Lurching from one crisis to another

High-profile tragedies and industrial relations crises brought the state of the health service into sharp focus, writes Eithne…

High-profile tragedies and industrial relations crises brought the state of the health service into sharp focus, writes Eithne Donnellan, Health Correspondent.

Back in January, when Kilkenny woman Susie Long (41) telephoned a radio programme and outlined how she had waited seven months for her cancer to be diagnosed, nobody could have known the year ahead would be dominated by stories of women waiting months and even years for their cancer to be properly diagnosed.

In Long's case, her bowel cancer diagnosis was delayed because she was a public patient who was put on a lengthy waiting list for a vital colonoscopy. By contrast, she knew of a patient with private health insurance who was scheduled for the diagnostic test within three days. She died in October, and amid the public outrage that followed at the manner in which the two-tier health system had cost her her life, there was a promise from Minister for Health Mary Harney, under a new contract for hospital consultants, there would be a common diagnostic waiting list for all patients, whether they were public or private, and they would be seen in accordance with their clinical need.

The problem is that negotiations over a new consultants' contract have dragged on and on, and have still not concluded. The talks hit a number of stumbling blocks again this year, particularly when Harney and the HSE decided in April to advertise for 68 new consultants on terms that had not been agreed with the consultant representative bodies.

READ MORE

Members of the Irish Hospital Consultants Association (IHCA) voted in favour of industrial action and urged doctors not to apply for the new posts, which were promising salaries of up to €205,000 - an amount described by one IHCA member as "Mickey Mouse" money.

But recruitment of specialists to the new posts was eventually put on hold, on the advice of the independent chairman of the talks, to allow fresh negotiations take place between management and consultant representative bodies.

THE DEVELOPMENT CAME just weeks after Harney was reappointed Minister for Health following the May general election.

During her election campaign there was intense pressure on her to give way to demands by nurses for a pay rise and a shorter working week. Some 40,000 nurses from the Irish Nurses Organisation and the Psychiatric Nurses Association began industrial action in April in pursuit of a 10.6 per cent pay increase and a 35-hour rather than a 39-hour week.

The bitter dispute, which lasted 7½ weeks, resulted in some hospitals cancelling elective surgery. In the end, proposals from the National Implementation Body, which will see a 1½ hour cut in the working week of nurses by June next year, were accepted by all sides, and nurses were told to pursue their pay claim through benchmarking.

Health service management was also in dispute with pharmacists, prompting some of them to withdraw from the methadone maintenance scheme, and then there was a dispute with electricians in hospitals in the south of the country over issues such as who was authorised to change lightbulbs.

By September, all health service unions were up in arms when the HSE imposed a ban on recruitment in an attempt to control overspending. Cutbacks were also imposed in hospitals to try to get them to stay within budget.

But just days after that ban on recruitment was announced, it emerged the HSE board had approved an €80,000 bonus for HSE chief executive Prof Brendan Drumm. Nurses in particular, who had been on the picket line for several weeks earlier in the year, seeking a pay rise, were incensed.

Amid all the debate on the cutbacks and predictions that they would result in longer waiting times for elective surgery came the findings of the 2007 Euro Health Consumer Index, which ranked Ireland's healthcare system bottom of the league in Europe when it came to waiting times for patients to access services.

Members of the Oireachtas were also getting angry about the length they were waiting for the HSE to answer their questions and make decisions. In October, the Minister for Community, Rural and Gaeltacht Affairs Éamon Ó Cuív, described the HSE as an "impossible" body that he could make "neither head nor tail of".

But the HSE argued its establishment speeded up decisions on national issues, such as the decision to locate the new national children's hospital at Dublin's Mater hospital, which it persevered with during the year in the face of stinging criticism. It also made progress on Government plans to have co- located private hospitals built on public hospital sites and announced a five-year plan to reduce the incidence of MRSA in hospitals by 30 per cent.

It also initiated several reviews. There's an ongoing review of maternity services - some maternity hospitals are bursting at the seams and the Rotunda had to accommodate a number of patients at a nearby hotel earlier this year; there's been a review of the appropriateness of bed use in hospitals, which found fewer beds would be needed if they were properly used; and there have been a number of reviews of care given to individual patients such as Tania McCabe (34), who died in March within hours of giving birth to twins by Caesarean section at Our Lady of Lourdes Hospital in Drogheda. One of her twins also died.

BUT IT WAS the number of reviews put in place in relation to care given to an incredible number of cancer patients who were found to have been misdiagnosed that 2007 will be most remembered for.

In May, it emerged there had been a 14-month delay in diagnosing Tipperary woman Rebecca O'Malley with breast cancer. The 41-year-old mother had presented for tests at the Mid-Western Regional Hospital in Limerick and a biopsy taken from her was sent to the laboratory at Cork University Hospital for analysis, where it was misread and she was wrongly given the all-clear. The newly established Health Information and Quality Authority (HIQA) began an investigation.

In early August it emerged that another Tipperary woman, who has remained anonymous, had also been misdiagnosed. Her treatment for breast cancer was delayed by 18 months after she was given two incorrect biopsy results following their analysis at the laboratory of University College Hospital Galway. Another HIQA review was announced.

And when it became clear that a locum pathologist, Dr Antoine Geagea, who worked in Galway when one of these errors was made, had also worked at CUH during July and August 2007, the hospital ordered a UK laboratory to review his work.

At the end of August it was confirmed that more than 3,000 breast scans at the Midland Regional Hospital in Portlaoise were being reviewed by Dr Ann O'Doherty of BreastCheck, after a consultant radiologist at the hospital was sent on administrative leave. The review found nine women, who are now undergoing treatment, had wrongly been given the all-clear.

Serious concerns were also raised with Hiqa about the management of breast cancer patients at Barrington's private hospital in Limerick. The hospital agreed to a request from the Department of Health in August to suspend its treatment of breast cancer patients. An inquiry was also initiated.

Just when it seemed the worst of the revelations were over, came an out-of-the-blue announcement at an Oireachtas committee meeting in November that the HSE was also undertaking a review of breast ultrasounds performed in Portlaoise hospital. The review at that point had found 97 women needed to be recalled for further tests, but the HSE locally had forgotten to tell the women, Prof Brendan Drumm or Harney.

There was uproar about the HSE's handling of the situation, and then, when it rushed to contact the women whose ultrasound records had been reviewed, it bizarrely decided to call the women who had nothing to worry about first. Harney demanded an urgent report from the HSE and said she would decide then what should be done. The HSE board has commissioned a review for her. The speculation is heads might roll when the report is finalised.Opposition parties claimed the responsibility for the sorry mess ultimately lay with Harney because of the way the HSE was structured, and demanded she resign. She refused and faced a motion of no confidence in the Dáil. That motion was defeated.

The whole affair has resulted in people's confidence in cancer services being seriously eroded. It will be the task of the State's newly appointed director of cancer control, Prof Tom Keane, to try to rebuild trust in services. Having recently arrived from British Columbia in Canada, where cancer survival rates are among the best in the world, he plans to reorganise cancer services nationally within two years, with most services delivered through eight centres of excellence. The plan has already led supporters of local hospitals such as Sligo General, which is not one of the designated centres of excellence, onto the streets in protest. There are likely to be similar protests in other areas in 2008.