State where all standards are merely aspirational

Tue, Apr 28, 2009, 01:00

ARE THEY telling lies or are they simply ignorant of the truth? And which is worse? These are the questions that face the hapless journalist trying to fathom grossly misleading statements by Government Ministers. If they’re lying, there is a certain bleak comfort in the notion that they actually know what’s going on and are sufficiently in control of events to deliberately mislead the public, writes FINTAN O'TOOLE

If they’re so disconnected from reality that they actually believe the nonsense they come out with, their honour is saved but their incompetence is revealed.

I must confess that I am unable to resolve this conundrum in relation to the spinning that followed the revelation in last Friday’s Irish Times that one of the designated specialist centres had failed to meet 36 of 48 national standards for breast cancer treatment.

The first agreed official line was to emphasise that the report from the Health Information and Quality Authority (Hiqa) on which The Irish Timesstory was based is out of date. Brendan Drumm of the HSE, for example, told reporters that: “This is data from April 2008.” He further suggested it was from “pretty soon after we established the cancer control programme”, ie November 2007.

This is simply untrue. As The Irish Timesreport made clear, the Hiqa report is based on an inspection of Waterford on October 2nd last.

The difference in time is crucial. Hiqa was assessing Waterford – and the other seven designated cancer centres – against a set of national standards, which were intended, as Hiqa chief Dr Tracey Cooper, explained in February 2008, to highlight “key issues needing to be addressed in advance of the HSE plan of transition from multiple diagnostic centres to eight specialist centres”. The important words here are “in advance”. The implementation of the standards was to be done before 25 smaller breast cancer clinics were closed and the patients transferred to the eight specialist hospitals. In April, that process was just beginning. By October it was, in Waterford’s case, well under way. By shifting the timeframe back six months, the spin conjures away the central fact that patients were transferred to institutions which the HSE knew were not up to scratch.

When this spin proved to be ineffective, it was left to Mary Harney to come out with a statement so breathtakingly false that the kindest course is to assume complete ignorance on her part. Unable to deal with the evident truth that the standards were not being met, she came up with an Orwellian solution: the standards are not really standards at all, but aspirations: “These are not minimum standards,” she told Seán O’Rourke on RTÉ Radio. “They’re not patient safety standards. These are the standards we have to aspire to.”

It is, I admit, quite an achievement to utter three sentences in a row, each of which is more bogus than the last. The standards are indeed minimum requirements. Hiqa’s Tracey Cooper explicitly referred to them in February 2008 as part of the authority’s remit “of setting minimum standards for quality and safety”. Harney stood beside Prof Niall O’Higgins in May 2007 when he said the standards are “the requirements of a functioning specialist breast centre”.

She herself stated last year: “I strongly believe that symptomatic breast services should be provided only in hospitals which meet these standards in full,” though that statement is dated April 1st so she may have had her fingers crossed. It is quite staggering to claim that the standards are not about patient safety. What does Harney think is the meaning of phrases like “to ensure accuracy of surgical treatment”; “to ensure speed of diagnosis”; “to ensure optimal outcome after radiotherapy” or “to maximise safety” – all of which are embedded in specific standards that Waterford Regional was found to be failing? And then we have the great kiss-off: “these are the standards we have to aspire to”. What Hiqa (naively, it seems) believed to be minimal standards that had to be reached before the transition from 25 breast cancer centres to eight, are now mere aspirations.

In the same week in which Dermot Ahern told us on Questions and Answers that the Budget itself is merely aspirational, we have the Minister for Health spinning the basic preconditions for implementing a policy shift with profound implications for the 2,500 Irish women who get breast cancer every year as nothing more than a wish upon a star.

We are left with two possibilities. One is that Harney knows that the national breast cancer standards are the basic criteria for a functioning service and chose to deliberately mislead the public. The other is that she doesn’t know this and that she actually thinks the basic standards of care for Irish women are aspirations, like a united Ireland, the revival of the Irish language and the draining of the Shannon. Let’s be kind and accept the second possibility. And let us then weep for all those subject to a governmental culture in which all standards are aspirational, all statements are provisional, and all sense of responsibility is fantastical.

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