Heart BeatOne thing I will say for the Minister for Health and for the HSE is that their inconstancy is constant. A myopic person peering into a fog can usually distinguish blurred shapes, writes Maurice Nelligan
Hawkeye, on a clear day, can discern no fixed pattern in our health service. Everything is variable: time, theory, policy, direction. Now you see it, now you don't. Isn't that a wonderful trick? Sit back, lesser mortals, and admire the panorama of future wellbeing unfolding before you. If the Taoiseach can speak in riddles, so can I.
Take direction; geographical direction that is. I take it as a given that none of the other sort is apparent to anybody with a scintilla of knowledge or a modicum of common sense. These folk can spread havoc to any point of the compass, north, east, south or west. Last week they hit them all.
I wouldn't like to live in the northeast, as for some obscure reason it seems chosen as some form of guinea pig on the road to the "first class health service". That's not necessarily a good thing. It reminds me somewhat of the social engineering that marked Pol Pot's Cambodia. First you got rid of anybody who could read or write and then you started over with a fresh slate.
Talking just about hospitals for now, and accepting that primary care in the area depends as everywhere else on local GPs giving far beyond the statutory commitment, this area has five acute general hospitals: Navan, Monaghan, Cavan, Louth (Dundalk) and Drogheda.
All of these hospitals for one reason or another have been in the news over the last few years. Not in the good and happy news I might stress; rather in the "another problem in the health service" kind of news and we get pretty numbed with those.
But help was at hand - theoretical help. The acute service in the area was to be reformed and a new super hospital serving this area was to be built somewhere.
Somewhere is part of the problem. In this area, a hospital covering all major disciplines, excepting only those covered on a national level, eg cardiac or neurosurgery, was to be built. This was to be a classical Hanly Report unit, serving a population of approximately 350,000. It was accepted on all sides, albeit reluctantly by the HSE, that local services would not be downgraded before this replacement facility was in place. All of this sounds reasonable and constitutes a path forward. However, in dealing with these folk, nothing is ever that simple.
A sensible person might think that they would quickly locate a site in the region with good access from the constituent areas; that they would make sure that the ambulance and paramedical services were in place and that the services to be provided were clearly delineated and staffed and funded appropriately.
The services to be provided in each feeding region would be outlined ie basic accident and emergency, physiotherapy and a range of outreach clinics as appropriate. Vacated beds in the hospitals would be used to free beds in the new acute unit and also as long-stay facilities.
I repeat, none of this was to happen before the new facility was in situ, but during the time of its development and building, the supporting infrastructure would be developed.
That's where the reasonable bit stops. Would you believe that in the wide open spaces of these northeastern counties, they have not yet identified a suitable site. I can appreciate some delay and difficulty, but not years of the same. Ardee, Collon, Kilnaleck, Effin, anywhere at all; let's have decision-making not, perpetual dithering. It can be done.
Remember Thornton Hall. On second thoughts, forget Thornton Hall. Not alone has a site not been identified, but it is intimated that such a decision is on hold pending discussions with the Northern authorities on cross-border cooperation in developing facilities in the area.
Talk about what our ancestors would have described as the "mear fada". Remember sending patients for hip and joint replacement up North some years ago, another example of cross-border cooperation? Didn't work out too well, did it?
Now such patients just sit and suffer at home unless they are fortunate enough to get picked up by that other unaccountable white elephant, the National Treatment Purchase Fund.
Meanwhile, what about the part where no services were to be run down before the replacements were in place? I would remind the good people of the region "put not your trust in princes", basically because if you do, you're likely to get shafted.
Throughout the whole area, services have been systemically downgraded and abolished. As if this was not bad enough, all the hospitals in the region have been hit very badly by the freeze in recruitment and replacement introduced as a budgetary measure last September and now extending into the New Year.
A document circulated to hospital managers in the region by the hospital network manager of the region tells of further shocks in store. Reduce orthopaedic surgery in Navan by 25 per cent, close beds in poor old Monaghan and take it and Louth hospital off call. Elective surgery in Monaghan and Cavan is to be reduced and out-patient clinics also, and Louth Hospital is to have a shorter working day.
What did the Minister for (ever increasing numbers of) Trolleys say recently about the new contract and an extended working day? Sounds like it in the northeast. It's just as likely everywhere else.
Maurice Neligan is a cardiac surgeon