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Dr Reilly must set the record straight about Roscommon care

The episode relating to the Accident and Emergency service in Roscommon Hospital might teach us something about hospital planning policy in our Republic, but it sounds a clarion warning call about much that is wrong in our politics and public governance.

One of the perennially contentious issues in health policy is the balance that must be struck between rapid access to hospital care and the undoubted quality improvements which occur when resources are concentrated in a smaller number of larger centres.

Hospitals are often major employers, and the electoral fortunes of constituency politicians are frequently tied to the enthusiasm with which they defend them, even if it is bad policy.

Emergency services in Roscommon have been a poster child for this controversy since the Sixties, and well-meaning thoughtful persons may reach different conclusions about the advisability of maintaining them.

Why? It is situated just far enough away from major cities to give some cause for concern about speed of access for emergencies, but is insufficiently comprehensively equipped for the full range of emergencies.

Prior to the 2011 election, the future Taoiseach, Tanaiste and Minister of Health committed to defending existing services in Roscommon. Enda Kenny was particularly vociferous, and a signed leaflet from Dr James Reilly was also distributed.

Policy changed post- election and, in response to a report by the Health Information and Quality Authority (which never inspected Roscommon), 24-hour emergency services were discontinued.

Subsequently, Dr Reilly supported the closure, quoting data from the Hospital In-Patient Enquiry (HIPE) survey which suggested that the mortality rate for heart attack patients was four times higher in Roscommon than in Galway.

Local Fine Gael TD Denis Naughten felt his reputation for honesty would be compromised by such a volte face, objected, and lost both the party whip and the chairpersonship of the Health Committee.

The mortality differential was not plausible to me nor to several cardiologists. I was also troubled by the source. HIPE is not a quality audit. It is a system which gives a picture of the workload and case diversity of a hospital.

I also saw data from Roscommon which told a very different story to the HIPE figures. The mortality was indistinguishable from those quoted for Galway. I raised these issues in the Oireachtas.

In December, Dr Jennifer Martin of the Department of Health, in response to Mr Naughten, informed the Health Committee that while the HIPE figures had originally given grounds for concern about Roscommon, the department was now reassured.

This reversal was not reported in the press at the time.

I support Dr Reilly and his healthcare reforms, but believe he needs to set the record straight. Dr Paddy McHugh and his staff who performed a heroic job in providing cardiac care in the shamefully and systematically under-resourced Roscommon Hospital deserve no less.

Politicians also need to learn that they will be called to account when "promise 'em everything" pre-election stunts are not honoured.

Senator John Crown is a consultant oncologist

Sunday Independent