Is a dream a lie if it don’t come true?
Or is it something worse.
(The River, Bruce Springsteen)
We mightn’t like what she is saying but you got to love Dr Susan O’Reilly. She’s no politician and she’s certainly no diplomat and with the candid directness of a detached outsider she has confirmed our worse fears.
There is a plan for Portlaoise Hospital. The diagnosis is not good. In fact this plan for Portlaoise is so bad, no one, not even the Minister for Health wants to admit to having read it. Yet, along with others, he seems to know what’s in it.
This plan, presumably running to many pages, preambles, predictions and presumptions when it all boils down, reduces to one word. DOWNGRADE.
It’s a plan that even the mere mention of it strikes fear into the hearts of those in the corridors of power. They know about the plan, have heard of its existence, haven’t actually seen it, and have certainly never read it. That all boils down to another word. DENIABILITY.
Normally, I would admire and have a great regard for someone like Susan O’Reilly. I do like directness and a refreshing honesty and no bullshit in a political world that never boils things down to one word when a thousand will do. However, on this occasion I beg to differ with her and we are at odds. Unlike Susan we don’t have the luxury of crunching the numbers and applying the theory. For us this is real. It’s personal. It’s about our families. It’s a matter of life and death. There is nothing theoretical about it. We depend on, rely upon Portlaoise Hospital and its over-worked, stressed-out staff.
Theoretical best practice
The world in which the infamous Portlaoise Hospital Report now exists is the land of theoretical best practice. In this world there is no time as we understand it. It is a world like no other where you can indeed buy time. Usually the more time you buy the better as the as yet unopened and unread report isn’t real and remains in a twilight zone also known as, not on my watch.
This world also has no queues out the door at A&Es in Tullamore, Nass, Tallaght and St James; fleets of modern ambulances parked up and ready for the next call out; sufficient GPs, proper out of hours services and Primary Care Centres, fully equipped and staffed.
However, for those of us who live in the real world, time is running out. Time is running out for Portlaoise Hospital as we know it and as we would like it to be, as we know it should be and could be.
Contrary to what the high-up people in the HSE would like to suggest, my attachment to Portlaoise Hospital is neither emotional nor parochial. But yes, it is personal. Personal based on personal experience and the legitimate requirements and needs of the vast population, catchment of families which the hospital serves – well over 200,000 people, many with young children and elderly parents. I have recited all the other reasons we require and insist on 24/7 A&E services until I am blue in the face.
Political interference and medical snobbery
The families in our community rely and depend on Portlaoise Hospital 24/7, not 9 to 5 Monday to Friday. Not everyone can go private or bypass Portlaoise and head directly to the Beacon, Bon Secors or Blackrock private.
It would probably suit many people to dump this time bomb of a report in the lap of Charlie Flanagan. Some might even suggest that I would be first in the line to do so. Not so.
Charlie is not to blame or responsible for this report and its politically explosive recommendations which are also critically dangerous to patient safety not only in Laois but throughout a vast catchment covering Offaly and parts of Kildare, Wicklow, Carlow, and Tipperary.
Charlie is certainly not the author of this report and he is absolutely not the architect of the serious problems at the hospital. However, he and others will be responsible if they allow the report to be implemented.
Charlie and the present minister are not to blame for the problems at Portlaoise because these have their genesis going back between 20 and 30 years and during that time Portlaoise has continued to wrongly play second fiddle to Tullamore, Naas and elsewhere. This is largely due to political interference, medical snobbery and an institutional bias against Portlaoise embedded in the HSE and the Department of Health, where Portlaoise has no influential allies.
During this time there have been eight different Ministers for Health who have all contributed to and compounded Portlaoise’s problems. Today, there are no fewer than five ministers attached to the Department of Health.
Under-funded and under-resourced
Year after year for over two decades Portlaoise has been constantly under-funded, under-resourced and under-staffed, rendering it unsafe and undermined. The only miracle is that there have not been more terrible tragedies. In my view no personnel should be expected to work in such stressful, unsustainable, and short-staffed conditions.
Everyone knows that Portlaoise has been short changed. No wonder it is difficult to fill vacancies and why those who can, chose to by-pass the hospital.
This suits the HSE and the Department of Health. It feeds into their statistics and strategy to justify their policy and their PLAN. For them Portlaoise is just one more report, one more tragedy away from a downgrade … ostensibly in the interest of patient safety.
Undermine, understaff, and underfund it enough and they just have to sit back and wait for the inevitable to happen. Someone under so much pressure is sure to make a terrible mistake.
This is neither alarmist nor hypothetical. This is the view of your local GP. I trust the GPs. Laois GPs to their credit have spoken out and spoken up to expose the folly and the danger to patient safety and the sustainability of Portlaoise Hospital if the HSE and their cronies in the Department of Health have their way. It will be death for Portlaoise by a thousand cuts and HIQA reports on safety until the final drop of public confidence and trust is drained away.
Dublin-Midlands – no such place
Dr Susan O Reilly is the Chief Executive of the newly configured and so called Dublin-Midlands Hospital Group. But this too is an arbitrary concoction as there is no such place as the Dublin-Midlands, except in the minds of HSE mandarins who once again want to make Portlaoise peripheral, always on edge, always on the edge. If the region was for instance Mid-Leinster, the fastest growing population centre in the country, then Portlaoise would be in the centre, the hub, at the heart of the action.
But none of this should surprise us. None of this is new. Portlaoise Hospital has been betrayed and double-crossed before and there were dire warnings which were ignored, with extremely dire consequences.
Back in 1994 the then President Mary Robinson officially opened the Mammography Unit at Portlaoise Hospital. Apart from the tremendous strides forward it represented in terms of women’s health and tackling breast cancer it was a significant and prestigious step forward for the hospital.
It was led by Mr Peter Naughton the Portlaoise-based consultant. The initiative justifiably created the reasonable expectation that Portlaoise and its pioneering staff would be to the fore in cancer care and treatment for the region.
Lead cancer centre
In 1997 Brian Cowen became Minister for Health. In 1998 over 6,000 people marched on the streets of Portlaoise to protest the decision by the then Midland Health Board to designate Tullamore as the lead cancer care centre for the region in preference to Portlaoise. Many promises were made that day, since broken.
It was to be the first of many protest marches and meetings and it is a saga that continues to this very day.
From then onwards Portlaoise started to see a discernible decrease in funding, resources and recruitment. These were identified and repeatedly highlighted in letters (from 2001 to 2006) to a succession of Ministers for Health year on year by both consultants and nursing staff at the hospital.
They warned of the stark consequences and dangers of this underfunding, antiquated equipment, understaffing and key posts left vacant. These letters from people like the surgeon Pete Naughton and the INMO spoke of the ‘shambles’ in the hospital and the potential for tragic consequences. Unfortunately, they were ignored and proven right.
In an attempt to defuse the controversy around the cancer care decision the government commissioned an independent National Expert Group on Radiation Oncology. Headed up by the renowned and respected Professor Donal Hollywood of Trinity College it reported in 2003 and affirmed the status of Tullamore as lead centre for cancer care in the Midlands.
There was a public and political split but despite the consternation and disappointment in Portlaoise it was difficult to dispute the expert medical position. With some reluctance, I for one came out in favour of the Hollywood Report. I had seen too much politics and parochialism played with people’s health and felt it was best have a cancer care centre of excellence on our doorstep than none at all, or one in Dublin.
When a loved one is grievously ill from cancer you want them in the care of a medical expert in the field, with the resources, staff, know-how and critical mass to support best outcomes. I had a great friend from Clonaslee who was being treated for cancer at the time. It didn’t matter to me if he had to go to Tullamore instead of Portlaoise, once he got the best care, and it was far preferable than the trek and hassle of Dublin. (Ironically, Professor Hollywood himself died of cancer after a short illness in May 2013, aged 53).
Some people still hold that stance I took as editor of the Leinster Express against me and still don’t speak to me because of that. For the proponents of the Hollywood Report they felt I didn’t support it robustly enough.
So while you could die in Tullamore, you couldn’t be born there.
The basis of the Hollywood Report was that in the best interest of patient care, safety and outcomes you had to establish centres of excellence in the various medical disciplines.
The future of Midlands General Hospital Portlaoise was to be anchored by focusing on maternity and the attendant specialities of obstetrics, gynaecology and paediatrics. 24/7 Emergency Department A&E with full supporting midwifery staff and ambulance cover is critical to the safe and sustainable delivery of these services and these babies to expectant mothers.
Notwithstanding the quote mischievously attributed to a local election candidate back at that time, that there was a ten-month waiting list to get into the maternity wards in Portlaoise, there was a baby boom in Portlaoise and maternity numbers rocketed.
Same old story
But resources and staff numbers did not increase accordingly. The same old story all over again, with the same dire warning, protest marches, public meetings and unfortunately the tragic consequences for some families.
Portlaoise Hospital has been betrayed and double-crossed a good few times. The Report on Minister Simon Harris’s desk that no one wants to read is only the latest example.
Like a doctor, I want to give it to you straight – if previous experience is anything to go by there is no Hollywood ending in sight for Portlaoise Hospital.