There are worries that the reconfiguration of the health service may be used to disguise cuts in care, writes MARESE MCDONAGH.
THE PLACARDS have been dusted down and the nurses and the public are on the march.
Last Thursday it was the nurses at Sligo General Hospital who downed tools, furious at what they regard as unsafe staffing levels. On Friday nurses at Killarney community hospital walked off the job for an hour saying they had serious concerns about whether future vacant nursing posts within the care-of-the-elderly sector would be filled.
On Saturday parents protested outside Our Lady’s Children’s Hospital, Crumlin, following the closure last week of a 25- bed ward and an operating theatre, and confirmation by management that more closures are on the way as it seeks to save €9 million under its “Break Even plan”.
Also at the weekend a protest was held following the decision to axe 18 beds at St Colmcille’s hospital in Loughlinstown in Dublin. Another protest is looming in Sligo unless unions and management can reach an agreement early next week.
According to the HSE, the number of hospital beds closed this year, as of May 10th last, was 491; 488 of them inpatient beds while three were day beds.
The majority, 323, were closed for “cost containment” reasons, while 30 were attributed to infection control, 58 to refurbishment and maintenance and 77 to other reasons such as staff shortages.
A memo about the recruitment moratorium, which was circulated to HSE management on May 15th last, suggested that the number of nursing posts would be down 700 this year, that management/administration posts would be cut by 500 and 2,000 HSE staff are to be deployed from the National Hospital Office to primary, community and continuing care.
Every day the newspapers report yet another planned “reorganisation” or cut. Reconfiguration is the new buzzword in the health service and it has seen smaller hospitals in the midwest and the northeast downgraded to centralise services in the larger regional settings which the HSE says is in line with best international practice.
The HSE is also anxious to stress that bed closures to a certain extent reflect the shift from inpatient care to increasing numbers of day case procedures.
But many of the cuts and the recruitment moratorium are causing fear among the public and indeed the health professionals.
“We are staring into the abyss of the 1980s and it may well be much worse,” according to Donal Duffy, assistant general secretary of the Irish Hospital Consultants’ Association. The moratorium on recruitment and promotions within the health service is “a very, very crude instrument” which will continue through 2010, according to Duffy.
Fewer staff will inevitably lead to delays in treatments, with very serious consequences, he points out.
“I think we are at meltdown, big time,” says Janette Byrne of Patients Together who has spent 10 years highlighting inadequacies in the health service.
She can rattle off a dozen human stories without prompting such as the 13-year-old girl with a suspicious mole on her back whose family has a history of malignant melanoma and who still has to wait for a year for an appointment with a dermatologist.
“It is quite scary. I am getting calls from consultants who are quite stressed and you think, if these guys are fearful about the state of the health service, how bad must it be.”
Jack McNiffe isn’t four yet but he has spent over three years of his short life in Crumlin hospital. Last week when the hospital closed a 25-bed ward and a theatre, Jack’s mother Aisling felt that his second home – and his chance of a having a future – had been attacked. News that another ward and possibly another operating theatre will close later in the summer to achieve savings of €9 million was like a sickening kick in the stomach.
Surviving has been a battle for Jack. He had his first heart operation at six weeks, he has Down syndrome, he is the only child in Ireland to suffer from Cinca (chronic infantile neurological, cutaneous, and articular syndrome), a rare degenerative disease, he cannot walk or talk, he is fed through a tube, he suffers from elevated brain pressure and so without a (risky) operation could lose his sight.
Crumlin isn’t perfect, his mother stresses – twice he has had his gown on ready for surgery and the operations have been cancelled because there was no bed in ICU, and he has contracted four hospital infections, including MRSA, there – but without it and its dedicated staff she would have lost him long ago.
Reconfiguration has seen the shutdown of some services in Ennis and Nenagh and also in Monaghan and Cavan which have been relocated to the larger regional hospitals in Limerick and Drogheda.
Clare family doctor Tom Nolan says it’s “coming soon to a town near you” and he doesn’t like it.
Nolan, long-time campaigner against the downgrading of Ennis General Hospital, is scathing about the fact a HIQA report branding the hospital “unsafe” across a range of services was published three days after the night AE services in Ennis and Nenagh were shut down.
"I have listened with increasing nausea to self-serving politicians and unrepentant HSE minions accepting the recommendations of the report, and see it as a justification of their lack of due diligence," Nolan recently wrote to the Clare Championnewspaper.
The death last month of 59- year-old Daniel McConnell from Kilkee in an ambulance just minutes from Limerick regional hospital has focused the minds of those who believe the journey to Limerick may be too far for residents of west Clare.
The HSE insists that the basis of the reconfiguration process is to provide high quality and safe services “in accordance with the overwhelming weight of medical evidence” but Nolan utterly rejects the principle that higher volumes automatically mean better outcomes for patients.
He believes it is irrefutable that the further away you are from acute services the greater the risk of mortality and he believes HIQA cherry picked from the international studies to bolster its case while ignoring evidence that patients in some situations fare better in smaller hospital settings.
“Ireland remains a predominantly rural country; the issue of the distance to the nearest hospital for acute care cannot be air-brushed away,” says Nolan.
The volumes/outcomes principle has been controversially argued in other battles, notably the imminent transfer of breast cancer services from Sligo General Hospital to Galway, with local consultants and family doctors insistent that the figures show their patients will not do better and may do worse in the bigger ‘centre of excellence’.
Donal Duffy accepts the arguments in favour of designated cancer centres just as he accepts the bona fides of those arguing for reconfiguration but he baulked this week at a leaked report outlining the HSE’s plans for acute services in the south.
The report by Horwath Consulting Ireland Limited and Teamwork Management Services recommends the transfer of all acute services from Mercy University and South Infirmary Victoria university hospitals in Cork city as well as from Bantry and Mallow general hospitals to Cork University Hospital over a five-year period but even more controversially it proposes that acute services at Kerry General Hospital in Tralee should also be relocated there in the sixth year of the programme.
The report is to be published on June 9th, days after the local and European election, timing which has drawn derision in many quarters.
Duffy says it is “hard to rationalise” how a “whole swathe of the southwest” could be served by one centre, especially given the road network from Kerry to Cork.
The first region in Ireland to be reconfigured was the northeast and on the morning last January that the HSE unveiled its reconfiguration plan for the midwest, the INO and the IHCA rained on their parade by highlighting what they regarded as intolerable conditions in Drogheda.
Staff said that more than 40 patients were on trolleys in the overcrowded AE unit at Our Lady of Lourdes Hospital and that some of these had been on trolleys for three nights.
Those opposed to the closure of beds in the smaller hospitals in the region have always argued that Drogheda has not the facilities to take them and indeed local Minister Dermot Ahern has confirmed that there is now “not a red cent” available to build a new hospital in Drogheda.
Monaghan-based campaigner Peadar McMahon believes that there is always a domino effect when a hospital service closes.
A decade ago there were 169 beds in Monaghan but the hospital is expected to go off call on May 31st – they may wait a week until after the election, sceptics are suggesting – and at that stage only 26 beds will be left. Peadar McMahon believes that it won’t be long before the authorities argue that heating and staffing a hospital of that size is not sustainable.
Labour’s health spokeswoman, Jan O’Sullivan, said while there were well meaning people pushing the reconfiguration who genuinely believe it will lead to better outcomes, “there is a danger in the current climate that cost cutting will be cloaked in the guise of reconfiguration”.
She said that while, as Donal Duffy stresses, “every hospital has its own story” the most alarming one is being written in Crumlin where vulnerable children will pay the price of the book-balancing exercise. “To make cuts in this indiscriminate way, irrespective of the effects, is appalling,” she says