Sunday, 1 March 2009

A View from the Pew - Reconfiguring Our Hospitals

View from the Pew is a regular column I write for Newslink, the Diocesan magazine for the Diocese of Limerick and Killaloe. This one appeared in the March 2009 issue.

Concerned citizens listen in the rain at Nenagh Hospital Rally (photo Bridget Delaney)

What in the name of heaven is the HSE up to?
It has been an open secret that the HSE planned to ‘reconfigure’ acute public hospital services in the Mid-West. But they did not tell us - the people they are meant to serve – what this would mean until mid January. That was when they finally published a report by management consultants Teamwork and Howarth dated April 2008. And only then did they publicly announce they would remove services from Nenagh and Ennis General Hospitals and St John’s Limerick to the Mid-West Regional Hospital in Limerick: A&E is to go by April this year, acute surgery in July, and critical care services in 2010. In effect the smaller hospitals, which currently handle about half of acute admissions, will be converted to step-down and day-case/minor injury clinics, and acute admissions to the Regional Hospital will be doubled.

The case for reconfiguration
In so far as I understand the Teamwork/Howarth case for reconfiguration, it is that the present services are unsafe and unsustainable: unsafe, because there are too few consultants to provide adequate consultant supervision in all four hospitals; and unsustainable, because the workloads in the smaller hospitals do not justify employing more consultants or keeping operating theatre and intensive care units open around the clock. Teamwork/Howarth also says that doctors admit many patients who should not be in hospital, and do not discharge them early enough: acute beds can be cut, if doctors can be made to follow best practice clinical guidelines. In other words, they believe that the proposed reconfiguration will save money.

But they also claim that the changes will lead to: ‘much better patient experience and interaction with health care services; patients accessing more care at home and in their community setting; fewer patients spending unnecessary time visiting or being an in-patient in hospital; and safe and sustainable local and regional hospital services for patients, the population of the Mid-West, and for staff.’

Who could possibly object to all that? Better patient care and money saved too!

The case against
But I do not believe in the tooth fairy, and I do not trust the HSE reconfiguration plan. Here are some of the reasons why:

Reconfiguration of hospital services in the North East has been a disaster – Teamwork consultants advised the HSE there too. A&E services in Cavan, Monaghan and Navan hospitals were closed and transferred to Our Lady of Lourdes in Drogheda. As a result the Drogheda A&E service collapsed this winter, and the hospital was forced to suspend A&E services for a while. Following this crisis morale is very low, and many senior staff resigned in protest. The promised new regional hospital has been put on the long finger - local TD and minister Dermot Ahern said there isn’t a ‘red cent’ available to build it.

Howarth/Teamwork says clearly that reconfiguration in the Mid West will not succeed unless pre-requisites are met. These include more A&E consultants, more resources for primary care around the clock, enhanced ambulance services with advanced paramedics (they even mention air-ambulances!), urgent care/step down centres to take pressure off acute beds, and IT services to support electronic records and telemedicine. An earlier draft report is said to have called for 165 extra beds in Limerick Regional, but this is omitted from the published version. I suspect their HSE paymasters found this recommendation unacceptable.

These pre-requisites will cost money – a lot of it! Do we seriously believe the Department of Finance will provide it in this recession? The HSE claim they will provide sufficient advanced paramedics, though they are not in place yet. But the HSE is already cutting expenditure – as recently as 29th January the Mid-West Hospital Group manager John Hennessy said, “The 2009 budget allocation will require reconfiguration and service efficiencies in excess of €10 million”. The jargon is barbarous, but I think it means that reconfiguration is being rushed in now as a cost saving measure, and the costly pre-requisites will be ignored.

The HSE is forcing this plan through by stealth without consulting the public, hospital staff or GPs. Minister Harney refused to publish the plan earlier, admitting she feared it would engender opposition and prevent implementation. Consultants, doctors and nurses that I respect have publicly said that reconfiguration will harm their patients. And not one of 80 Mid-West GPs who recently attended an HSE briefing voted confidence in reconfiguration.

No wonder people are up in arms!
I attended a public meeting in Nenagh on 31st January, organised by the Nenagh Hospital Action Group at the request of Nenagh Town Council and Mayor Virginia O’Dowd. As least 1000 people turned out on a wet Saturday night, many standing outside in the rain because they could not get into the hall. They listened to doctors, patients, politicians from all parties and other speakers express their concern, even outrage, at how reconfiguration would affect Nenagh hospital.

Rev Marie Rowley-Brooke speaks her mind (photo Bridget Delaney)

Nenagh Rector Revd Marie Rowley-Brooke, as Church of Ireland Chaplain to the hospital, spoke from the floor of the healing benefits for patients being cared for in their own community surrounded by loved ones, something not factored in by HSE accountants. She expressed shock that unelected and unaccountable people were given the authority to impose ill thought out plans against the wishes of the community, threatening trust and the whole basis of our democracy.

Outrageously, although invited, no one from the HSE chose to attend and speak. Local Minister for Older People Maura Hoctor also disgraced herself by her absence.

I feel sure the people of Clare and Limerick are no less concerned than those of North Tipperary.

How should a Christian respond?
My own fury at the HSE attempt to ram this reconfiguration through must be obvious by now! It is not that I think change is unnecessary – after all medical science develops all the time and services must change accordingly, as they always have done. But I do believe these changes are ill-planned and dangerous. The public hospitals belong to us all, and the HSE has no right to proceed in this underhand, undemocratic way. All of us, but particularly the chronic sick, the vulnerable young and old, and those without private medical insurance, will pay the price if they succeed, I think.

The author expresses his opinion (photo Bridget Delaney)

My conscience tells me that I must resist the HSE plans, and that is what I intend to do. I shall go on the protest march planned for Saturday 21st February, where I confidently expect to join several thousand others. That will only be the start of a campaign which will continue until reconfiguration is rescinded. The ultimate decision will be a political one, and if the people are united I am sure we will prevail.

I shall also pray for the success of the campaign against reconfiguration. I may be on dangerous ground here. Some may feel it is wrong to invoke God’s help in what is a political campaign: much better Christians than I will take the opposite side. But I believe they are wrong, and I must obey my own conscience, as they should obey theirs. Jesus prayed in the Garden of Gethsemane, ‘Father, if you are willing, remove this cup from me; yet, not my will but yours be done.’ I think it is right and proper to pray for what we desire. But, like Jesus we must also pray that God’s will be done.

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