Analysis: Is this what happens when politics and medicine clash?

Portlaoise hospital is the health controversy that refuses to go away.

Ever since revelations almost two years ago about baby deaths in the maternity unit, questions have been raised about the safety and viability of services at the hospital.

Outwardly, the message from the health service has been that it’s business as usual and that, broadly speaking, services will not be affected.

Behind the scenes, it is clear now there were deep divisions between the worlds of health and politics about the issue.

Health managers and clinicians were concerned about a series of red flags at the hospital, including low volume of surgery, declining numbers of patients, unsupervised work environment and a high reliance on temporary staff.

However, not much happened in relation to these concerns after they were summoned to meet senior politicians, it appears.

The documentation obtained by The Irish Times shows that last year the HSE and the Department of Health were united in believing the 24-hour emergency department should be closed, surgery ended and the hospital generally downgraded.

Closure

The memo from two senior department officials, chief medical officer Dr

Tony Holohan

and assistant secretary

Tracey Conroy

, to then minister for health Dr

James Reilly

said that the department was “fully in agreement” with the HSE’s proposed response.

This was in June 2014, five months after the scandal at Portlaoise’s maternity unit broke on RTÉ’s Prime Time.

This triggered a highly critical report by Dr Holohan and a "performance diagnostic" by HSE official Ian Carter.

Mr Carter’s document recommended the closure of emergency services at Portlaoise and its replacement by a medical assessment and local injury unit operating during the day.

It said the 24/7 emergency service at Portlaoise was “not clinically sustainable” and warned of a collapse in care processes and risks to patient care arising from the “many internal medical challenges” at the hospital.

The report was never published, though The Irish Times obtained a copy and published the details last year.

The HSE drew up an action plan on foot of Mr Carter’s recommendations and the department officials said they fully agreed with this document.

This pointed out the critical care unit cared for just 38 patients a year, while the emergency department was 50 per cent more likely to admit patients than the national average because of a lack of senior decision-makers.

Declining admissions

In contrast to national trends, admissions to emergency were declining, while paediatric surgery was “mainly circumcisions”, with others cases being referred to Dublin hospitals.

The mystery is why nothing happened, given that the changes were supposed to be implemented over the following six months.

What we do know is that senior department and HSE officials were called to meetings at the Taoiseach's office and also to see Minister for Foreign Affairs Charlie Flanagan, the local TD in Portlaoise.

There’s a touch of “groundhog day” about this. In 2011, earlier HSE plans to downgrade the hospital were scotched following the intervention of Dr Reilly and Mr Flanagan.

The difference is that the safety risks were theoretical in 2011, while by last year we knew about specific incidents such as the deaths of at least five babies, and numerous reports had highlighted the risks involved.

With an election in the offing it can be expected that political considerations will take priority in relation to the future of Portlaoise hospital.