Political expediency and patient safety

Sir, – Further to "Staffing crisis putting patients at risk" and Paul Cullen's accompanying article "Recruitment rules for doctors defy understanding" (News, Analysis, June 29th), the junior doctors referred to in these articles work largely in hospitals that struggle to provide acute services. It has been repeatedly pointed out by the surgical community, including the HSE-sponsored clinical programmes and the Royal College of Surgeons, that there are too many hospitals providing acute surgical services for the size of our population. At least seven such hospitals should cease provision of 24-hour acute services and be reconfigured to elective care centres without any loss of jobs.

The single greatest impediment to progressing this strategy, which is widely supported in the health system, is concern about the political consequences and not the health outcomes of patients treated in these hospitals. In fairness to the medical staff who try to provide the service, they do not have the appropriate imaging or intensive care resources to properly care for these often seriously ill or injured patients. In addition, as highlighted in the Paul Cullen articles, the junior doctors are not on training programmes and are frequently employed through agencies. The doctors who are most senior and are employed as consultants are more likely to be locums and not on the specialist register. The starting point is to keep the service operating even if it is substandard or unsafe because of the fear of causing political instability if the local TD loses his or her seat because of perceived downgrading of the local hospital.

Patients must be informed by the health system about the appropriate hospitals for treating seriously ill or injured people. All evidence points to better outcomes when patients are treated in the setting appropriate to the severity of their condition. This principle has largely been accepted in terms of cancer care since the cancer strategy of 2006. We should be getting the same message out about acutely ill or injured patients who need the attention of well-motivated, knowledgeable young doctors who are on training programmes supervised by highly specialised consultants who can offer the highest quality care available. Every citizen deserves access to this quality care and not just those who by chance of geography live near a larger, well-equipped and well-staffed hospital. The sooner the smaller, less equipped and inadequately staffed hospitals are bypassed for emergency care, the more lives will be saved.

Our politicians have signed up to the consensus strategy of Sláintecare. Acute hospital reform is an essential pillar of Sláintecare even though all the current discussion centres largely on integration of acute hospitals with community and primary care services. Unless we reform the acute hospital system in parallel, however, patients’ lives will be unnecessarily at risk and money will continue to be wasted.


Before the country goes into serious election mode this important issue must be tackled. Politicians who, despite evidence to the contrary, continue to champion their local poorly staffed and poorly equipped institutions as appropriate providers of high quality emergency care should be asked the question, “Would you want your family treated in such a hospital?” – Yours, etc,


Group Clinical


RCSI Hospital Group,

(Past President, RCSI),


Co Dublin.