Mick Clifford gets it right again

Politicians pandering to healthcare fears

Michael Clifford
Saturday, July 02, 2011
THERE was no room for basic civility. When Enda Kenny stepped from his vehicle in Athlone last Monday, he saw his fellow TD, Luke “Ming” Flanagan, and approached him. Flanagan was among a large group of people protesting at the scheduled downgrading of A&E facilities at Roscommon Hospital.
Kenny appeared to be on the point of extending his hand for a civil greeting to a fellow parliamentarian, but Flanagan was having none of it. He might shake hands with the Taoiseach in the corridors of Leinster House, but out here, surrounded by his constituents, he was having none of that. Out here, surrounded by his constituents, he had to present himself as the local hero, standing up to the centralised powers who care not a whit for the plain people of Roscommon.

It later emerged that at a meeting with HSE officials the previous week, Flanagan told an official that if he were in the official’s position he “would get a rope and hang myself”. The comment was made to Philip Crowley, the HSE’s national director of risk and quality care, during a meeting over the future of Roscommon hospital. Flanagan refused to apologise for the remark. Instead, he revels in the portrayal of a local hero overcome by emotion for his constituents, hitting out at a faceless official who cares not a whit for the plain people of Roscommon.

The incidents involving Flanagan were particularly disappointing coming from somebody who has shown bravery on other issues.

You can agree or disagree with his campaign to legalise drugs. But at least he is honest on the issue, unlike the vast majority of politicians who just parrot what they think will go down well with their constituents.

As far as the hospital issue goes, though, Flanagan is demonstrating that he can pander to fears with the best of them, that there are few depths to which he will not sink to root around for a few votes.

The protests over the downgrading of Roscommon hospital were not unique.

Similar protests have taken place in recent years in Nenagh, Ennis, Monaghan and Dundalk. All have lost 24-hour emergency services since 2009. Last week also saw a protest in Portlaoise, although the situation there is not as clear-cut as in most other centres.

The protests, against what is perceived as stripping a local community of a vital service, are not confined to provincial Ireland. There was a gathering this week outside St Mary’s Hospital on Cork’s northside, over the transfer of orthopaedic services to the South Infirmary later this year. Some see the transfer as an effort to shut St Mary’s completely.

In Dublin, A&E services in Loughlinstown Hospital were recently transferred to St Vincents, from the southern tip of the conurbation to the centre. Dublin has six A&E units, which is high by international standards and there will inevitably be more closures in the city.

Even if the country was flush, the dispersal of such a high number of hospital services would not make sense. Repeated studies have shown that the health of all the citizens would be better serviced with centres of excellence.

In the A&E area, the Association of Emergency Medicine, a medics organisation, is of the opinion that fewer centres are required to order to provide a better service.

This has been borne out in the area of cancer care, which has improved greatly since the development of centres of excellence in recent years.

Reconfiguring the hospital service is not just a matter of money. It’s a matter of saving more lives, improving the quality of care for those who are ill, and speeding up recovery times. Why then all the resistance?

The fears displayed by people at protests are rooted in a number of causes. In the first instance any change in an area as primal as health is bound to generate some fear. This natural caution has been exacerbated by the performance and reputation of the HSE. Fairly or not, the executive is now regarded as a byword for incompetence.

The removal of the board by Health Minister James Reilly in April indicated how tarnished the brand of the HSE had become.

Much of the criticism is justified. Deep-rooted problems within the executive go all the way back to its formation in 2004. The stated objective in setting up the HSE was to take politics out of healthcare in order to provide better care for citizens.

The objective of the government — and particularly then taoiseach Bertie Ahern — was to ensure no electoral backlash would occur if services were streamlined and jobs lost. The end result has been an unwieldy beast, top heavy with administration, generating a culture where ass covering is high on everybody’s agenda.

Some of the criticism to which the executive is subjected is unfair. There have been improvements in a number of areas. But progress has been slow, and whatever hope the HSE had of blooming after its troubled early years were dashed by the collapse of the economy.

Beyond the HSE itself, the vested interests in the health system have not put patient care to the fore when it came to centralising services. From consultants down, individuals, some with a lot of influence, have put their own personal circumstances ahead of any concern for standards of care.

Then there is the politics.

It’s a decade since medical leaders have accepted that the way forward is centralisation of services. Yet politicians have continued to use the issue as a political football, pandering to fears rather than attempting to lead, putting votes ahead of any commitment to better society.

During the Ahern years, when there was a feeble attempt at reform, even a government minister took to the protest lines. Michael Smith, then defence minister, marched in a protest in Nenagh against his own government’s policy. His constituency colleague Marie Hocter had the good grace to stay at home, but Smith’s move was seen as an attempt to position his son for an eventual run for the Dáil.

Government TDs have resigned party whips over attempts to retain local services. Jimmy Devins, a medical doctor, resigned the whip over the downgrading of cancer services in Sligo as part of the centre of excellence strategy.

Before the last election, James Reilly, the Health Minister and a doctor, gave written assurances about the future of Roscommon hospital.

Local Fine Gael TD Denis Naughten felt compelled to do the same despite being positioned to retain his seat with little difficulty. Flanagan made Roscommon a major plank of his campaign, and it undoubtedly helped get him elected.

These are the politics that governs healthcare. The common good is irrelevant. The healthcare of constituents over the long term is irrelevant. All that matters is that you are seen to be pandering to fears, feeling pain rather than attempting to address it.

The ultimate result of all this cowardice is that vast tracts of the population would rather have a substandard level of care on their doorstep than travel a relatively short distance for the best care on offer. It’s a sad reflection on both governors and the governed.

This appeared in the printed version of the Irish Examiner Saturday, July 02, 2011

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