Expectations. This is the word that haunts the image of the NHS and “strangles” the showcase of public hospitals, which are none other than the Emergency Departments (EDs).
In the well-known long-hours…wait was recently trapped, cross-referenced, an elderly relative of a well-known ex-politician, who was forced to leave quietly (that is, without invoking the “heavy” family name to bypass the queue), in the middle of the night and in distress, from emergency hospital of Athens. But the same story wants the health condition of the same patient to deteriorate, with the result that the very next day he is once again taken to a nursing institution of the NHS, receiving the necessary medical care with a delay. It is documented and publicly stated by the leadership of the Ministry of Health that the data collected by the 1st and 2nd Health Regions reflect a harsh reality that is far from ideal.
The wait reserved by the System for a patient with mild symptoms until the first clinical examination by an on-call doctor can even reach 6 hours. However, the time may be doubled if it is deemed necessary to undergo laboratory and imaging tests. However, there are also important qualitative elements that make up – albeit roughly – the profile of those who turn to hospitals in the morning, at noon and even in the middle of the night, looking for advice, care and relief. For every 1,000 citizens who come to the TEPs, it is estimated that only 20% are admitted. Among them are patients (emergency or ultra-emergency cases) whose life is in critical condition or hanging by a thread. Then the waits shrink, as every minute counts and the good face of the public Health system emerges. On the other hand, the remaining 800 patients spend their time knocking on the closed doors of the examination rooms trying to make their presence felt, suffering in silence or rebelling against the poor services provided to them.
In the meantime, the question of emergency services remains in the foreground at a political level, while plans are being evaluated in Aristotelous Street that aspire to heal a system that is suffering.“In October, there will be relevant announcements regarding the improvement of on-call services” confirms the Deputy Minister of Health speaking to “Vima”. Marios Themistocleous. He admits, however, that the interventions should be surgically studied, likening on-call hospitals to a car running at 180 km per hour. “And in this moving vehicle, we will have to make changes”. And then he explains that there is no room for experimentation and failure. “The TEPs are one of the most critical departments of the NSS. Patients have the right and we are obliged, along with any plans, to ensure that their service will not be interrupted”. However, other important parameters are included in the same equation, making it even more intractable. For example, the building upgrade of TEPs in pillar hospitals, such as “Evangelismos” and “Attikon”, cause inflexible time constraints for the planning and initiation of a more modern ward model. So, for example, scenarios that want e.g. during the daily vigil from six to eight autonomous TEPs throughout the Basin are forced to go on “ice”.
Given this and, as well-informed sources note in “Vima”, in the first phase the planned changes will be mild, such as, for example, the redesign of the groups of hospitals that are on duty and/or their operating hours in an attempt to better distribute and incident management.
Recruitment of 500 paramedics
Also, the upcoming recruitment of 500 paramedics is expected to partially defuse the situation, with the Minister of Health Adonis Georgiadis to set as an achievable goal in 2025 the waiting time to be reduced by one to one and a half hours.
There is, however, one more important factor contributing to the vicarious “crash”. Shortages of personnel in biological laboratories, combined with the fact that a certain amount of samples must be collected at the analyzers, further block the system and consequently “overflow” the waiting times. However, similar delays are also recorded in the imaging sector (e.g. CT scans), hence the Ministry of Health is promoting legislation that will give the green light for remote diagnoses by collaborating doctors (public or private sector). The Ministry of Health is additionally investing in digital tools under development and funded by the Recovery and Efficiency Fund (RRF). In this context, by the end of 2025 citizens, according to Mr. Themistokleous, will have the possibility to be updated in real time about the waits, thus creating a navigation map for ambulatory patients.
“The last century’s model of the personal physician”
Primary Health Care (PHC), which over time has been the most neglected field of the system, is on the path to upgrading, with the result that it is unable to fulfill the role of a “breakwater”.
Thus, every day, citizens continue to flock to the emergency rooms of on-call hospitals, which bear a disproportionate burden. It is no coincidence that the plan submitted by the Special Committee of the Athens-Piraeus Hospital Physicians Association (EINAP) recently on Aristotelous Street underlines, among other things, the need to create an urban-type network of Health Centers throughout the Basin, with the expansion and staffing of existing structures, so that to be able to cover primary care emergencies on a 24-hour basis. It is enough to consider that the Hellenic Society of Emergency Medicine estimates that 25%-45% of cases of mild severity could be treated by the personal doctor or in a Health Center.
Focusing on the British model, LSE Health Policy professor Ilias Mosialos clarifies speaking to “Vima” that in the NHS Primary Care is funded by the system, but doctors are not NHS employees. “There, the problem lies in the fact that general practitioners cannot deal with complex cases. In our country, the disadvantage resulting from the surplus of doctors of various specialties can be turned into an advantage, due to the change in epidemiological patterns and the large number of patients with comorbidities.” He comments that the model of the personal doctor “belongs to the previous century.
The decongestion of hospitals could also be achieved by the creation of urban-type Health Centers, not necessarily public in their entirety, with state funding, supervision, quality control and also a closed budget, so that there is no inflation of unnecessary medical procedures”
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