The Phoenix opinion column, which has been running in the Waterford News & Star for more than 30 years
THE unbelievable news blew up from nowhere that the HSE planned to close the fixed cath lab at UHW for refit for 12 weeks. Local politicians were informed by a senior South-South West Hospital Group source. The refit of the lab with the most modern equipment is very welcome, but the stark fact of emergency heart attack care being unavailable here for nearly three months has caused a silent paroxysm of rage and worry. Had John Halligan done what he should have, a new lab would be in situ already. His failure to close a political deal has landed us all in very dangerous territory.
It was always known that the single lab was a single point of failure hence the campaign from the very start for a second unit. We have a mobile lab in situ at present, but space constraints apparently make it unsuitable for emergency heart attack care.
‘The refit of the lab with the most modern equipment is very welcome, but the stark fact of emergency heart attack care being unavailable here for nearly three months has caused a silent paroxysm of rage and worry.’
Following what is described as a “high level meeting” at UHW last week the responsibility for the whole business has been subtly shifted by the HSE SSWHG management onto the UHW cardiologists. They must come up with a solution. Blame is being shifted to them despite the fact that the SSWHG have known this risk for years. They have tried their utmost to drive UHW cardiology into the ground while undermining services here.
Public bleatings from Cork are shameful. They fear a really public heart attack death. Remember, these are the people who caused a 17 year long wait on the UHW mortuary and have still failed to deliver that “priority” project. These are the people charged with delivering a second cath lab which John Halligan and Mary Butler insist is “all systems go”, yet there is no published tender or planning for that project. Where is it?
By now people will have heard of Dominic Cummings, the campaign director of UK Vote Leave who has been appointed as a cabinet advisor by new UK PM Boris Johnson. Cummings is seen as a maverick and revolutionary by many people, but his ideas about the nature of the upper levels of the UK civil service, of which the Irish civil service is an offshoot, have a lot of resonance when we consider what the mandarins in the HSE, the SSWHG and the Dept. of Health have constantly done to acute hospital services and cardiology in UHW.
Patrick Wintour wrote in the Guardian: “It is not just that Dominic Cummings hates individual civil servants, he hates the whole Northcote-Trevelyan civil service system and believes it is one of Britain’s decrepit institutions that will most benefit from Brexit.” Cummings says, “It keeps out great people, it hoards power to a small number of people who are increasingly crap. And the management of the whole thing is increasingly farcical, like that of any closed bureaucracy keeping its perks. It cannot manage public services, it cannot deal with counter-terrorism. It’s programmed to fail – and it does.”
Brexit, he told the journalist Tim Shipman, “would force people to think about these things rather than being in the brain dead stupor they have been in the last 20 years where Whitehall just thinks about being in a Brussels meeting.”
It is very easy to understand reading that, rather like us in Waterford, how people in the north of England who voted for Brexit and those who voted for Donal Trump, who are alienated from the centre of power, would feel about the administrative and political system who are seen as pursuing their own agendas.
At the MacGill Summer school in Glenties, Co Donegal the Taoiseach Mr Varadkar said that politicians needed to make big policy decisions in relation to health, rather than operational ones. He said the six new regional health bodies announced recently were an example of where the Government had to resist political interference. “That was done totally based on population health analysis, that was totally objective by Sláintecare executive director Laura Magahy, and by chair Professor Tom Keane and there was loads of political lobbying to move those boundaries and we said no,” he said.
The jury is still out on just how positive the new regions will be for UHW. The proposal, and it is only a proposal, to realign the four hospitals in the South East together in conjunction with St Vincent’s Hospital in Dublin offers some opportunity to maintain and develop patient pathways in the South East. It is hard though, not to see the new region as being for the benefit of the powerful St Vincent’s lobby.
Remember they are a voluntary hospital with an independent board and CEO. They can and do take unilateral action when they so desire. UHW is a public hospital in the HSE system. It does not have an independent board or an independent CEO. When UHW line management may wish to do things, they are at all times subject to control and budgetary restrictions imposed from above. There is no wriggle room.
The traditional South East hospital region will be realigned with the old SEHB Community Health Office system based in Kilkenny. That CHO region has a population of over 500,000 people. It is very hard, despite the protestations of independent decision making advanced by the Taoiseach, to understand how Limerick and the mid-west with a population of 400,000 can have a new independent region, while we do not. The great worry for UHW is that the management CEO for the new east/south east region will be based in Dublin and we will again be peripheral to decisions about resource allocation. Is it a case of exchanging the Cork frying pan for the St Vincent’s fire?
It’s the economy, stupid!
Each year, with the publication of a new edition of the South East Economic Monitor these words come to mind. SEEM assembles information and data sets from official sources and produces an analysis of the south eastern economy. It is hated in official circles. And why wouldn’t it be? There is a huge and visible gulf between the South East and Dublin.
The difference between Waterford and the other cities of Cork, Limerick and Galway is obvious to anyone who has recently been in any of them. The lack of state investment here is palpable across all sectors. We all know that to be true. The region has a low share of IDA jobs, albeit slowly changing. There is a lift in the local economy and we can all feel that. The trouble is that we are still lagging in terms of high quality jobs. I don’t think anyone really disputes that.
There may be arguments about wage levels and disposable income, but the reality is that the South East is improving from a low base line. By 2017 real disposable income per household in the SE had still not surpassed its pre-crisis high in 2007. The median nominal income per household in the SE was €34,501 in 2017 (€47,477 for Dublin), a 1.5% decline since 2016.
The particularly important take from SEEM for the South East is that the Department of Public Expenditure maintains a database of significant capital projects (greater than €20 million), which lists 144 projects representing €16.4bn of exchequer expenditure identifiable to a particular county. €7.8bn is committed expenditure between 2018-2022. Only four SE projects are included on the table representing €92m of exchequer expenditure or 0.6% for a region of 8.86% of the population. For Waterford city, SEEM analysis of the most recently published Higher Education accounts indicates that €130m is currently being spent (or is committed in ongoing projects) in Cork/South-West, €80m in Limerick/Mid-West and €72m in Galway/West, whereas the equivalent figure for Waterford /South-East is €10m. And while we are being treated like lepers, Mr Halligan is a minister in the Department of Education!
A sign on the old TSB in Arundel Square says “Wetherspoons coming soon”. It will be interesting to see what happens. This is a UK company led by an arch Brexiteer, but that does not seem to stop them investing in Ireland. Money is the same wherever it comes from. Yuval Noah Harari wrote in his book “Sapiens” about the anonymity of money. While the crusaders and the Muslims were hacking each other to pieces in the Holy Land in the 11th century over religious differences, they were still happy to take gold or silver coins on each side, some featuring the Blessed Virgin and some dedicated to Allah. The Romans said it too. Pecunia non olet, “Money does not smell”. In other words people don’t care where it comes from.
We all hope that Wetherspoon moves quickly to develop their shop units in Broad Street and Arundel Square. The closed units have really had a negative impact on both streets and the planned gastro pub should attract new business and increased footfall. If they do move soon and the new retailers in the Broad Street centre, Mountain Warehouse, get open quickly it will have a transformative impact on the fortunes of this street, which has been at the heart of Waterford as the city market place since the 13th century.
And more money
Tomas O Sé writing in the Indo says that Dublin GAA got €1.3 million in Games Development money last year, a year in which their footballers won a fourth All-Ireland in a row. Tyrone, who they beat in last year’s final, received €119,000. In Dublin, that money pays for 50 per cent of every Games Development Officer’s salary. There’s about 70 currently working in Dublin (fewer than 10 in Cork), which means 70 clubs have to come up with 50 per cent of that salary. That is easier done by a Dublin club than one in a very rural location as big Dublin clubs attract corporate-level sponsors.
While we wait and wait and wait for the Waterford GAA board to come up with funding for a disgracefully long overdue re-development of Walsh Park, we might begin to understand that everything is connected to everything else and money above all else can determine success in economic, business and sporting life.