Controversies surrounding local hospitals have played a major part in politics in the west and northwest of Ireland for over half a century.
Political careers have been born – and have been abruptly terminated – over the perennial threats of downgrading Roscommon hospital in particular. An Independent, Tom Foxe, was elected specifically on this single issue. It was also broken promises over the hospital that led to Denis Naughten leaving Fine Gael.
The sensitivities run deep. Over the years there have been similar protests over plans to redesignate or downgrade services in other hospitals in the region: University College Hospital Galway; Portiuncula in Ballinasloe; Castlebar; Sligo; and Letterkenny.
The proposed plans for trauma centres are ambitious and rational. As evidenced by the experience in other countries, the prospects of a patient surviving a major trauma can increase by up to 30 per cent if services are improved.
A major trauma centre would allow access to the full range of emergency and specialised services, including neurology. The full service would be concentrated in major hospitals in key locations, with trauma units (which would have specialised services but not the full range of services) in other areas.
Two Ministers, both from the west, have objected that only two centres, Dublin and Cork, will have major trauma centres
Such a development would involve consolidation and concentration, and would impact on existing emergency departments. However, the Government has stressed it will have no implications for emergency departments outside Dublin.
However, before it has even been presented to Cabinet the plan for a new trauma service regime has provoked a negative response within Government.
Two Ministers, both from the west, have objected that only two centres, Dublin and Cork, will have major trauma centres, while Galway will have a trauma unit which does not have the same status – in particular, no neurological services would be available there.
Is he making a slightly oblique criticism of the Government ceding to the interests of powerful hospitals in Dublin?
In a criticism, Minister for Rural Affairs Michael Ring – a Deputy for Mayo – has said the trauma unit did not equate to a major trauma centre.
Minister for Communications Denis Naughten said the proposal failed to take account of the way in which the population of the State was dispersed.
He is particularly critical of the fact that not only will Dublin have a major trauma centre, it will also have two trauma units. Naughten has argued that having the services in three centres in the capital rather than concentrated in one is not practical. Is he making a slightly oblique criticism of the Government ceding to the interests of powerful hospitals in Dublin?
From a policy perspective he has made a couple of salient points around patient transport. A critical part of the new trauma service will be a smoothly functioning helicopter emergency medical service. At present this helicopter service operates only during daylight hours, and there is one aircraft available.
Like Ring, his net point is that Galway’s status as a trauma unit with specialised service will not be adequate given the large territory involved.
Over a decade ago, when there were local objections to a threatened downgrade of Nenagh Hospital, then taoiseach Bertie Ahern more or less preserved the status quo, saying “demographics and geographics” justified it. It is likely that Naughten and Ring will use the same argument for Galway when trying to convince their predominantly Dublin colleagues to vary the proposal.