Enda risks becoming the new Bertie over A&E closure fiasco
Why now?
Why the sudden urgency?
Especially in the light of all the promises made in the run-up to the general election, why are senior members of the Government in such a hurry to break the promises they made then?
They — the Taoiseach and several of his Fine Gael colleagues — have massively undermined their credibility over Roscommon.
And they have destabilised their own government, make no mistake about that. It mightn’t seem that much to take the whip off one backbench deputy when there is a huge majority, but the defection of Denis Naughten will send serious ripples throughout both government parties.
Most commentators, if you had asked them to identify a government TD likely to buckle under the pressure of tough decisions, would not have put Naughten high on their list. Mind you, he was pretty exposed.
If you google him on the web, you can still find the following on his own website, from as recently as last February: “This election is a referendum on the hospital.
If people want the reconfiguration of services — which would lead to the downgrading of services — to continue then they should vote Fianna Fáil. If they want the exact opposite and to see services retained and enhanced then they need to vote for Fine Gael.”
It’s hard to see, I suppose, how you could put something like that in print and still vote for the closure of A&E a few months later. That didn’t stop Enda Kenny, of course.
He was equally explicit in his promises, and just as explicit in denying he ever made them. He needs to take his lumps, and apologise for misleading people, whether he meant to or not. Otherwise he’ll have taken the first step in becoming the new Bertie. And that’s absolutely the last thing Ireland needs — another Taoiseach who shoots his own credibility in the foot.
But the hard thing to figure out still is why they are doing it, and why they are doing it in such a hurry. There is only one possible explanation. They have decided that now is the time, with five years of the Government’s life to go, to take all the really tough decisions in cutting down the health budget. And if that’s the case, Roscommon will be the first of many unpalatable decisions.
The case being made, of course, is that HIQA, the body responsible for safety standards, has demanded the closure of Roscommon A&E, and that the decision is based only on concern for patient safety. The Minister for Health has claimed to have access to statistics (that no one else has seen) which would frighten the life out of anyone entering the A&E in Roscommon.
All of that may be true, but is it? I spent a good deal of the weekend searching, but as far as I can tell, HIQA has never done a report on safety in Roscommon A&E. They may have done something private, for the benefit of the minister and his department, but that’s not their normal form. Normally, anything they complete they publish.
And what they have published is reports on safety, staffing, resources and management in Mallow and Ennis General Hospitals. These reports, while dealing largely with the hospitals in question, clearly do have national implications, and HIQA are quite explicit about this.
For example, in their Mallow report, HIQA said: “The HSE and all healthcare service providers must take prompt action to ensure that any hospital providing 24-hour, seven-days a week emergency care ensures that the system of emergency care includes immediate access to clinical triage and assessment, resuscitation and diagnostic support and full-time on site senior clinical decision makers with the required competencies. Where such arrangements are not achievable or sustainable, the HSE should make the appropriate arrangements to discontinue the emergency service.”
Earlier, in their report on Ennis Hospital, HIQA included a “national” recommendation (their word) that “the Health Service Executive should undertake a strategic review of configuration for emergency care services. This should lead to a prioritised programme of service development aimed at consolidating emergency services in regional centres with smaller hospitals (having a similar activity profile to Mid-Western Regional Hospital Ennis) re-designated for minor injuries and non-acute care”.
And lest there be any doubt, HIQA made it absolutely clear in its Mallow Report that the HSE had supplied it with a list of hospitals that all suffered from the problems of scale that led to patient risk. These are Our Lady’s Hospital, Navan, Louth County Hospital, Midland Regional Hospital, Portlaoise, St Columcille’s Hospital, Loughlinstown, Ennis, Nenagh, St John’s Hospital, Limerick, Roscommon County Hospital, Mallow General Hospital and Bantry General Hospital.
Perhaps it’s not surprising therefore that Roscommon was soon into the fray — and perhaps it’s possible to see in that list where the next controversies are going to come from. But it’s important to be clear — HIQA hasn’t recommended the closure of any of these services. Although it’s clear from the language that their preference is for consolidation of emergency services in larger centres, their key recommendation is “invest or close”. In other words, patient safety requires additional resources in these areas — or else closure.
One of James Reilly’s first acts as Health Minister was to welcome the HIQA report on Mallow. He did so on April 19, in a press release that was actually highly coded in its language. Among other things, he said: “This report underlines the need for the HSE to recognise the implications in the previous HIQA Ennis report, for all hospitals of a similar size. Both reports deal in particular with the type of services that can safely be provided in smaller hospitals, and with the structures required for good governance and accountability.”
And then he went on to say: “I am strongly committed to developing the role of smaller hospitals in Ireland so that they play a key part in the services provided to local communities. Local hospitals can and should be a vibrant element of local health services, providing treatment and care at the appropriate level of complexity to the patients in their area. Patients should only have to travel to the larger hospitals for more complex services.”
If you were looking for a clue there that A&E in Roscommon was under threat, no doubt you could find it. On the other hand, if you wanted to be reassured that Roscommon was safe, the statement says that too. Isn’t it time to end all this double-speak?
As an ordinary taxpaying citizen of Ireland, I’m utterly confused by all this haste. I genuinely don’t know why we’re doing it. Are we trying to save money irrespective of patient safety?
Or are we actually trying to improve patient safety?
It’s possible to reach either conclusion by following events. The reason that is so is because none of this is underpinned by a plan.
We’ve had endless reports, yes, but if there is any plan behind it I can’t see it. And until there is a plan we can at least understand, it’s not just the people of Roscommon who should be scared.
We should all be.
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