The two separate reports into the circumstances surrounding the premature birth and death of baby Bronagh Livingstone reveal a clash of mind-sets within the health service. A clear conflict emerges between the local health board and independent medical experts about the treatment of Ms Denise Livingstone, exposing the incompatibility between the administrators of the health system and the medical imperative to put the patient first.
This tension, rather than the apportionment of blame, is the key finding of the reports published by the Minister for Health, Mr Martin, at the weekend.
The treatment received by Ms Livingstone, a young women in premature labour, while in the care of the North Eastern Health Board, has raised many questions, most of which relate to the tragedy itself. But, other core issues relating to the management and organisation of the health service in this State were also brought sharply into focus.
Both the independent report - produced by a team of experts appointed by the Minister for Health, Mr Martin - and the report by the NEHB itself, provide answers to most of the questions raised by the Livingstone tragedy. While the independent review concluded that Ms Livingstone did not receive appropriate treatment in Monaghan Hospital on December 11th, the health board report supported the decision to transfer her to Cavan hospital without the presence of a doctor or a nurse in the ambulance. The NEHB have accepted there was "a series of shortcomings" and "a lack of senior clinical leadership" in the care provided to Ms Livingstone and her baby.
Looking beyond the immediate concerns raised by this tragedy, it is clear that fundamental reform of the health service is required. It is not about the ritual demand for more money. The health budget has increased massively in the last five years without any discernible benefit to the patient. The health boards must cease to be bodies which serve local political interests at the expense of people receiving health care. They have dysfunctional roles, providing health services in conjunction with social services, such as the care of healthy but troubled children.
Much of the recent investment in the health service has gone towards creating a multi-layered health board bureaucracy. Relatively small hospitals which were once administered by two senior health board personnel now require up to ten times that number of managers in order to function.
Health care must be about patients first. The system comes second. It must be accepted, at the same time, that structures which were appropriate 30 years ago must be modernised. Advances in medical science require changes in the way that health care is delivered. All of these concerns call for a change in culture. Bronagh Livingstone's short life and tragic death will not be in vain if they highlight the problems at the core of the health service.