As political fixes go, the inaction over Portlaoise hospital is not usual. Politicians know they are more likely to draw flak for taking a difficult decision, even the right one, than for doing nothing.
The decision facing Minister for Health Simon Harris is whether to curtail specific services at the hospital, notably 24/7 emergency cover and the maternity unit, on foot of concerns over safety expressed in numerous reports in recent years.
A draft action plan for the hospital has been ping-ponging between the Dublin Midlands Hospital Group and the Department of Health since the start of last year, before finally coming to rest on the Minister's desk last December.
It is believed to set out major changes in the way the hospital is run. Depending on which options are selected, some services are likely to move out of Portlaoise to other hospitals in the group, while other, lower-complexity work would be expanded in the hospital.
Softened
This is a “least-worst” solution that has worked reasonably well in Roscommon, where the controversial closure of the emergency department has been softened by an increase in elective procedures.
In a similar vein, the forthcoming report of the Oireachtas committee on the future of healthcare suggests one hospital per hospital group should do elective work only.
The Midlands Regional Hospital, Portlaoise, to give the hospital its proper name, has been the focus of controversy since 2012, when news emerged of a series of tragic and unnecessary baby deaths. Subsequent reports into the hospital have been critical of the emergency department and surgical care in addition to the maternity unit.
The scandal prompted greater investment in maternity services, and a link-up with the Coombe women’s hospital in Dublin. In other ways, though, the situation has got worse rather than better.
Due no doubt to concerns over safety, the number of women giving birth in Portlaoise has plummeted, from a high of more than 2,300 in 2010 to 1,400 last year. High-risk pregnancies are diverted to Dublin in recognition of the challenges such cases pose to the limited resources in Portlaoise.
Out-of-hours
Meanwhile, the number of patients treated out of hours in the emergency department remains low – as few as a handful on some nights. Ambulances carrying serious surgical cases out-of-hours are often diverted to hospitals in Tullamore or Dublin.
It is simply not possible for doctors to maintain their skill levels with this low volume of patients. For this reason, the Health Information and Quality Authority last December repeated its earlier concerns about safety standards and the risk to patients. The uncertainty has made it even harder for the hospital to recruit staff, thus further adding to safety concerns.
Yet the stalemate is likely to continue, because no-one in Portlaoise – from Minister for Foreign Affairs Charlie Flanagan down – wants to see the hospital downgraded. Meanwhile, no-one outside the area cares all that much.
This might be acceptable so long as nothing goes wrong, but if it does, politicians will not be able to claim they were not forewarned.