Since when did we agree to centralisation?

HEART BEAT: There has been no mandate for hospital centralisation – we need to debate this

HEART BEAT:There has been no mandate for hospital centralisation – we need to debate this

IT IS a lovely day here. A westerly breeze is stirring the meadow and ruffling the receding waters. The wavelets reflect the sunshine in irregular ever changing patterns.

Birds of sea and shore are gathering to explore the flats and banks exposed by the ebbing tide. Apart from the cry of the seabirds and the whisper of the wind, it is peaceful and quiet. The Highest Authority is walking and lunching with friends, which explains the last sentence and I am like Alexander Selkirk (aka Robinson Crusoe).

Christy Mahon in The Playboy of the Western Worldopined that, "if it's a poor thing to be lonesome, it's worse maybe to be mixing with the fools of the earth". I wonder if there was an election in the offing when Synge wrote that. The poster and platitude-free environment here almost breeds tranquillity.

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The fundamental truth of Plato’s observation that, “those who are too clever to engage with politics are punished by government by those who are more stupid”, is glaringly obvious to us now. However, let us make it clear to the politicians as they come calling, as always solicitous for our welfare, that it is not business as usual.

Decimated pay cheques, disappearing savings and pensions, absent or inferior services are things that make people unsettled and angry. The hitherto sheep are in pretty foul humour.

Over the past few days I have heard a defence proffered by Government that, as there are policy differences between the two main opposition parties, accordingly they cannot be trusted to govern.

In that event, this hypothesis would seem to suggest, the present administration is the most suited to continue the ruination of our State.

Credit where it is due, and it must be admitted that they have accomplished this ruin with considerable skill; and the rest of us thought it was just a mixture of stupidity and incompetence with a leavening of neglect.

I suppose that when backs are to the wall and all appears lost, the possibility of dividing your adversaries appears attractive. Spread the word, “if those other showers get in we’ll all be ruined; sure they can’t agree amongst themselves”.

There are a few difficulties here. First, the people know who caused our problems and are not likely to tolerate the mixture as before. Furthermore, it is not the time for political or ideological posturing. Failing a stable overall majority for one of the two main opposition parties, an unlikely event, the people will expect them to agree a programme and form an alternate administration.

There will be little tolerance for those parties if they cannot form a combined front to enable them to face the appalling prospect ahead. In these worst of times, we’re going to need flexible, quick thinking people, unfettered by ideologies and theories. It’s a big ask.

I came here via Limerick. A lot of comment about Limerick is negative but in reality it is a vibrant beautiful, historical city. There was one puzzling thing. Everywhere you looked there were flags, Munster flags.

A horrible thought possessed me. Maybe they didn’t know yet. Maybe nobody had told them that the centre of the universe had moved to Dublin?

I was there to participate in a debate about centralisation of hospital services being in the best interests of the patients. I spoke against and our side carried the day. Not, it must be said, by a wide margin. An interesting point was that almost all who spoke from the body of the hall were against the proposition. Many of these were doctors from the surrounding counties, familiar with the situation on the ground.

I am not going to go over the pros and cons again, God knows I have written enough about it; but I will say this: there is no democratic mandate for such dramatic change. Let us debate the issue at length and, if centralisation is agreed to be the way forward, let us not embark upon it until the chosen central locations are bedded, staffed and equipped. It is also fundamental that they are easy to access. This is not the case now.

Over the past few days this topic has raised its head in the HSE Southern and South Eastern regions. From what we gather, all acute services in the south are to be centralised at Cork University Hospital. In the southeast, Wexford, Kilkenny and Clonmel are to have services devolved to Waterford. In the south, leaving aside Cork city, hospitals affected would be Mallow, Bantry and Tralee.

That these revelations came before the local and European elections is simply amazing. Does the HSE know something, hidden from the rest of us? Have we struck oil? I’ll tell you one thing, I hope to be around when they try to remove the services from Kerry General. That should be worth seeing.

It would be amusing except for the fact that all this “planning” (the paper wouldn’t let me use my preferred word here) is costing us money, serious money. We all know that this nonsense is incapable of realisation in the foreseeable future.

Across the border, the health authorities are redeveloping the Erne Hospital at Enniskillen and are to build the new Downe Hospital near Downpatrick, some 20 miles from Belfast. They do not want their tertiary referral hospitals, “centres of excellence”, overrun by problems that could just as easily, and with far less expense, be dealt with in the regions. What a mess, the Government is decentralising and the HSE is centralising. Soon Lord, let us be able to say, as Francois Rabelais wrote, “draw down the curtain, the farce is played”.

Maurice Neligan is a cardiac surgeon