Flowing trolleys

It’s time to get worried when public hospitals rebrand bed managers as ‘patient flow’ managers, writes Maurice Gueret, as he contemplates wards open all hours

Flowing patients

I have noticed a new grade of hospital staff creeping into clinical linguistics. Or rather, a novel appellation for a very old occupation. Bed managers are dying out, and they are being replaced by ‘patient flow’ managers instead. ‘Flow’ isn’t a word that comes to mind in a packed emergency department, with 40 patients waiting on beds that don’t exist.

My dictionary defines flow as something that happens when gas, liquid or electricity “move steadily and consistently in a current or stream”. Where humanity is concerned, flow can refer to the movement of people “from one place to another in a steady stream, typically in large numbers”. The opposite of stagnation, I’d say. Why can’t we just be more honest? Let’s park the word flow in the bathroom, and opt for trolley manager instead.

Ratra House

Last week, I wrote about Winston Churchill (pictured above right, aged seven), and whether his black dog of depression was based on medical fact or myth. One proven way to improve the mood is to get a good dose of daily exercise. My own preference is for an hour away from the office with the dog, often around lunchtime.

I have my favourite treks, and one of the best daytime walks in dry weather is a wide circle around the house of President Higgins in the Phoenix Park. One of the landmarks at the back of the Aras is the rather unloved-looking Ratra House. It housed President Douglas Hyde after the war when his term in office ended, and doctors judged him too ill to return home to Roscommon. Phoenix Park visitors would know the house best as a training base, as it once housed the Irish Civil Defence, and had a longstanding role in the training of fire and ambulance personnel.

Winston’s chest

Well, I have been perusing a recent book by Dr Andrew Norman on the health of Winston Churchill, and was astonished to discover that the former PM was the first resident of Ratra House in 1877. Winston’s father was appointed private secretary to the Lord Lieutenant of Ireland, and three-year-old Winston spent his preschool years in the new house, being tutored by a governess. He would speak fondly of the gardens, and of his nursery room, which included a real steam engine, a magic lantern and an army of no less than 1,000 toy soldiers.

Churchill’s school life was so miserable when he returned to England that he retained fond memories of his Dublin childhood home. Dr Norman also makes clear that Winston’s chronic chestiness of childhood, which persisted courtesy of his cigar smoking as an adult, was a legacy of the three-and-a-half years spent in Ireland. It seems a trifle unfair to blame a childhood illness on a country. Perhaps the builders of Little Lodge (as Ratra House was then known) left more dust lying around than they should have.

Paris sirens

Some Irish ambulance personnel have been involved in an industrial-relations dispute this year. It’s mainly over the refusal by the HSE to deduct union membership fees at source from the salaries of its members. During the summer, members of the unrecognised union refused to carry out unessential duties, and earlier this month, a few placards were waved outside Dr Steevens Hospital.

Our emergency-medicine technicians could learn a thing or two from their French counterparts. Paris awoke one Monday morning this month to the sound of thousands of wailing ambulances, and blocked ring roads around the capital. Those who missed the news feared another terrorist attack. It was hundreds of ambulance crews, sounding their sirens and driving much slower than usual. When the bug bites and the world is conspiring against you, nobody protests quite as loudly as the French.

Open all hours

English hospitals have been experimenting with extending visiting hours. Old matron would regard families as a bit of a nuisance on wards, especially in the mornings. But this may be about to change as hospitals discover that they are less likely to be sued if they do more to build rapport with families.

A common complaint from relatives is that they find it very difficult to speak to lead doctors. Some NHS doctors, especially those dealing with older patients, are now inviting family members to be there during their ward rounds. They take on average half-an-hour longer, but are much shorter than court cases.