Monday 22 July 2019

Medb Ruane: Mary Harney's lasting contribution will be a two-tier health system ... and a monolithic Stalinist-scale HSE

Medb Ruane

The PD conference in 2003 was a (genteelly) rip-roaring affair. Fighting talk spouted from Michael Mc Dowell, Mary Harney, Tim O'Malley and others once known, now forgotten. Health-service reform was near top of their agenda -- especially 'patient-centred healthcare.' Harney began pursuing it when Bertie Ahern made her Minister for Health the following year.

Six years on, Harney's habitual eloquence is falling short of slick phrases to label the scandals raining down on her domain. Tracey Fay's intolerable life and death in care couldn't be massaged away last week. Now, there's the X-ray scandals in Tallaght Hospital.

The numbers involved are bigger than the population of a major Irish town -- imagine neglecting all of Waterford city and county. A total of 57,921 X-rays weren't examined by consultant radiologists.

This neglect lasted for five years, although Harney says she only heard about it just before Christmas 2009 and only realised the scale, along with the rest of the country, this week.

The Tallaght saga mirrors everything the PDs said was wrong with Irish healthcare. Money was spent on services that didn't deliver for patients and weren't accountable in good enough time. Patients were almost the last to know.

Local GPs complained. Dr Tom O'Dowd, a west Tallaght GP, contacted the hospital in April 2009 but didn't receive a reply. New CEO Prof Kevin Conlon learned about it when he began there on December 14. According to Harney, he told her there were "issues in the radiology department" at the end of her first meeting with him the next day.

One patient with a delayed diagnosis died last summer, although Prof Conlon explained that their death was due to disease rather than delay. Another is now undergoing cancer treatment. Meanwhile, the hospital cleared over 50pc of cases.

This leaves a 'backlog' of 23,169 unexamined X-rays. Harney rushed to point out that the numbers, though shocking, represent only 6pc of total X-rays processed in Tallaght, which was a strange kind of gloss. Life isn't about 100pc results, but turning almost 58,000 images of people's body parts into a neat little statistic masks the issues involved.

Patient-centred care is about the '6pc'. Most people improve after treatment but that's unremarkable, because people have a legitimate expectation they'll be treated properly. The 6pc matter, because they're usually the most vulnerable.

Such as Susie Long, who went on radio as 'Rosie' in 2007 because her cancer became terminal after waiting and waiting on a public list. Such as Ann Moriarty and Edel Kelly, who died of breast cancer after another 'systems failure' in Ennis.

That single number also covers over lethal failures at Barrington's, Portlaoise, Drogheda, Navan, Cork University Hospital -- and more. Or careless errors such as happened to a reader's elderly mother, admitted for observation but not given her anti-psychotic medication despite reminders. She had a psychotic break, which delayed her routine surgery and left her more ill than on admission.

What exactly is Harney responsible for? Issues of patient-centred care echo many PD criticisms of the old health boards. With one big difference. The question of accountability seems to have shrunk since Harney took over six years ago. That includes political accountability, both the HSE and, especially, Harney's own.

Would health services differ at all if Mary Harney lost her slot? Despite some positive evidence, she's failed to persuade people that Irish healthcare has actually improved.

Surprisingly, she hasn't succeeded in leading from the front -- and certainly hasn't delivered belief in that distant 2003 PD goal of putting patients first. There may be less confidence in the health system now than when she took office.

For many, she's part of the problem rather than the solution. Her ideological embrace of an incentivised, public-private model belongs to a long-ago free marketeering era, now discredited. It's like trying to fit a round late 1980s peg into a third millennium hole.

Harney's lasting contribution, unfortunately, is the two-tier public/private system -- and the monolithic Stalinist-scale HSE bureaucracy. The HSE's extensive remit, along with its top-down management hierarchy, discourages critical and independent thinking, never mind dissent. Just wonder where to access reports on the 22 other children who died since 2000 while in HSE care or why the HSE won't publish them.

Minister Harney's department's mission statement is abundantly well-intentioned.

"To improve the health and well-being of people in Ireland in a manner that promotes better health for everyone, fair access, responsive and appropriate care delivery, and high performance."

Match this to the endless lists of promises made (and broken) that litter the last six years -- special wards for cystic fibrosis patients, separate mental health facilities for adolescents, giving anti-cervical vaccines to all young girls, not just a single school yearful. You could go on.

Mary Harney can't be responsible for every X-ray or misdiagnosis, every misread prescription or patient lying on a trolley for way too long. But she is responsible for overseeing health services in people's interests, for shaping the system, especially after six years in the job.

For five of those years, X-rays weren't properly processed in Tallaght -- which says at least that something is badly wrong in her chain of command.

Irish Independent

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