No easy way to deliver dreaded 'downgrade'
POLITICIANS have always struggled to deal with the issue of hospitals. They employ large numbers and treat large numbers of patients. They are often seen as a symbol of the vitality of a constituency.
So woe betide any local TD who is seen as being asleep on the job as the local hospital is undermined – or worse still, shut down altogether.
But it is the job of Health Ministers to look at the bigger picture – and those who have the will to drive through changes can deliver huge improvements for patients.
Mary Harney was much criticised during her time as health minister, but even her opponents praise her for the decision to centralise cancer services at eight regional centres of excellence. It led to two Fianna Fail TDs in Sligo-Leitrim losing the whip because Sligo hospital lost its cancer care services.
Health Minister James Reilly got an early lesson in how tough hospital politics can be within months of taking office when he decided to shut down the A&E in Roscommon Hospital. Local Fine Gael TD Denis Naughten resigned and his colleague Frank Feighan was threatened with a "bullet in the head".
So it is understandable that Dr Reilly has taken plenty of time in deciding on the six hospital groups, particularly in the tricky case of Waterford Regional Hospital.
Local Fine Gael and Labour TDs had met him several times to lobby against any downgrading, and there had been a protest march by 15,000 people. Dr Reilly has promised it will become a teaching hospital, have 24-hour cardiology services and retain its existing services.
The real test for Dr Reilly will be in the coming years, when his new hospital groups produce their plans about what services are provided by each hospital. There will be more opposition from TDs if they fear that their hospital is being "downgraded".
Such protests have succeeded in the past – with the Fitzgerald Report in 1968 into hospital reform and the more recent Hanly report in 2003 both being only partly implemented.
So Dr Reilly will have to walk the walk to deliver on his promise of "the most fundamental reform of the acute hospital system in decades".