Dysfunction in our country’s Acute Hospitals leads to substandard health service and denies equality of access to specialist health services for our citizens!
THE reconfiguration and reform of our country’s acute hospitals was first proposed back in 2012 when Professor John Higgins was tasked by government to analyse and recommend a new way to efficiently manage our hospital networks and deliver a quality health service. This he did when he published his comprehensive and now well known “Higgins Report”- the main recommendation of which was the reform of the hospital network through the establishment of Hospital Groups as a transition to Independent trusts
In my opinion, if the Department of Health was serious about these hospitals’ reform they would have ensured that the Hospital Boards for the new groups were appointed by now.
We are four years on since the establishment of the hospital groups and the boards have still not been appointed – what does this tell us about urgency regarding the implementation of these reform plans!
The intention was that the boards would govern the hospital groups from a strategic perspective and they would also be responsible for and hold the hospital management and HSE to account from a governance perspective.
The boards would also have control over budget priorities for the Hospital Groups and investment decisions for the various hospitals would be decided by the board.
Due to the lack of progress to date my suspicion is that the department of health are reluctant to cede control to these boards and this is why we see the prevarication and delaying tactics that we are witnessing over the past few years.
The Department of Health is doing a disservice to the very citizens it is there to serve and I believe that the Minister for Health needs to urgently take his senior officials to task on these fundamental issues.
The HSE cannot be held properly accountable until these hospital boards are in situ and therefore is it any wonder we are seeing recent controversies and scandals in our acute hospital health service with:-
- unacceptable waiting lists and trollies at A & E,
- missed diagnosis of cancer patients,
- problematic and tragic maternity cases,
- bed and ward closures due to the lack of adequate nursing staff
- The denial of equal access to 24/7 cardiac care for South East Citizens.
Taking University Hospital Waterford as an example:-
It is really only since the new government was formed that the campaign for 24/7 Interventional Cardiology services at University Hospital Waterford has gained real national prominence, this is mainly due to the public protestations of Minister John Halligan TD who claimed that he had negotiated the delivery of a second Catheterisation Laboratory at UHW in return for his support for this government.
It’s a fact however that this campaign has been going on for a number of years and is just another prime example of how our acute hospital services are not meeting the needs of our citizens.
Following public protests at the time and concern that Waterford Regional Hospital would be downgraded as part of the reform plans I sought assurances regarding the future of specialist services at the hospital from the then Health Minister James Reilly and Secretary General of the Dept of Health Mr Ambrose McLoughlin.
In a letter dated 13th April 2013 from Minister Reilly (below), I received these assurances and following these commitments I was confident that the future of specialist services at the renamed University Hospital Waterford was secure and that cardiology services at the hospital would be developed to achieve 24/7 interventional cardiac care.
In 2014 I subsequently received further written assurances from the HSE CEO of South/ South West Hospital Group Mr Gerry O Dwyer and the Director General of HSE, Mr Tony O Brien.
During my Dail term I met with and exchanged numerous correspondence and verbal exchanges with former Health Ministers James Reilly and Leo Varadkar as I pursued the advancement of cardiology services at UHW.
I was not surprised to see the latest controversies surrounding this issue because now I believe, with the benefit of hindsight, that there is an agenda within senior ranks in the Department of Health to downgrade the service at UHW in favour of sending patients from the South East to Cork University Hospital.
Information provided by the Department of Health to Professor Herrity, who was commissioned by the Government to report on Cardiology services at UHW, conflicts with previous written commitments given to myself and consultants at UHW. The Department of Health changed its position and stated that it was not a priority to develop Cardiac services at UHW even though it puts lives at risk in the south east due to the unavailability of after hours interventional cardiac care.
It is for this reason that I believe that the Herity report is flawed and I also believe that the current Health Minister, Minister Simon Harris is being led astray by the senior officials within his department who have no regard for the rights of citizens in the south east to have equal access to interventional cardiac care in times of an emergency.
Politics has been played by all sides on this issue and in fairness most Waterford politicians, from all parties and none continue to campaign and lobby to try and advance the commitments given in relation to the status and services to be delivered from University Hospital Waterford.
There is one exception however and it is with regret that I note my own constituency and party colleague, Deputy John Deasy, has shown little or no interest in standing up for the health services at University Hospital Waterford.
This is evidenced by his failure to:-
- attend numerous meetings organised by the HSE for Oireachtas members at the hospital over the past few years,
- his general lack of representation in the Dail on UHW issues,
- his failure to attend recent meetings between hospital consultants and Waterford Oireachtas members regarding current issues of concern,
- his failure to respond to local radio and media queries on hospital issues.
- As recent as last week he refused to support a topical issue in the Dail on Cardiac services at UHW which was co-signed by a number of cross party deputies from the south east.
I can only deduce from Deputy Deasy’s apathy on these critical health issues that he is comfortable in the knowledge that his political power base in West Waterford is not affected by the downgrading of services at UHW despite the fact he is elected to represent the entire Waterford constituency.
Fianna Fail on the other hand opportunistically promised the delivery of 24/7 cardiac care at UHW just two weeks before the 2016 general election in an attempt to bolster their vote.
This promise was made despite the fact that only a month earlier the FF Health spokesperson Billy Kelleher TD refused at a public meeting in Waterford to make any such commitment. Micheal Martin TD and Mary Butler TD had no such qualms and unashamedly stood outside UHW with a placard committing to delivery of the service – where are they now on the issue? – sitting on the fence!
Despite my own best efforts during the term of the last government the delivery of the 2nd Cath Lab for UHW was an issue that I pursued vigorously but unfortunately failed to deliver.
If I am honest, it remains one of my biggest disappointments that while I was a member of the Dail supporting the last government that more progress on this issue was not made.
I strongly believe that FF should stop the posturing on this issue and make no further promises unless they are willing to use their Dail support, which in Waterford was gained on the back of their very public campaign to deliver 24/7 cardiac care at UHW, to force the delivery of these critical services.
I am concerned that the current Health Minister, despite his best intentions, is heading for failure on these critical hospital reforms, just like his predecessors did, unless he grasps the nettle and takes his senior department officials and senior management in the HSE to task and hold them to account regarding the lack of progress on hospital reforms.
The boards of hospital groups, if and when they are appointed, can help the Minister hold the HSE management to account but the question is when will they be appointed?
I am calling on Minister Harris to immediately appoint the Hospitals Boards to the various Hospital Groups.
I also believe that he should appoint Professor John Higgins, the architect of the Hospital Reconfiguration programme, to take charge of the hospital reform programme within the department of health.
It is only by making these critical interventions and by having committed leadership within the Department of Health that the Minister and the government will achieve the reforms and the accountability that is so badly required in our acute hospitals.
I would urge any journalist who wishes to establish the root cause for dysfunction in our hospitals to make contact with Professor John Higgins at Cork University Hospital and seek his views on where the implementation of his 2013 reforms are at – I believe it may provide very interesting information and an insight into why exactly our acute hospital service is not serving its citizens well.
Commitments by previous Ministers for Health, the secretary general in the Department and senior HSE officials have been broken.
Trust has been undermined and respect has been lost for the HSE with regards to how they are managing our hospitals and health services.
It is not too late to address these problems in our health service but we need strong leadership at the helm within the department of health and the HSE and only Minister Harris can make this happen before it’s too late!
I still believe that with the right people in the right leadership positions we can achieve a health service that we can be proud of – I wish the Minister well and in the meantime the fight must go on!
Senator Paudie Coffey
20th January 2017
Appendix – Written Commitments
- Quote from Prof John Higgins Report on Hospital Reform
“Waterford Regional Hospital will continue to provide invasive cardiology services for the South East population. Working in collaboration with the cardiology service in Cork the current service should be extended with new joint appointments of cardiologists.”
13th May 2013
- Letter from Minister for Health, Dr. James Reilly to Paudie Coffey
“The establishment of Hospital Groups will enhance cardiology cover in Waterford regional Hospital. At present, this is provided 9am to 5pm. The increased flexibility of staff across the group will enable us to achieve our goal of providing cardiology cover at Waterford Regional Hospital 24 Hours a day, 7 days a week.”
14th April 2014
- Letter from Gerry O Dwyer, CEO, HSE South/South-West Hospital Group to Paudie Coffey
“Interventional Cardiology Services
The Cardiology Department of Waterford Regional Hospital is the regional service for 500,000 people and offers a comprehensive range of invasive and non-invasive diagnostic services including: E.C.G., Exercise Stress Tests, 24 hr. Ambulatory monitoring, Permanent Pacing and Follow up, T.T.E. (including contrast), T.O.E., Stress Echo and 3D Cardiac Ultrasound. The Cardiac Catheterisation Laboratory for diagnostic and interventional services commenced in May 2008 opening 2 days per week. It is now open 5 days per week.
The provision of invasive cardiology procedures is both a clinical and political priority.
It is essential that this service is located at Waterford Regional Hospital to serve the population of the South East. The service is critical to deliver on the performance requirements of the National Clinical programs particularly compliance with the protocols, targets and evidenced improved patient outcomes of the Acute Coronary Syndrome Programme.
The third Interventional Cardiology consultant post will commence in Sept 2014 and WRH are progressing in consultation with the South/South West Hospital Group a business case will be progressed within the hospital group in support of a 4th consultant post to commence in 2015. In order to provide 24/7 cover over the coming 2/3 years Patients with ST Elevated MIs (STEMI) currently have access to out of hours interventional Cardiology services in CUH and SJH Dublin.”
16th October 2014
- Letter from Tony O Brien Director General HSE to Paudie Coffey
A business case has been prepared and was forwarded as part of the 2015 Estimates, for expansion to a twenty four hour service, seven days a week ( 24/7), and the associated requirement for a 2nd Cath Lab. This will be re-examined in the 2015 Service Planning process light of the previously published Public Expenditure Estimates. A 24/7 PCI service can only be achieved when significant resources are available.
The total Capital Costs for the 2nd Cath Lab are €1.9m. The total Revenue Costs for the 24/7 expansion of services and the 2nd Cath Lab are €2.7m.”