The fatal cost of shabby local politics
Mary Harney seems to be the only politician who is willing to embrace unpopularity for the sake of the ill, writes Emer O'Kelly
THE rage of losing a beloved young wife or a treasured child is more bitter now than it has been throughout history simply because of the advances of medical science: we expect people to be cured of their illnesses. We forget at times that we are not immortal, and that we will all die.
Doctors are not miracle workers. Nor are nurses and health technicians. And what's more, they make mistakes. And when they do, they probably live through their own agony: to make a mistake that costs a life must be a dreadful burden, particularly for a person who has chosen to work in the field of saving and preserving life.
Politicians, however, are not in the business of saving and preserving lives, except perhaps their own political lives. At least that's the way it seems, given their cowardly and self-serving behaviour concerning events at Ennis General Hospital in recent weeks, and indeed around the country in recent years. It almost seems that the put-upon Minister for Health is the only politician in the country with real compassion; she is certainly the only politician in the country willing to embrace unpopularity for the sake of the sick and helpless in our communities. And yes, I do mean Mary Harney.
I carry no brief for bureaucracy, and I believe, along with most other people, that the Health Service Executive is unacceptably, even unforgivably, bureaucratic and over-staffed at middle management level. But I also believe (unwillingly) that it is probably no more bureaucratic than the old health boards system. And there is certainly far less opportunity for corruption and favouritism in the HSE system than there was in the cronyism of the health boards. (That was one of the reasons for abolishing them.)
There is also the point that in public service terms the HSE is a very young organisation, and needs time to settle down. And of course there is the point that there would have been blue bloody murder if there had been mass enforced redundancies in the health services at the time of setting it up; blue bloody murder from the very people who are now complaining that it is slow-moving and incompetent. (And I'm afraid I do mean some of those who work in the HSE.) Indeed, we heard the howls of indignation in the Dail last week concerning the optional redundancy scheme in the HSE being extended to the wider public service.
The other reason for abolishing the health boards and establishing the HSE was to take the health service out of the hands of political appointees and give it into the care and administration of the medical profession. But the members of the medical profession are human as well, with human weaknesses. And some of them are high-minded and noble, just as a percentage of them are probably self-serving and greedy. So somebody has to take the courageous decisions involved in squaring all the conflicting circles. That person has been Mary Harney.
The Bacon report, delivered on her watch, recommended down-grading some local hospitals. A decision was also made to establish centres of excellence for specialist care of people suffering from cancers and particular forms of heart illness. But the specialist knowledge and medical provision is complex and expensive, just as the numbers of patients requiring such services are mercifully small. They're certainly not such as to require services being provided in 40 hospitals around the country serving a population of 4.2 million people. Or do we expect that people of enormous, rare and expensively acquired medical skills should sit around for five days out of seven, surrounded by massively expensive equipment in what are effectively no more than cottage hospitals in order to preserve local pride and political advantage?
The head of the HSE, Brendan Drumm, was on Morning Ireland last week, and he came as close as I've heard him to becoming emotional about the tragic deaths of Edel Kelly and Anne Moriarty because their cancers were mis-diagnosed at Ennis. Mistakes will always be made, he admitted because human beings are fallible. But mistakes can and should be minimised, and the only way to do this was to ensure that highly specialised medical care was delivered in highly specialised centres, by highly qualified specialist staff utilising their knowledge all day, every day, rather than allowing it to become rusty and out of date. The previous day, Tom Keane said the same thing on the same programme. And he's head of cancer services at the HSE, a man newly returned to Ireland to take up the post after impressive and eminent international experience.
Later the same day, the Minister announced an independent review of services at Ennis General Hospital. Immediately the local politicians lined up to squawk about a diabolical plot to downgrade Ennis. They included the Labour Party Health spokeswoman, Jan O'Sullivan, who also happens to be a local TD, and Madeleine Taylor-Quinn, the Fine Gael mayor. Both of them women, rushing to a judgement that could easily cost more women their lives. Breast cancer diagnostic services are no longer carried out at Ennis, thankfully; but had there not been determined political opposition from people who should know better to moving services to centres of excellence, tragic deaths might have been avoided.
But political courage is unpopular and costs votes. All politics are local. So let's talk about our pride in our local hospital, rather than accepting that in many health areas it is inadequate and its staff at best under-qualified, at worst culpably negligent. Let's keep shouting about 24-hour accident and emergency services because people will vote for us if we say that. Let's not point out that a split lip from a drunken brawl or a broken arm from a fall from a bicycle can be dealt with in a first aid clinic, and that such injuries form the bulk of A&E requirements. Let's not do our elected duty to lead the community, but let's block measures that can save lives.
All over the country we've seen people stand on election platforms shouting about "saving the local hospital". What they are doing is saving, or advancing, their own political advantage. Beverley Flynn did it in Mayo, steadfastly opposing the "downgrading" of Mayo General Hospital, only accepting it when it was part of the price of her re-admittance to Fianna Fail. Clare and Limerick politicians are now doing the same for Ennis.
Accepting the downgrading of local hospitals, or even their closure, is part of mature and responsible thinking. Medicine is a complex science, and becomes more so every day. If we want the best, we have to be selective. If people are brought to ill-equipped, under-staffed hospitals, they will die. The answer is not to spread funding so thinly that this is allowed to continue. Mary Harney knows this, and is prepared to say so, knowing it will make her unpopular. But already, Limerick and Clare politicians are hedging their bets about the results of the review of Ennis Hospital.
It's easy to see what will happen should closure be recommended. But how easy will it be for people to accept the deaths of loved ones because they are encouraged by self-serving politicians to believe that driving to Limerick is unbelievable and intolerable hardship?
