YEAR IN REVIEW: From funding shortfalls and pay cuts to misdiagnoses and the spread of swine flu, Eithne Donnellan, Health Correspondent, looks back at the events and issues that made the health headlines in 2009
NEWS HEADLINES may have been dominated by banking crises and Nama over the past 12 months but there were also significant events in the health sphere, not least the declaration by the World Health Organisation (WHO) of the first influenza pandemic of the 21st century.
That declaration came in June, just weeks after people were hearing for the first time about the threat posed by a novel virus – a mix of swine, avian and human influenza – which had been confirmed in two US states and which had been reported to be responsible for several deaths in Mexico in March and April.
What became known as the swine flu or A/H1N1 virus spread quickly around the world, with the first probable case confirmed in Ireland at the end of April. The Department of Health warned that a quarter of the Irish population could become infected.
Initially the virus was believed to be more deadly than it actually turned out to be, based on death rates reported from Mexico. Gradually though, it became clear that cases occurring outside of Mexico were mainly mild. Experts said what could have happened was a “biased” picture of the outcomes for all those who fell victim to the virus in Mexico was presented based on hospitalised cases only, but many others may have had mild illness and never sought medical help.
Nonetheless, hundreds of deaths from the virus did occur in the weeks and months that followed, with those with underlying medical conditions and pregnant women most at risk. Worryingly, severe disease and even deaths were also reported in small numbers of children and adults who had previously been in the whole of their health.
By late December, more than 10,500 deaths from the virus had been reported to the WHO.
A swine flu vaccine became available by October and the HSE’s national H1N1 immunisation programme began at the beginning of November and will continue into next year.
The first wave of the pandemic had peaked in the Republic by the end of November but further waves could be more severe, especially if the virus mutates.
A surge in swine flu cases during October resulted in two of Dublin’s children’s hospitals – Our Lady’s Hospital for Sick Children in Crumlin and Temple Street Children’s Hospital – having to cancel elective surgery.
But long before that Crumlin hospital was in the headlines after it emerged in April, through documentation released to this newspaper under the Freedom of Information Act, that it was planning to close a 25-bed ward and a theatre from May 1st in a bid to stay within budget. It claimed it was facing a €9.6 million deficit.
It also planned further ward and theatre closures in July and August, but was forced to row back on these after several protests at the hospital gates and HSE claims it could save money in ways other than cutting frontline services.
There was outrage too over many children waiting too long for scoliosis surgery at the hospital. Eventually an arrangement was reached to have some of them treated at Cappagh Orthopaedic Hospital in north Dublin.
But problems persisted and in September Dr Paul Oslizlok, consultant paediatric cardiologist at the hospital, warned a shortage of intensive care beds meant children’s heart operations were being cancelled on a weekly basis.
The HSE promised additional intensive care beds would be provided in 18 months.
Ward and bed closures weren’t confined to Crumlin. By the end of October the HSE’s own figures indicated there were 839 beds closed in acute hospitals across the State. However it insisted more patients were still being seen. It said by the end of October day case attendances were up year on year by 5.5 per cent and outpatient attendances were up 2.5 per cent. Inpatient discharges were down by 0.7 per cent, but it said this was because more patients were being seen on a day case basis – a less costly alternative.
The HSE was under financial pressure too. At the start of the year its chief executive, Prof Brendan Drumm, said the executive faced a funding shortfall of over €1 billion. By March that was revised downwards to €735 million, with a promise of some extra Government funding to cover the cost of reduced income from the health levy and extra medical cards as jobless numbers soared.
Apart from closing beds, home help hours were cut, a recruitment embargo saw staff who left not being replaced, and many temporary staff were laid off when their contracts expired.
In this context there was outrage when it emerged in the autumn that Prof Drumm was being given a bonus of €70,000. This was in respect of work done in 2007 but its payment had been delayed. Prof Drumm, who announced he was leaving next year when his five-year term is up, said it would go to a “good cause” but did not specify what the good cause was or whether it was even a charity.
There was a payout too to hospital consultants. They received average pay increases of about €25,000 in May for having signed up to new contracts, which saw them rostered to work a longer day and at weekends as well as accepting restrictions on private practice rights. However, the increase was set to disappear by year end following a decision in the December budget to impose a 15 per cent pay cut on anyone earning over €200,000.
There were pay cuts too in May for other health professionals holding contracts with the Health Service Executive including GPs, dentists and opticians. They had their fees cut by up to 8 per cent.
Pharmacists had to wait until June for news of the cut to their fees. When it came, in a move aimed at saving €51 million in 2009 and €133 million in a full year, it provoked a bitter dispute, and prompted hundreds of pharmacies to withdraw from dispensing drugs to medical card holders and those on other community drug schemes from August 1st.
After 12 days however and with no sign of a climb down by Minister for Health Mary Harney, the pharmacists decided to go back to work no better off.
Another coup for Ms Harney and the HSE was seeing the completion of plans to reorganise breast cancer services. The initial diagnosis and surgical treatment of breast cancer has now been centralised into eight hospital sites.
The final hurdle was passed with the reorganisation of services in the south in December but there was war earlier in the year over the decision to move breast cancer services from Sligo to Galway. It resulted in two local Fianna Fáil TDs – Dr Jimmy Devins and Eamon Scanlon – resigning the party whip.
There was significant opposition too to the decision to bring round-the-clock AE services at Ennis and Nenagh General Hospitals to an end in April. But the fate of the 24-hour emergency department and a number of other services at Ennis hospital was definitely sealed that same month with a report from the Health Information and Quality Authority (Hiqa).
Its report, which followed an investigation into the quality and safety of services at the hospital upon the revelation in 2008 that at least two cancer patients – Ann Moriarty and Edel Kelly – had been misdiagnosed, said continuing acute services, including acute and complex surgery, cancer surgery, level 2/3 critical care and 24-hour emergency department services at the hospital in their existing format was exposing patients to potential harm.
Hiqa’s work didn’t end there. It began independent inspections of both public and private nursing homes for the first time in July.
In a further historic move, the Medical Council began holding fitness to practice inquiries in public in March. The change had been provided for under a new Medical Practitioners Act.
There were also new ethical guidelines for doctors published in November which made it clear patients and their families are entitled to honest, open and prompt communication from doctors about adverse events that may have caused them harm.
By year’s end the so-called Fair Deal system for funding nursing home care – under which people can pay for their care from beyond the grave – had finally commenced, a former High Court judge, Mr Justice TC Smyth, has been appointed to examine allegations of sexual assault against former Drogheda surgeon Michael Shine to decide if a full inquiry should be opened, as well as a promise to finally begin planning for the roll-out of a national bowel cancer screening programme in 2012.
But there was also a significant threat of industrial action by nurses and others working in the public health sector after a cut in their pay was announced in December’s budget – from January they will suffer a cut of 5 per cent on the first €30,000 of salary, 7.5 per cent on the next €40,000 and 10 per cent on the next €55,000.
A one-day strike by public sector employees in November led to 16,000 procedures being deferred, according to the HSE. Many more may have to be deferred in 2010 if there are further strikes.
