just one, are not affected.

Deputy Seymour Crawford: What about the removal of home help for the elderly?

Deputy Eamon Gilmore: Susie Long was a very brave woman who has done this country a great service. Her e-mail to Joe Duffy last January, which is reprinted in full in today’s The Irish Times, is probably the most compelling narrative we have seen about what is wrong with our health service. She describes how she had to wait for seven months for a test which could have been carried out in three days and describes the disgusting conditions she had to endure at the Mater Hospital while she was a patient there. The Taoiseach is wrong. Susie Long did not blame the system – Susie Long blamed the Government. I will read from her e-mail, which she wrote when she was, admittedly, angry:

“I’ve finally reached the angry stage, I guess. Who am I angry at? I’ll tell you, Joe. The health service has been in the hands of Fianna Fáil and the PDs for years and all they can think to do is put resources into privatisation. They don’t have the ability to change structures in the public sector that would put more resources toward patient care.”

Why did Susie Long have to wait seven months for a test that could have been carried out in three days? Why, if medical science, hospitals, consultants and doctors are in a position to carry out a test or procedure for a patient who is insured or who can pay directly, do public patients have to wait for months for the same service? After more than ten years heading this Government, what is the Taoiseach doing to put that right?

The Taoiseach: It is deeply regretted that any patient referred to a hospital with possible symptoms of cancer was subjected to a delay in diagnosis.

Deputy Damien English: It is normal practice.

The Taoiseach: As we know, the earlier the diagnosis of a cancer is made and treatment commences, the better for the prognosis. The Minister has been assured by the Health Service Executive that any patient referred to St. Luke’s for an endoscopy which was considered urgent by a doctor is given an urgent appointment and is seen within a week or two. That is the stated policy of the organisation. Urgent cases are forwarded daily, directly to the medical consultants, for prioritisation and general practitioners are encouraged to make contact directly with the medical consultant. That is how the system is meant to operate and how it normally operates but it did not do so in this case, which I acknowledged earlier this year. The system should have allowed Susie Long to be given a diagnosis and that should have been the case whether she was a public or a private patient.

Deputy Pádraic McCormack: It is not the case.

The Taoiseach: Very regrettably, it was not. Susie Long concluded, from her conversation of that day, that it was because she was a public patient. I can understand that, but that is not the practice or the policy.
I do not want to repeat the data to Deputy Gilmore but enormous resources are being put into the health services. In the period I have been Taoiseach, they have increased from approximately €3 billion to €15 billion.

Deputy Damien English: The country has changed.

The Taoiseach: Most of that figure goes towards staff, with almost 120,000 staff employed to provide services in what is a relatively small country.
Deputy Noel J. Coonan: The Government is getting rid of them now.

The Taoiseach: I have acknowledged some of the services which we do not have but resources are being prioritised and given to certain services such as those related to cancer. BreastCheck alone has received €60 million in additional funds in the past decade. As part of the capital programme, €27 million was spent on services last year.

Deputy Pádraic McCormack: Why are they not working?

The Taoiseach: Resources are improving services but is it perfect? Are there services in every part of the country? At this stage there are not but I have outlined why the reform programme is necessary. One of the aspects of the reform is based on the continuous advice that we are better having centres of excellence in fewer locations, where all ancillary services and all the medical and surgical facilities are available in single campuses. It is hard for people to accept that because they believe it is better the services be as close as possible to their own homes—–

Deputy Liz McManus: That is not the point.
Deputy Damien English: They are afraid they will not get into the hospitals.
Deputy Olwyn Enright: People are fed up waiting.

The Taoiseach: —–but that is not the advice of any international group which has looked at the matter. The Health Service Executive is doing its utmost, as are we by committing resources to assist in that regard.

Deputy Liz McManus: Is that why we have a staffing crisis?

The Taoiseach: The HSE has approved over €5 million to build a new 24-hour day-procedure purpose-built colonoscopy unit at St. Luke’s in Kilkenny. It is putting in the resources for the facilities to provide the services to which Deputies refer.

Deputy Eamon Gilmore: The Taoiseach’s answer is a total red herring. First, how does one know a case is urgent until one carries out the test? This woman was looking for a test to be carried out to establish her condition. To suggest there can be an urgent and non-urgent list, as if GPs, to whom patients present in the first place, can, without the benefit of the diagnostic tests, make such judgments in advance, is absolutely absurd. If it is suspected that somebody has cancer, to the extent that they need a test for the disease, that is pretty urgent and they should not have to wait seven months for that test.
There is a problem in the way the Taoiseach looks at the health service. He looks at it from a completely different perspective from the people who experience it. He looks at the health service from the perspective of reports, advice, the HSE and budgets, etc, but the people who have to use the health service see it from the other end. They see it from a plastic chair in a waiting room. From that point of view they are seeing a service which they expect to receive and are not getting. I accept that the Government is spending more than €14 billion per year on the health service and that 120,000 people are employed in it. However, with a population of slightly more than 4 million, it must be possible to organise the service so as to avoid the continuing problems we experience day in and day out.
The tragic case of Ms Susie Long is not a lone one. People tell us every day of their experiences waiting for procedures and tests. The issue, which after ten years in office the Taoiseach has not addressed, is the provision of a health service to which everyone has access, regardless of ability to pay, possession of insurance or appearance on one list or another. Anyone who needs a service should be able to access it reasonably quickly. No one should have to face the awful circumstances endured by Ms Susie Long and eventually expire.

The Taoiseach: The Minister for Health and Children has been assured by the Health Service Executive that any patient referred to St. Luke’s Hospital for an endoscopy and considered urgent by her doctor will be given an immediate appointment and seen within one or two weeks.
I do not look at the health service from a strange or different perspective from Deputy Gilmore. I hear what patients are saying and I also hear complaints. Improvements are required. Annual capital investment to improve services and facilities amounts to €500 million. In some cases reforms are necessary. These are well documented. The HSE and the Department of Health and Children have spelled out where reforms would systematically help the health service in areas where there are difficulties. For example, they believe centres of excellence and the grouping of consultants and facilities would lead to a better service, which brings its own controversies.
Availability of staff is also an issue. The health service must be available 365 days a year. It is not a 35 or 39 hours a week service. Extra staff are needed at key times. Reforms are required and we are trying to implement them at all staffing levels.
I acknowledge that many complaints are genuine and that upsets or even fatalities are suffered by patients. Nevertheless, when patients, as distinct from commentators, were asked about the health service, 76% of inpatients said they were admitted to hospital immediately upon being told they needed admission.

Deputy Pádraic McCormack: If they got that far.

The Taoiseach: In response, 11% said they were admitted within one month and 4% within three months; 76% of non-GMS patients were admitted to hospital immediately they were told they needed admission; 83% of hospital inpatients felt they had been treated with dignity and respect; and 64% of inpatients and 54% of outpatients rated their experience as excellent.

Deputy Damien English: The Taoiseach is a joke.
Deputy Fergus O’Dowd: What about MRSA?

The Taoiseach: There are difficulties but one should not try to paint a picture which puts fear into people who are going into the hospital service when those in hospital rate the service as very good. One should not turn the health service into a fear issue.
(Interuptions).
The Taoiseach: I acknowledge difficulties where they occur but these are the facts as given by 3,500 people who were beneficiaries of the health service. They did not all say they were satisfied but a high number, by international standards, commended the service. We will continue to deal with areas where there are difficulties.

Deputy Leo Varadkar: Did they survey the ones who died?