Phoenix: An injury undone?
Anyone giving the Capital Plan even a cursory glance can see that UHW as a Model 4 hospital is just not in the same capital projects league as the other hospitals of that level.
On the day that the National Report on Cardiology Services 2023 emerged, the Minister for Health, Carroll MacNeill, in a welcome positive from a Fine Gael minister, announced that 24/7 emergency cardiology will be provided at UHW.
Funding of €611k will be made available in 2025 to begin phasing in the extra staff and other resources to move to a full 24/7 cardiology service.
None of what became the cardiac campaign would have fully developed from people power and relentless protest without the selflessness of senior consultants in the system, namely Paddy Owens, Mark Doyle, Aidan Buckley, Niall Colwell and Rob Landers. They raised their heads above the parapet in 2016, risking future career promotion, by publicly calling a Dublin press conference to push against the Herity Report.
While acknowledging Ministers Butler and Cummins, the massive public input of Matt Shanahan during Dáil Leader’s Questions over the past five years was crucial.
Anyway, it’s a good day for Waterford. An incredible disgrace has been remedied.
The injury is undone, but the scar remains. Think particularly of those whose lives were lost or seriously impaired by those who actively prevented this service from being put in place. In the upper levels of Irish politics, something very weird and dark went on. For tiny money over the past decade, the department and the HSE held the line, to prevent this service coming on line.
It speaks volumes, while the funding wait goes on for SETU, our airport, port, roads etc., that on the day of the 24/7 announcement, they were unloading €456 million in Cork for a motorway to Ringaskiddy, “to commence immediately”!
There was or is something rotten in the HSE or Dept. of Health system, which opposed the regional development of tertiary acute medical services in Waterford. Is it temporarily dormant or does an embedded, malignant opposition remain?
The National Cardiology Report was not favourable to UHW. It said: Recommendation 4.0 “The NRCS recommends that the 24/7 emergency care of patients with STEMI-ACS continues to be concentrated in the four National Comprehensive Cardiac Centres (MMUH, SJH, GUH and CUH).”
It went on: Recommendation 4.1 “The NRCS recommends that interventional cardiology services should be sustained and strengthened at Beaumont Hospital (BH), University Hospital Limerick (UHL), University Hospital Waterford (UHW), St. Vincent’s University Hospital (SVUH), and Tallaght University Hospital (TUH) and that these centres should focus primarily on scheduled care.”
On December 8, 2015, following the publication of the 2014 Annual Report of Cardiology Services, this column contacted the HSE national clinical lead for cardiology Prof. Kieran Daly of UCG asking why that report contained no cardiology procedures data for UHW. He replied: “However, I will say that there were problems transferring from the local database in Waterford to the national database in 2014, not allowing core analysis. This is being rectified.”
In last week’s national report we find again in a data list of all the hospitals in Ireland (including Altnagelvin in Derry), which provide public PPCI: “Table 72.0: NOCA, IHAA data on PPCI in reporting centres, 2017-2020. UHW did not return data to the audit.” This farrago was shown to be manifestly untrue by UHW cardiologists in 2016. The UHW computer and the HSE computer apparently had incompatible software. The problem existed in 2014 and earlier. Was it ever fixed, or was it allowed to persist to conveniently skew findings and conceal UHW’s true level of activity?
Last week, the HSE National Capital Plan 2025 was published. This lists what the HSE hopes to build. Anyone giving the plan even a cursory glance can see that UHW as a Model 4 hospital is just not in the same capital projects league as the other hospitals of that level. The number of projects for CUH, UHL, UHG etc is enormous, while the historic failure to get vital UHW projects on the list in 2022 and 2023, other than those growing grey hair, still haunts. The one bright spot is the UHW surgical hub, which is under construction. Credit for that lies wherever your political loyalties take you.
The systems view of UHW is summarised by an entry on the list of projects, “To Proceed to detailed design”, in the 2024 National Capital Plan: Project 11810 “Two-storey extension to the existing UHW laboratory providing, specimen delivery etc.”
This identical project appears again on the same list in the 2025 National Capital Plan even though the extension is currently under construction. Do they even know what’s going on here?
Two new UHW projects appear on the 2025 Capital Plan, one is a proposed 96-bed ward block and the second is a multi-storey car park. Both are at the appraisal stage and would be a massive boost for UHW.
The plan also has several other proposed developments listed for years without any visible progress. Among them are: Project 13239 “Refurbish part of St Otteran’s incorporating an extension to house diagnostics to provide a permanent location for ICPCD & ICPOP for Waterford” which is at detailed design stage and Project 11730 “Replacement of the existing Adult Acute Mental Health Unit 44-bed multi-bed unit at UHW with a 50- bed single bed unit”, which is at appraisal stage.
Project 11455 “New build St. Otteran's: Children’s Therapy facility to facilitate therapy services for children and young with complex needs (including Sacred Heart Centre). Works part funded by Touching Hearts charity” is at detailed design stage and is listed for so long that it’s just plain disgraceful.
What is in evidence is the level of capital projects completed and planned for St Luke’s Hospital Kilkenny, a Model 3 hospital under the aegis of UHW tertiary services.
Kilkenny has attracted far more capital spending than UHW in the past five years. All hospital investment in the South East is welcome, but we must take issue with politics that direct capital spending. UHW as the largest hospital in the South East does not and has not fully benefitted to the level its status requires. Long-term doubts about the level of push for UHW projects by the HSE Estates office for the South East, which has been based in Kilkenny since SEHB days, are again beginning to surface.
