The Phoenix opinion column has been running in the Waterford News & Star for more than 30 years
SADLY to say, rather than being the score in some esoteric sport or other, those are the figures which emerged during our mortuary ‘bodily fluids on the floor’ debacle for post-mortems (PMs) carried out in UHW versus those carried out in CUH in 2018. The comparison does not look too bad until you realise that the 600 UHW post-mortems were carried out by four pathologists in very poor work surroundings, while the CUH ones were performed in hotel like surroundings by 20 pathologists. The math, as the Yanks say, is simple. Every UHW pathologist did 150 PMs in that year, while the Cork lads did 40 each.
I have seen no evidence that any element of the national media picked up on those numbers? To do so would pose very fundamental questions to the HSE/Dept. about the allocation of resources? It would hardly be unfair to suggest that Cork political strength has ensured that CUH has been stuffed with staff, budget and capacity. The relativities of staff numbers per bed, bed numbers per head of population and general budget allocation etc are all explored in the annual South East Economic Monitor. The comparisons don’t make for comfortable reading. 20 pathologists versus four just about describes it.
‘Out of the Cork frying pan, into the Dublin fire perhaps?’
When you question these things you are told that the funding/resource disparity is “historic” and can only be remedied “over time”. It’s actually hysterical, but no one in Waterford is laughing! The figures can be better understood in terms of the SSHWG structure where the total numbers will be presented as 24 pathologists (20 CUH plus four UHW) doing 1,400 PMs, making a fairly respectable average of about 60 each per annum. Huge investment has gone into CUH in recent years. Are relative CUH inefficiencies being masked by the UHW efficiencies? Were PMs a private business, CUH mortuary would probably be closed and its work transferred to UHW.
The figures are more important than ever in the context of the resignation of Laura Magahy and Prof Tom Keane from the Sláintecare Implementation Advisory Committee. Prof Keane, the man who designed and oversaw the implementation of the National Cancer Service, said: “Sadly, I have come to conclude that the requirements for implementing this unprecedented programme for change are seriously lacking.”
Chief among the reasons for the resignations was the failure to agree the Sláintecare regional structure and the transfer of budgetary control from the HSE/Dept. of Health to those regional boards. Once again we are faced with the truism that power is never willingly surrendered but has to be taken. In recent months, the HSE has quietly gone about its business, beefing up central management, hardly evidence of anything except a desire to keep holding the strings. The Dept. of Health mandarins will never surrender an iota of power or control. It simply is not in the nature of the beast.
Remember, CUH is the Model 4 hospital for the 650,000 people in Cork and Kerry, while UHW looked after the traditional south east, Waterford, Wexford, Carlow, Kilkenny and South Tipp with a population approaching 550,000. This traditional south east region is homogenous and geographically compact and is still used by the HSE as the basis for its Community Health Office (CHO 5). This was also the region used by the HSE from its inception in 2005 and by the old SEHB since 1972 for its South Eastern Hospital Network.
The network was long established. Patient pathways and inter hospital agreements were well understood and sustainable. The notion that people would be treated close to home was central, except for the most serious acute cases, which needed treatment in Dublin or Cork. In general the idea was to develop the hospital network with all appropriate tertiary services locally. The network was destroyed under Fine Gael’s hospital group structure reorganisation in 2013. UHW and South Tipp General came under Cork control and St Luke’s Kilkenny and Wexford General came under St Vincent’s in Dublin. Sláintecare 2017 plans that the traditional south east region CHO 5 would be reformed around UHW and united with St Vincent’s along a “leg” of coastal east Wicklow into South Dublin, thus leaving CUH to soldier on alone with Kerry General under its wing.
If you break up the SSWHG structure, which is now one of the largest hospital groups in the country and align UHW and the traditional South Eastern Hospital Network with St Vincent’s in Dublin, CUH, with Cork and Kerry, would then be one of the smallest groups in the country, left trying to explain what it should do with the massive staffing and budget resources it has been politically endowed with since the inception of the hospital groups. Cork determination to extend Leeside medical influence, driven by a raft of cabinet ministers, was paramount. UHW is almost a decade working under the yoke of the carnage Cork SSWHG group. Promises were made but never kept. I wonder, does UCC’s Professor John Higgins still visit this outpost of the empire he handed Cork and what does he say to the people of the South East when they look him in the eye?
At its heart, the, “who will control UHW and the South East Hospital Network budget and its acute patient load?” is one of the biggest questions in Sláintecare. Politics suggest that CUH, with the Taoiseach and two senior cabinet ministers in situ, has too much power to be overruled and therefore UHW will forever be tied to Cork apron strings. Others say that St Vincent’s, in the heart of Dublin 4, has embedded power and influence across the whole Dublin political, commercial, medical and educational spectrum. Would a move from Cork to Dublin control be of any benefit to UHW? Would St Vincent’s be any more inclined to share staff and budgetary resources with UHW than CUH were? The supercilious Dublin viewpoint of things “down the country” is well known. The word from Wexford and Kilkenny, currently in St Vincent’s tender embrace, is that resources have not appeared at all. Out of the Cork frying pan into the Dublin fire perhaps?