The arguments abound in relation to the future of acute hospital services in the southeast, writes EITHNE DONNELLAN
THOSE LEADING a group established by the HSE to draw up plans for the reorganisation of acute hospital services in the southeast have had “their wings clipped” during a meeting with the Minister for Health Mary Harney, it has been claimed.
The Fianna Fáil backbench TD Mattie McGrath who was part of a delegation from Tipperary which met Ms Harney and HSE chief executive Prof Brendan Drumm last week to voice concerns over the possible removal of acute services from South Tipperary General Hospital in Clonmel, said he felt “bureaucrats” in the HSE were pushing the reconfiguration of services to advance their own careers.
But he said they had “their wings clipped” by Ms Harney when she made it clear to his delegation that the final decision in relation to any changes would be hers, something he regards as a positive development. “She pulled back the lads,” he stressed.
Mr McGrath is resolute he will not support the Government if acute services are removed from South Tipperary General Hospital, where his eight children were born. “I’m totally opposed to this . . . definitely I will not support the Government if they withdraw acute services. I’ve told the Taoiseach that,” he said.
He added that he was not opposed to change but said there wouldn’t be “a red cent” extra for Waterford Regional Hospital if services across the southeast region were centralised there. Furthermore, he said the recent flooding had shown the importance of having services available locally. Clonmel was a fine hospital with no “unopened letters”, he continued, in a reference to the recent controversy at Dublin’s Tallaght hospital.
A submission from South Tipperary County Council, presented to Ms Harney at the meeting, stressed the importance of maintaining acute services in Clonmel given the projected growth in population of the region, the poor road network to other hospitals, and so as to retain and grow employment opportunities.
Some similar arguments have been made in other regions when the HSE set out to reorganise services but the changes went ahead nonetheless with the HSE insisting the reforms are in the best interests of patient care. The first changes were in the northeast, then in the midwest, where last year round-the-clock emergency services at Ennis and Nenagh General Hospitals were brought to an end. Services have also begun to be reconfigured in Cork and Kerry and now the spotlight has turned to the southeast.
Hundreds of people have turned out at public meetings in Wexford, organised by local Labour TD Brendan Howlin, to air their concerns about the possible downgrading of Wexford General Hospital and just over a week ago up to 15,000 people marched through Clonmel in opposition to the anticipated removal of acute services from South Tipperary General Hospital.
There are also concerns in Kilkenny over the future of acute services at St Luke’s Hospital in the city. Local Fianna Fáil TD John McGuinness accused the HSE of being less than forthcoming about what is happening.
He stressed St Luke’s had consistently been cited as an example of an efficient hospital with good practices, especially when it set up a medical assessment unit, and he wondered how it could now be penalised for that. If people had to go to Waterford instead for services it would be very difficult for them to get a personalised service in “a hospital that is like a factory quite frankly”, he said.
The lead clinician on the steering group drawing up the reconfiguration plans for the southeast region is Dr Colm Quigley, a consultant at Wexford General Hospital. Asked if Ms Harney had clipped the wings of people on the group, he said Mr McGrath was entitled to his view but he wondered which audience he was aiming his comments at. The steering group was very clear it had to prepare a report for the HSE, he said. He stressed that elected representatives had a duty to be honest with the public and that they should not use healthcare as a platform for electioneering. “What they do should be in the best interests of patients and not themselves,” he said.
A spokesperson for Hs Harney would only say when she met the Clonmel delegation she had “listened to their concerns”.
While it was originally expected that the plans for reconfiguring hospital services in the southeast – across Wexford, Waterford, Kilkenny and South Tipperary – would be finalised at the end of this month, it’s now, in Dr Quigley’s view, more likely to be September before a final report, after further consultation, is ready.
He stresses that planning sustainable, staffable and safe services for patients into the future – services that will withstand the scrutiny of future licensing bodies – is what the steering group is about, not about downgrading hospitals. “There is a future for every hospital in the southeast but the future may change,” he said. “Smaller hospitals will not close. The question is, can smaller hospitals keep doing everything? That is the question we have to answer.”
The steering group was trying to do its work in a very difficult and charged environment, he said, and had the best interests of patients at heart. Those who were extremely critical of the group’s work “would want to be very clear in their own consciences that the interests they are serving are those of patients not their own”.
Figures he presented recently show there is just one AE consultant in Wexford General, in St Luke’s and in Clonmel, and when these senior physicians are not on call, patients have to be seen by unsupervised junior doctors. Furthermore, his figures show emergency department attendances between midnight and 8am in Clonmel averaged just 3.5 a night in 2008. On average there were five attendances in Kilkenny, 5.2 in Wexford and 14 in Waterford during those hours.
Other data, presented by him, show there were on average 3.2 deliveries a day in the maternity unit of Clonmel hospital in 2008 compared with six a day in Kilkenny, 6.6 in Wexford and seven in Waterford. All the while doctors have to be on call around the clock to run the emergency departments and maternity units, as well as all other departments, of all four hospitals. The overtime bills are significant. Having medical staff on call across the four hospitals in 2008 cost €15.4 million.
At a time when the economy is on its knees, efforts will no doubt be made to cut back on these costs when services in the region are being reorganised.