Chapter 1: What is the main topic discussed in this episode?
The Clare Byrne Show on Newstalk. With Aviva Insurance.
We begin with the National Ambulance Service engaging in a strike today in this dispute over pay. The HSE is warning of significant disruption to ambulance services. Pickets are at ambulance bases around the country as part of the action, which started at 8 o'clock this morning. It'll last for 24 hours.
Well, I'm joined now by Dr Brendan O'Shea, who's Assistant Professor in Medicine at Trinity College Dublin. Good morning to you, Brendan. Good morning, Brendan.
Chapter 2: What is the reason behind the National Ambulance Service strike?
Can you hear me?
Good morning.
Good morning. Good to have you with us, Brendan. From your point of view, are there immediate patient safety risks when something like this happens?
We have to consider that there would be.
Chapter 3: What disruption is the HSE warning about during the strike?
This is an essential service and is catering to time-sensitive medical conditions that evolve in the community. So in theory, there absolutely is a concern. I'm looking at this from the perspective of a general practitioner. There are large numbers of vulnerable people, particularly older, complex people, and this is a cause of significant concern for them, as well as a real and material risk.
Also looking at it from the perspective of a GP out of ours cooperative, I'm the medical director at KDOC. To date, we haven't noticed any impact. But today, again, there's an uncertainty with respect to what's going to happen later on during the day.
And also, I mean, there may not be an official, we might not see officially that there is an impact here, but it is likely, isn't it, to impact people's behaviour when they know that there is a strike on and they're considering whether they will seek medical help or not.
Yeah.
The majority of people are very effective at understanding whether they're seriously ill or sick or not. There's a smaller minority of people who are vulnerable, people with significant mental health issues, and again, complex frail elderly, especially living alone. And for them, it is more difficult. Increasingly, numbers of people in the community have blood pressure cuffs.
They have pulse oximetry at home. They've got better self-knowledge regarding managing their medical conditions. And all of this adds certainty. But we are not in a really great situation with this today. It's really unfortunate that this has been allowed to develop. I have no doubt, based on my understanding of the IOR process within the HSE, that this has been simmering probably for years.
So it is really, really quite frustrating and a cause of concern that people are on pickets and that the strike action going on is most unfortunate.
Well, from what we see this morning, it seems it's been going on since 2020 when it was first before the Workplace Relations Commission. And all of us, I think, would have imagined that it would have been solved and sorted before it got to this point.
Well, the taxpayer pays an awful lot of money to run the HSE. You can look at some big ticket items. We have 28 acute hospitals. The majority of them still run their administration on paper. It's 2026, for God's sake.
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Chapter 4: What immediate patient safety risks are associated with the strike?
We look at the leak and the hemorrhage of young qualified medics who will not work in a system that they find to be impossible in terms of training, in terms of basic, again, HR issues and HR skills. And what's happening today is essentially a failure at a HR level.
Well, just on that broader point, we were speaking last week about this proposal, which is doing the rounds in government that students who finish their medical degrees would be compelled to stay here. They would be told that they will get a break on their student loans or they'd get a bursary in order to have them stay working in Ireland after they qualify. Would you support something like that?
Well, that's a very different big can of worms from this morning's headline in relation to the ambulance service. But that, to me, sounds like a knee-jerk politician response. And again, if you compare the manner in which junior hospital doctors are treated... In Australia, for example, in North America, even in the UK, there's a huge difference.
It's extremely difficult as a young hospital doctor to plan a professional life and a personal life in this country as you work through your late 20s and early 30s, working ridiculously long hours.
on training programmes which have them travelling all over the country at every six-month intervals, grappling with a housing crisis, and a HR function which, when you drill into the detail, these young people typically can't plan their holidays, for example. They can't obtain their study leave with certainty. Many of them are on backwater jobs that are leading to no career progression.
So I think the politicians deciding that they will compel them to work indentured is only going to hasten and worsen a situation that's already arguably, well, it's important to keep the tone of this interview polite.
Well, listen, I've distracted us both now from the issue at hand, but I was interested to get your view on that topic. Coming back to what's happening with the ambulance service. I mean, we see that if this isn't sorted out, there'll be a 48 hour stoppage on the 19th of May, 72 hour stoppage on the 26th of May. If this doesn't have an impact today, it certainly will as the month goes on.
Well, we're bracing ourselves. We're depending on the good sense and the kindness of the public. And again, for anybody out there listening who particularly knows an individual who has significant mental health issues or a complex, frail elderly person, just be aware and be available to them. OK, and to help out, let's just be practical about it. This is going to get sorted out sooner or later.
I hope the HSE have the ability to get it sorted out sooner.
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Chapter 5: How do vulnerable populations react to ambulance service disruptions?
And just in terms of how GPs manage this now, I mean there are implications I would imagine for what you do when you feel somebody needs the help of an ambulance to get them to a hospital.
Well, in Ireland, we still have reasonably good continuity of care at the practice level. In most practices, we know our patients well, and it's easier for us to make a quick, rapid determination whether there's a serious acute issue going on or not. The extent to which this continuity of care is generally available, it's not available in every practice.
But in most practices, that's still the case. And we will be relying on that and on the good sense and the goodwill of people to make good decisions. It's one of the core skills of general practice to differentiate between minor and major illness, between minor illnesses and emergencies. And we'll certainly be put to the pin of our collar during the next 24 hours.
And hopefully this will get sorted.
Brenna, does this point to additional or wider pressures across the emergency care system here in Ireland?
I think we understand that the population is growing. We understand that the growth in population is almost certainly outpacing the services that are available. And this is very evident both in GP cooperatives and in emergency departments. In GP cooperatives and emergency departments, these are services that are established for the treatment of acute urgent issues.
But people, an increasing proportion of people are having to use emergency departments and GP cooperatives as surrogate GP services. They are not surrogate GP services. There is no continuity of care available. worth talking about in either GP cooperatives or casualty departments. Every time you go in, you're seen by a different physician. So this is what we're seeing at a population level.
So answering your important question, yes, there is a mismatch between capacity and the actual healthcare needs of a growing population.
Wow. I have a paramedic in touch with us here who says, I'm sad to tell you, many 999 calls are not what would generally be regarded as emergencies. People call because they can't get a GP appointment on the day that they want. People call with alcohol, substance addiction issues. People call out of loneliness and a need for social care.
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Chapter 6: What historical context led to the current strike situation?
For months he's been fending off accusations from Number 10 that he was plotting. But he was ready for this moment. Wes Streeting huge support amongst the Labour Party membership in the way that Andy Burnham would have or Angela Rayner would have.
West Sweden could also be sure that if he goes for it, if he tries to force an early leadership contest and force a swift timetable, that somebody from the soft left of the party will challenge him if Burnham is not there to do so. But I think Angela Rayner at the moment, for the moment, she has moved into the Burnham camp and that is clear.
I mean, she's made several calls for Burnham to be allowed to run in a by-election to come back But, you know, if a contest is held before Burnham is eligible to take part, well, then you wouldn't rule Andrew Rayner for standing out or somebody else on the soft left. I wouldn't even rule out Ed Miliband, even though he keeps saying that he doesn't want it.
But somebody from the soft left of the party will challenge treating, I think, if he goes without Andy Burnham in the race.
Ian, what do you think about that theory?
I think it all depends on the timing. Andy Burnham has a real problem now because even if today a Manchester MP or an MP in the North West decided to resign their seat to allow him to then stand, that would be the mother of all by-election campaigns because Reform UK are on the march in the North West and they would do everything they could to beat Andy Burnham and they might well succeed.
But a by-election wouldn't be held until, say, the middle of June. So by that time, nominations could have closed. And Andy Burnham's campaign could have been scuppered right from the beginning. Now, I suspect they will find a way around this, but this is not certain.
I'm not an expert on the Labour Party rulebook, and rules can be bent, and the Labour Party have shown that they've done that in the past. So who knows? Wes Streeting's best chance is if there is a very quick leadership contest. He... I think a lot of Labour people will hope for some sort of coronation. That's not going to happen.
West Streeting is seen as a Blairite on the right of the Labour Party, and there'll be a lot of enemies that will try and stop him. Angela Rayner has a huge problem in that her tax affairs still haven't been sorted out. So I can't see how she can run until HMRC, His Majesty's Revenue and Customs, until they have cleared her tax affairs and she's repaid what she owes.
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