The Phoenix opinion column has been running in the Waterford News & Star for more than 30 years

LAST week, news broke in the Irish Examiner, quickly followed by the rest of the national media, of a delay in processing pathology tests at UHW. The hospital issued an emergency alert to Health Minister Stephen Donnelly because “demand is exceeding capacity”, resulting in the delay to tests being screened. A spokesman for Mr Donnelly said the HSE has established a joint Serious Incident Management Team with South South-West Hospital Group and Ireland East Hospital Group.

The traditional South Eastern Hospital Network was dismantled in 2014 by James Reilly, then Minister for Health and great friend of Phil Hogan. WRH was the regional hospital for Carlow, Wexford, South Tipperary and Kilkenny. The idea of academic hospital groups pushed by Reilly and Hogan saw WRH renamed as UHW and realigned with South Tipp hospital to Cork University Hospital.

‘There are only nine Model 4 units and UHW has traditionally trailed the pack on every possible metric’

Wexford and Kilkenny general hospitals were realigned with St Vincent’s in the Ireland East Hospital Group. This politically driven realignment, created as far as I could see to allow St Luke’s Hospital in Kilkenny turn its back on its Waterford neighbour, has failed. The unwillingness of the Kilkenny hospital (described in detail in a meeting at Waterford’s Granville Hotel), since the launch of interventional cardiology services in UHW in 2008, to engage with those services, has been a tragedy reeking of an “anywhere but Waterford” mindset.

Regardless of that, long established patient pathways into UHW still persist and the SláinteCare project aims to recreate the old South East Hospital Network with an added, albeit grossly unnecessary, leg up the east coast to include St Vincent’s Hospital Dublin.

Any delay processing medical tests can be dangerous and the shadow of Vicki Phelan looms large. David Cullinane says that UHW management had sought additional resources to fund new posts to deal with the backlog. He said, “if the funding has been made available, there can be no delay in filling these posts and ensuring the backlog is cleared”.

Interestingly, the Consultant Applications Advisory Committee (CAAC) only approved the recruitment of one new Histopathologist (they do the testing required) for UHW in February 2023. A trawl of the CAAC approvals website for 2022, which includes some hundreds of consultants for the HSE nationally, shows no other such post was approved. In 2021 CAAC did not approve any new UHW Histopathology post, but did approve one microbiologist post there and three microbiologist posts sharing time between UHW and Clonmel, Kilkenny and Wexford hospitals.

The situation obviously reminds us of the UHW mortuary debacle of May 2019 when temporary fridges had to be brought on site. It emerged that four pathologists at UHW performed 600 post mortems in 2018 while their CUH brethren (18 or 20 of them, the number is unclear) performed 800.  Does anyone question relative performance? Once again we look to the Cork SSWHG about resource deficits at UHW. Once again we look to the Taoiseach Leo Varadkar for an answer. He won’t be caught out about UHW resources again after the mortuary situation and the national embarrassment it caused.

If the Dáil speeches of Matt Shanahan are anything to go by the Taoiseach fully understands UHW’s deficits. When pressed about the delay in tests at UHW, Mr Varadkar said, “Further additional resources are required to meet the demand capacity gap for this vital regional service and recruitment or rather approval for recruitment of additional consultants, of histopathologists has been granted.”

His use of the plural suggests that more may be on the way, but the CAAC does not reflect that. It is probably a kneejerk reaction from SSWHG to the public disclosure (again) of a serious UHW resource deficit. The Taoiseach acknowledged the gap between demand and capacity and that is why authorisation has been given to appoint needed new consultants.

Mr Varadkar told the Dáil, when questioned by David Cullinane, that UHW has received considerable increases in resources in the past two years, “with the number of staff increasing by almost 20% and the hospital’s budget increasing by almost 20%”. This is indeed true, but an examination of HSE figures shows that there have been massive increases in staff and budgets at every hospital in the country. There are only nine Model 4 units and UHW has traditionally trailed the pack on every possible metric. Increases in staff and budget have been from an extremely low base. Drogheda’s Model 3 Hospital had 200 more staff in December 2019 than UHW Model 4! How did that happen?

In the three years to January 2023, CUH increased from 4,000 to 4,800 staff and UH Limerick increased from 2,800 to 3,700 staff. HSE acute hospitals in total went from 62,000 to 74,000 staff, which is an approximately 20% increase. UHW increased from 1,950 to 2,500. Good work has been done, but much remains to be achieved to bring UHW into alignment with staffing levels at other national Model 4 hospitals.

The physical development of UHW still lags. Prefabs have been built at the emergency department entrance, but these are no substitute for proper facilities. Planning permission for a major laboratory extension for UHW has been granted but when will it happen? The existing lab was the first part of UHW built in 1987 and is well past its use by date. Are these delays partially explained by the division of the south east region between two hospital groups?

This came into focus last week when fire broke out at Wexford General Hospital. Patients were being moved everywhere without any initial mention of UHW despite a very large (the largest?) number being transferred there, it being the nearest hospital and Emergency Department to Wexford General. One media report located the fire at “Waterford General Hospital”! Some place down there starting with W? Does it confirm the south east region lack of cohesion and our national profile?

When the SláinteCare programme delivers a renewed South Eastern Hospital Network with UHW at its core for acute services, with someone like Grace Rothwell as hospital CEO, instead of having to take direction from CUH or St Vincent’s, this city and this region will be able to compete for its due share of acute hospital staff and physical infrastructure.