Lasting health service reform requires political consensus

Sat, Nov 10, 2007, 00:00

The news that a number of women who had undergone tests for breast cancer at Portlaoise hospital had been misdiagnosed was understandably met with anger by the public at large and indeed by the political system.

Anger is the appropriate response to this disturbing news. However, the emotive atmosphere generated was not one conducive to informed or measured consideration of the state of our health service or to making important decisions about its future direction.

This issue requires some patience. It is hard to be patient when angry, but restraint is necessary. Of course, those directly affected, and those whose general confidence in our cancer services may have been damaged by these revelations are entitled to answers. An insistence on immediate answers to what is often rapid-fire questioning will not necessarily improve our understanding of what actually happened in Portlaoise hospital.

We are told that the report into what happened, which is being prepared by Dr Ann O'Donoghue, a radiologist with BreastCheck and St Vincent's hospital, will be available within three weeks. In this context, three weeks is not a long time and when that report is published we will be in a much better position to assess the events behind the controversy. We will know then whether responsibility for these diagnostic errors is isolated to individual practitioners, or extends to peers who failed to identify those mistakes, or whether indeed wider systemic failures are to blame.

We will also know at that stage whether issues of wider political accountability actually arise.

Meanwhile, while it may fill space in newspapers and absorb airtime, speculation is of little real value. Some of this speculation has been informed (or perhaps misinformed) by items of correspondence, copies of which have suddenly found their way into the media.

Not prepared to wait for the report on the debacle, many reporters and commentators have instead taken the correspondence in isolation, perhaps even out of context, and used it to suggest that hospital managers ignored concerns raised by staff. The final story, when it fully emerges, is likely to be more comprehensive.

The suggestion, for example, that the age of the X-ray machinery somehow accounts for the misdiagnoses is likely to be shown to be inaccurate. The machinery in question, while 15 years old, had passed annual tests and been certified as fit for purpose when the X-rays were conducted. Indeed, it is worth noting that the 3,000 or more X-rays which have been re-examined by other radiologists as part of the review are the same X-rays done on that machinery. Moreover, it was this second look at the same X-rays which revealed those cases where misdiagnosis was suspected.

It is difficult for the HSE in meeting this controversy to advance rational or logical argument in the highly charged emotive atmosphere which these revelations have generated. Last Sunday the executive's chief executive Prof Brendan Drumm suggested that local political factors or turf wars within the medical profession have thwarted or delayed efforts to improve our cancer services. For his trouble he was attacked from some quarters for being insensitive.

Drumm's interview last Sunday is available on the RTÉ website and having listened to it twice I have heard nothing which justifies the suggestion from some politicians that he was insensitive to the plight of the women affected. His apology and concern for those who have suffered additionally because of misdiagnosis in Portlaoise were genuine.

The most striking thing about the interview is the sheer level of frustration in Drumm's voice as he talks about the difficulties that local opposition has created for the wider effort to improve our national health service. Listening back to last Wednesday's Dáil debate about the breast cancer controversy one gets a sense that Drumm's frustration is justified. Many of the contributions from backbenchers voiced support for improving the service, but coupled this with appeals for the retention of current levels of services in their local hospital.

The possibility of a rational and measured debate about breast cancer services in the light of revelations about Portlaoise hospital is made all the more difficult because of the media and political environment in which debate on all health issues is conducted in this country.

Media coverage of health issues almost always accentuates the negative. Stories of personal pain and tragedy are media friendly. Complex tales of organisational reform or of gradual improvements in services are not. The word "crisis" is even more overused in coverage than any other topic. The situation in hospital A&E units, for example, which attracted blanket media attention at precisely this point two winters ago, has clearly improved but little credit is given for that in television or newspaper coverage.

In the Oireachtas the Opposition seems to see it as its job to talk down the quality of our health services. They give little recognition to the significant improvements which have occurred. There is a great need for a "Tallaght Strategy" on health policy in this country or something akin to the all-party consensus which emerged on Northern Ireland during the peace process.

Adopting such a consensus approach is also more likely to benefit the Opposition in the long term. Moreover, such a consensus would significantly strengthen the hands of the politicians and health managers trying to improve the service and take on vested interests such as consultants and pharmacists.

Sadly there is little sign of such a consensus approach emerging. Instead the Opposition has opted for the lazy and short-term expedient of noisily attacking the Health Service Executive in the hope that this will have the effect of producing collateral damage for the Government.

Implementing real reform takes time and requires political support.