the politics of health

The Limerick Leader posted an interesting article online this week.

University Hospital Limerick’s ‘colossal spend’ on hiring ambulances

Limerick Leader 6 July 2017

The growth in spend quoted in this article makes for good politics but it doesn’t get to the bottom of the story. What kind of private ambulances were hired? Staffed by what level of clinical qualification?

TD Quinlivan says four fully equipped ambulances could have been bought with the spend since 2012 – I assume he means emergency ambulances with fully qualified paramedics or EMTs on board.

But it’s far more likely than non-emergency patient transport is needed in Limerick far more than emergency ambulances. Managed well, this is a good clinical decision and good business too. And this is very likely what this private ambulance spend was used on.

Non-emergency patient transport is staffed by people with lower clinical qualifications using a vehicle with far fewer pieces of expensive equipment and little or no drugs on board. The majority of people requiring ambulance transport in any country need it not because they are a critical emergency case requiring high-speed transport by highly qualified (and relatively expensive) paramedics. They are the chronically ill or injured who cannot make their own way to hospital for regular appointments – chemotherapy, dialysis, rehab – because of the nature of their illness. They need a certain level of assistance and perhaps monitoring en route. And there are far, far more of these journeys needed every day in every city than people needing an emergency ambulance.

Funding four new emergency ambulances will not get these people to their hospital appointments on time and safely, but it would make a good political headline.

Investigating the need for this spend – the real people behind the headline – would have been a good piece of investigative journalism for writer Fintan Walsh, but I suppose that takes time and he probably doesn’t have the luxury of delivering that kind of good journalism these days.


australia day… my way

This evening, down at Altona Beach, I strolled in the evening sunshine and literally watched the world go by. Australia Day had brought everybody out to enjoy the beach, and the council had put on a festival to help.

A small number of Aussie flags were flying on cars and transferred onto sunburnt cheeks, a few green-and-gold sports shirts were in evidence, and two mounted police officers flew the Boxing Kangaroo flag from their saddles.

On the boardwalk people wore hijabs and chadors, beach towel turbans and long-haired topknots, bikinis and board shorts, saris and sarongs. There was Greek baclava, Italian woodfired pizza, vegetable samosas, New Zealand “fush, chups and igg”, SES sausages in bread, all for sale within a hundred metres. Young muscle-bound men showed their Polynesian tattoos with pride, and one brave soul rocked a bleached-blonde flat-top and bandana.

One end of the Esplanade had live Country & Western music, the other Tongan reggae blaring out from a huge speaker. Kite surfers hung out down the western end of the beach whilst kite flyers dominated the east.

I saw Africans of every stripe, Japanese tourists and Vietnamese families, three generations of Pacific Islander at the same all-day picnic, young and old from sub-continental Asia, Italian nonnas with gaggles of grandchildren, a handful of mix-race couples of various flavours. Not many pale-skinned, freckled people like me though.

There was no “love it or leave” slogans, no “Aussie Aussie Aussie, Oi Oi Oi” chants, just people being people, chatting and laughing, running after two-year-olds, drinking coffee and beer, ignoring boys and posturing in front of girls. This is the Australia I subscribe to, the Australia I belong to.






Today I went on a new adventure.
I reconnected with my origins and marveled and how far I’ve travelled since then.
I drew pictures of my past and built Lego models of my future, in the hope of making the present more meaningful.
I ignored the “what” and the “how” in favour of exploring the “why”.

The afternoon drew to a close and the rain fell.
Suddenly unsure of myself, I stood in the doorway watching the storm until at last, gripped by a sudden certainty, I stepped out and let the raindrops wash my questions away.

what’s important?

In no particular order:

Armour (killer heels; a good suit; the perfect lipstick).
Having a vote.
A sense of place.
A feeling of self-worth.
Good red wine.
Freedom to travel.
A nice cup of tea (or coffee, if you must).
Grammar. (yes, I’ve listed it twice)
Knowing where your next meal is coming from.
Access to knowledge.
Decent cheese.
A good winter coat.
The ocean.

same same, but different

Twelve months ago I ranted about how private sector people often perceive those who’d spent time in the not for profit world, how things were often much the same in both theatres despite the efforts (on both sides) to differentiate.

In the year since then, I’ve navigated the waters of the private sector and reflected on what I miss the most – and least – about the not-for-profit world.

The IT support is still woeful: I am still looked after by a bunch of blokes (yes, they are all men, unlike in Red Cross) who bend over backwards every day to do what’s needed on a shoestring and without any obvious IT strategy. Tick.

I am still working for an organisation talking about a flash new e-recruitment process that still hasn’t arrived. Tick.

I still work in a small, committed team whose mutual support and comedy banter is a joy and inspiration most days. Tick.

I still do a week of duty officer (a little more frequently with a lot more to do out of hours). Tick.

I’m still known as Darth Doyle.

Performance management is different. Holding people to account is not only talked about here, it’s expected. In the past year I’ve handed down countless first warnings and a handful of final warnings, and I have fired a couple of people. You don’t perform, you’re out. We have no room for passengers. At Red Cross we huffed and puffed quietly about poor performers until they left: not hugely helpful to the rest of the team or to the quality of our services.

I travel much further to work, but at least when I get there I have my own office, my own quiet working space. No more open-plan working. So I don’t work from home as much – I don’t need to. I can be hugely productive in my work environment.

Finance management is not too different. I steward my labour budget with a rod of iron and question every request to put another shift on the road; but in my not for profit role we counted the pennies obsessively too.

The business intelligence is much, much worse. I managed a $7 million budget with almost no BI at Red Cross. Now I manage a significantly larger budget with absolutely nothing apart from what I can pull together myself with my less-than-adequate Excel skills. It never ceases to alarm me how little analysis support I have, and how much relies on my long-winded workings.

I sit back at the end of each day, week, month, like every General Manager, and look at the numbers. It’s winter, so patient activity is up. This means more work, closer logistics management, worse traffic, but more revenue too. If my P&L matches budget and my productivity levels look good, I stop fretting and look ahead to the next month.  Job done. It’s that simple.

At Red Cross, it was a little different. Of course we carefully counted the financial cost of putting a thousand volunteers in the field, delivering hundreds of meals across dozens of towns, managing dozens of evacuation centres in flood-affected regions, doing outreach to hundreds of households following a devastating bushfire. We had funders and philanthropic donors to satisfy. We had to prove that we were a trustworthy steward of scarce relief and recovery funds, to demonstrate that we could make those funds go far and touch as many people as possible.

But we didn’t sit back at the end of the day (or summer) satisfied that we did what we said we’d do and stayed within budget. We worried about the outcomes of our actions. And I mean worried.

We visited disaster-affected people in their homes, providing information and practical support. We provided a safe place to sleep for people who’d had to evacuate their home. We took thousands of calls from people trying to locate their loved ones after the bushfire raged through their neighbourhood. We kept detailed spreadsheets and produced reports to show how many of each action we did.

But we also asked: did that visit, place to stay, phone call actually help those people in a meaningful way? Could we measure in some specific way exactly how our assistance hastened their psychosocial recovery? How could we be sure we did no harm to anybody, ever? How would we be able to measure our contribution in terms of long-term outcomes, not short-term outputs? Because if we couldn’t, chances are the funding would dry up, the donors would walk away.

Looking at my current job through that lens, it would mean that not only would I be concerned that we had moved every patient on time with no overtime, but I’d have to do research on how the quality and timeliness of my patient transport materially affected their healthcare pathways and by how much it hastened their recovery.

It doesn’t bear thinking about.

Perhaps it’s as easy as saying that governments and large corporates outsource only simple tasks, but we all know that’s not true. Across the world every day people are cared for in hospitals, kept secure in prisons, fed in schools, trained at work, looked after in nursing homes, given home help and cooked meals, all by armies of workers employed not by the government or the company being paid, but by outsourcing companies like mine.

We are not required to measure and be paid according to the health outcome of the patient we care for, the rehabilitation prospects of the prisoner we secure, the adult fitness and health levels of the school-child we feed, the quantitatively improved career prospects of the worker we train, the quality of life of the elderly, vulnerable lady we look after every day.

We deliver good service, on time and on budget, we record the data, we send the bill, we deliver the budgeted amount of profit, we switch of our laptops off and go home, we do it all again tomorrow.

But everything we do will have had some impact on the lives of the people we have served.

And yet…. and yet. The private sector is still seen as more complex, more difficult, more challenging, the real world. The private sector is where the real workers are, the ones who know what they’re doing.

The not for profit world is perceived as softer and fluffier, populated by well-meaning, left-leaning, sandal-wearing social workers who are probably still being bankrolled by Mummy and Daddy. Those who can, do. Those who can’t will probably be able to get a job in a charity somewhere.

I look back at the strategic planners, the IT service delivery gurus, the change managers, the logistics people, the departmental heads I’ve worked with in the not for profit world. All of them could run rings around many of the people I’ve come across in the private sector, in terms of intellect, strategic approach, long-term focus, commitment, ethics and sheer hard work. But most of them will never be considered for a role in the private sector, because their skills are not believed to be transferable.

And you know, it’s probably true. Many of their skills won’t be transferable, because they would not be used or valued. Many of them would see their skills wither away in the private sector, with its often shortsighted focus on this month’s bottom line, this quarter’s results or the exec team’s end of year bonus.

So do I regret my move? Not at all. This is not a polemic against the private sector world, just another small attempt at levelling the playing field. Most working environments, most teams, most organisations have more in common than divides them.  They are all less unique than they believe they are. And that’s across the board.

Private sector workers coming into the not for profit space will have some valuable short-term tactical focus, pretty robust people management skills, a fair amount of less-thinking-more-doing attitude to contribute.

Not for profit workers taking on a private sector role may have the ability to look a little further out and a little further up, consider the unintended consequences a little more, understand reputational risk and how to avoid it a lot better. They’ll sure as hell know how to make a little go a long way and still look good.

Same same, but different.


curly questions

I’ve had curly hair all my life. I had long hair for most of my twenties that eventually grew to be a curtain of unruly waves, then got chopped back to a bob.

1996 25 October Mairead Fiona Sue

my thirtieth birthday!

In my “world traveller” phase I chopped all my hair back to a pixie cut and when I grew it back the curls were a lot lazier, less defined.

Over the years I spent ten fortunes on hair products trying to tame my frizzy mane. John Frieda’s Frizz-Ease was my best friend. Styling my hair at home became a complex cocktail of up to seven (seven!) products in a specific order. And still five days out of seven I looked like Worzel Gummidge’s slightly messy younger sister.

The older I got, the more frustrated I became. My hairdresser bill grew and grew as I tried every new product on the market. Cupboards filled up with bottles, aerosols and pump-action containers of hair products, all seven-eights full. More times than not if I caught a glimpse of my reflection, my spirits would sink. I wasn’t vain and I didn’t have high expectations: I only wanted to look respectable really.

The dreaded mid-forties came. Looking for a new job, I polished up my working wardrobe and got new headshots done by a professional photographer. On the morning of the shoot I took particular care with my hair but it still grew into a halo of amorphous frizz. At the photographer’s suggestion I twisted my hair back into a severe up-style just to look halfway decent.




… and after.

I turned to the internet. Maybe I needed a new hairdresser. All roads led to a man called Neel in a funky-sounding salon in Collingwood called Cherry Bomb. Didn’t sound like a salon for an ageing executive with no tattoos. But I got an appointment anyway.

That first appointment changed my life. I walked into a colourful, cruisy salon staffed by an army of curly-haired stylists, and was taken in hand by the famous Neel. A young man from Brighton in England, Neel has made curly hair his niche (even though he wears his own close-cropped). He was positively evangelical about his advice, learned over the years from curly hair specialists all over the world.

  • First: shampoo is not your friend. It is full of sulphates that have been sucking the moisture out of your hair for years. Go home and throw all your products out.
  • Second: silicones are not your friend. John Frieda is an imposter. Silicones only give the illusion of a frizz-free solution for a few hours until your hair realises it is actually being parched to death and reaches back out into the atmosphere in search of water. Go home and throw all your products out.
  • Third: towels are not your friend. Your curly hair is actually quite fine and fragile. You need a micro-fibre towel and a gentle touch. Go home and throw all your towels out.
  • Fourth: hairbrushes are not your friend. You are damaging your fine, fragile hair every time you brush. Go home and throw all your hairbrushes out.
  • Fifth: your hair is unique. If it is cut when wet you will have no chance of showing off what curl you have. Always have your hair cut when it is dry.
  • Six: Moisturise, moisturise, moisturise.

Over the next three months I read all the books, subscribed to all the blogs and brought my haircare regime back to basics. I really did throw all my products out. I started to wash my hair with conditioner, massaging my scalp with my fingers to clean it instead of relying on the squeaky-clean feeling of a head full of suds.

I slathered good, simple, sulphate- and silicone-free conditioner onto my hair and didn’t rinse it all out. I wrapped my wet hair in a micro-fibre towel, combed it gently with a wide-tooth comb and then slathered even more conditioner onto it before allowing it to dry naturally. I washed my hair only every five or six days, and revitalised it in between washes with yet more conditioner.

After a month I could really see a difference. After another two weeks on a tropical island with pure coconut oil in my hair, I was like a different woman. Even after scuba diving I could simply soak my hair in conditioner and walk out the door looking fantastic. I finally achieved my impossible dream of half-decent hair every day.


after Neel cut my hair for the first time

The strange thing is that all of this cost so much less time and money: most of these pure products were very affordable and could be used as both a conditioner and a styling product. My seven-step styling regimen was reduced to a quick once-over with a wide-tooth comb and a generous dollop of Sukin conditioner. In summer my hair dried naturally in the car on the way to work. The extra time taken to wash and dry my hair in the morning went from one hour to barely ten minutes.

So why am I telling you this? Because so many women don’t know. We believe the Unilever/Procter & Gamble marketing hype. We don’t realise we are poisoning our hair and stripping away the very thing we are desperate for: moisture. We buy products full of petroleum-based chemicals, drying alcohol, formaldehyde and artificial perfumes, and wonder why our hair doesn’t react well. The alternatives are not expensive or hard to find, but I suppose they don’t help the bottom line of Garnier or Proctor & Gamble.

Lou Davison is a young Scottish woman who spent the early years of her life hiding her curls until an accident a few years ago left her with a lot of time on her hands. She did lots of research and discovered the so-called “curly girl” online community. When she moved to Melbourne Lou found that there were almost no resources for curly-haired people here so she started her own blog, sharing tips and tricks in the hope that she could inspire others to discover what she had.

“It sounds ridiculous, but discovering this new haircare method literally changed my life”, Lou tells me as we chat with other curly-haired women at a meet-up in Brunetti’s in Melbourne. “I used to hate my hair and now I embrace it. I see women in the street who are doing what I used to do, and I feel like going up to them to tell them there is another way.”

Love Your Curls

It’s hard to believe that Lou could ever hate the beautiful mane of golden spiral curls she loves so much now. Her website is a treasure trove of information and inspiration for all things curly. She even has interviews with regular curly-haired women who tell all about their routines and care tips – no two curly heads are the same so we are always on the lookout for similar people whose secrets we can share.

These days there are good websites and blogs in most countries for curly-haired people (mostly women) to get informed, share information and support each other in their quest to be kind to their hair. The interesting thing is that curly-haired people are still often seen as dangerous, uncontrolled, and even unprofessional in a workplace setting. It takes a little bravery to take the first step, but I can almost guarantee you that like Lou and myself, it will change your life and save you money and time into the bargain.

Useful links for curlies around the world:

what i wish i’d known…. by Nora Ephron

“I Feel Bad About My Neck (and other thoughts on being a woman)” is a book by the late great Nora Ephron.

It was a fantastic, hilarious read the first time around, maybe fifteen years ago. These days it feels more like required reading for everybody of my vintage. Here is an excerpt – my favourite chapter. Tell me which line rings most true for you.

What I Wish I’d Known

  1. People have only one way to be.
  2. Buy, don’t rent.
  3. Never marry a man you wouldn’t want to be divorced from.
  4. Don’t cover a couch with anything that isn’t more or less beige.
  5. Don’t buy anything that is 100 percent wool even if it seems to be very soft and not particularly itchy when you try it on in the store.
  6. You can’t be friends with people who call after 11 p.m.
  7. Block everyone on your instant mail.
  8. The world’s greatest babysitter burns out after two and a half years.
  9. You never know.
  10. The last four years of psychoanalysis are a waste of money.
  11. The plane is not going to crash.
  12. Anything you think is wrong with your body at the age of thirty-five you will be nostalgic for at the age of forty-five.
  13. At the age of fifty-five you will get a saggy roll just above your waist even if you are painfully thin.
  14. This saggy roll just above your waist will be especially visible from the back and will force you to reevaluate half the clothes in your closet, especially the white shirts.
  15. Write everything down.
  16. Keep a journal.
  17. Take more pictures.
  18. The empty nest is underrated.
  19. You can order more than one dessert.
  20. You can’t own too many black turtleneck sweaters.
  21. If the shoe doesn’t fit in the shoe store, it’s never going to fit.
  22. When your children are teenagers, it’s important to have a dog so that someone in the house is happy to see you.
  23. Back up your files.
  24. Overinsure everything.
  25. Whenever someone says the words “Our friendship is more important than this,” watch out, because it almost never is.
  26. There’s no point in making piecrust from scratch.
  27. The reason you’re waking up in the middle of the night is the second glass of wine.
  28. The minute you decide to get divorced, go see a lawyer and file the papers.
  29. Overtip.
  30. Never let them know.
  31. If only one third of your clothes are mistakes, you’re ahead of the game.
  32. If friends ask you to be their child’s guardian in case they die in a plane crash, you can say no.
  33. There are no secrets.