Thoughts on Roscommon Hospital

Much has been made in recent days about James Reilly's plans to close down the A&E service in Roscommon Hospital. He claims that the unit is unsafe and that patients are at more risk by being treated there than by traveling to Galway, Longford or Castlebar. This resulted in FG TD Denis Naughten losing the whip after voting against the government on the issue.

In my mind there are two major issues at play here. Firstly there is the conflict between the rationalization of services to provide economies of scale and the requirement for geographical spread of services to ensure no patient is too far from acute services. Secondly there is the political issue of promising rainbows and unicorns before an election and then not being able to deliver.

There are studies that show quite clearly that the further away from an A&E a patient becomes ill, the more likely the outcome will be bad. Therefore it makes sense to try and dot hospitals around the country in strategic locations so that people are not too far from help. In the current situation, closing Roscommon may lead to people driving to Galway for assistance. Having driven that road only a few months ago in some pretty heavy rain I can assure you that it is not something that you would like to do with a sick child or heart attack victim in the back seat. Double that length of time if you have to call out an ambulance and you can suddenly see why the people of Roscommon are up in arms about keeping the hospital open.

However, the flip side is that an A&E that doesn't see many patients will not have the experience and practice at dealing with serious problems. The figures speak for themselves in the Roscommon case where mortality rate was over three times higher in Roscommon than in Galway. In an ideal world, every city and town would have top class health (and education and transport and ...) infrastructure and services. But it doesn't work that way. There is a finite pot of resources and it can only make sense to invest heavily in areas that will provide the maximum return - ie where the population catchment area is sufficiently large.

People have to live with the choices they make. If you choose to live in a lightly populated area you can't expect the same level of services as those who live nearer each other. Density is king, and when you compare Dublin at nearly 1400 people per km^2 and Roscommon at 25 per km^2 you may begin to see where the problem comes from. I've been called on my urban bias before and accused of not understanding the rural way of life. And yes, maybe it's true. But you make choices in life and one of those choices is where you live. Living in Dublin 5, I can't have an expectation of waking to mooing cows and fields of corn outside my window. Likewise, if I lived in a rural area I couldn't have an expectation of rapid public transport, high-tech hospitals and third level education on my doorstep.

Politically it is also true - people have to live with the TDs they elect. The TD also has to live with the electorate and should stand by positions held in the run up to the election. That is why I have some grudging respect for Denis Naughten. It will be interesting to see ho long he remains outside the whip and if he will vote against the government on any other issues. It is not good enough for TDs to say the people have spoken and elected them to the Dáil if the premise on which they were elected is false. In any other sphere that would be a breach of contract and render the whole relationship void. Pity our politicians can't be held to account in that way.

Health Priorities

Briefing notes posted on the Dept of Health website at the end of last week make for depressing reading.

They state that Ireland must submit an action plan to the Committee of Ministers before mid June with respect to the ECHR judgement in the ABC case. It also notes that the ECHR decision is binding on the state and that action must be taken to avoid further violations of the Convention on Human Rights. Slightly further on in the 56 page document is a section on Assisted Human Reproduction where the issues on fertility treatments brought up by the frozen embryos case is discussed. So far so good. At least these two important issues are on the Department's agenda

But then at the bottom of the page there is a footnote that says "in light of current resources, a
decision will then have to be made as to which of these issues will be prioritised for
the development of regulation/legislation." This is an outrageous position for the Department to take. No matter what your views on the morals and ethics of either of these two issues, kicking one of them to touch due to cutbacks is not acceptable. You can be sure that plenty of other legislation will be prepared by the Dept of Health in the next period, much of it nowhere near as urgent or requiring the same level of scrutiny and sensitivity. It is this sort of carry on that gets the public service a bad name.

Hat tip to the Cork Irish Examiner for the story.