25 January 2001 Edition

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Hospitals face axe as Martin balances books

BY MICHAEL PIERSE

A spokesperson for the Irish Hospital Consultants' Association (IHCA), Dónal Duffy, has accused the 26-County Department of Health this week of being ``engaged in a budget balancing exercise, at the expense of patient care''.

     
Hospitals threatened with closure include those in Naas, Dún Laoghaire, Louth, Monaghan, Roscommon, Ennis, Bantry and Mallow
Duffy's comments come after a series of revelations about the dilapidated state of the health service in the 26 Counties. It emerged last weekend that new rationalisation plans for the service could mean the closure of up to 30 hospitals throughout the state. This was accompanied by news that 15 hospitals are to be penalised for inefficiency and keeping patients in bed too long and a report revealing that operating theatres in some of the state's major hospitals are lying idle for up to one week in every month, due to staff shortages.

The 26-County Minister for Health, Micheál Martin, had ordered a complete review of the state's hospital services following increasing demands from doctors for higher standards, legal pressure to upgrade patient safety and care and proposals for a reduction in the working week for junior doctors.

Junior doctors work an average of 77 hours per week at present, but this figure will be reduced to 58 hours in the next three years and to 48 hours by the year 2010. These reductions, coupled with the pressures of an already under-staffed and under-resourced health service, may lead to the closure of 30 hospitals, mostly in rural areas.

Hospitals threatened by the review include those in Naas, Dún Laoghaire, Louth, Monaghan, Roscommon, Ennis, Bantry and Mallow.

This revelation has been exacerbated by more bad news for Irish hospitals, especially those already crippled by massive financial strains. In an attempt to force hospitals to adhere strictly to their budgets, the Department of Health has introduced a `cash-clawback' system that will penalise `inefficient' hospitals by over £3 million and award the penalty fee to hospitals with a better budgetary performance.

Tallaght Hospital in Dublin will be the biggest loser, with fines totalling £1.3m, while Our Lady of Lourdes in Drogheda, Portiuncula in Galway, St Columcilles in Dublin and Croom in Limerick will foot most of the rest of the bill. The £3 million total will be divided between hospitals that performed well, such as UCH Galway, Cork University and Beaumont in Dublin, which stand to gain almost £500,000 each.

``This is a budget-balancing exercise by the Department of Health at the expense of patient care and without any area-specific considerations,'' Dónal Duffy told An Phoblacht.

``For example, Our Lady of Lourdes in Drogheda, one of the losers in the cash-clawback system, has to cater for a much older population than other hospitals. This means that longer stays and increased resources are essential for the hospital to function properly.''

Duffy believes that staffing shortages in the health system are responsible for the Department of Health reforms. ``Something has to give,'' he says, ``and that's possibly what's happening.''

More than possibly, according to an Eastern Regional Health Authority (ERHA) report this week. It finds that the nursing shortage and poor hospital management have led to a situation in which 22 per cent of operating theatre time in hospitals that fall under its remit is not being used.

``This is no great surprise,'' says Duffy. ``St Vincent's, the Mater and Tallaght in Dublin have each had theatres closed due to a shortage in resources. Tallaght in particular has a number of theatres that haven't opened since day one.''

While there has been what he terms a ``phenomenal growth'' in employment in the health service, this growth has been concentrated in the area of administration. The quantity of doctors servicing hospitals in the 26 Counties has grown only marginally in recent years, while the number of nurses has declined.

``There are three main factors in the decline in nursing staff,'' Duffy says. ``One is that they are leaving the country to find better conditions and pay elsewhere. Two is that they are changing careers, most often entering the pharmaceutical industry, for the same reasons of bad pay and conditions. And three, they are getting out of nursing due to the inordinate cost of living in Dublin.''

The problem with regard to junior doctors' working hours has been well flagged, he says. ``It's amazing that they are operating for durations that truck drivers are not allowed work, and I don't mean that in a derogatory way to truck drivers. The point is that the safety of the public is being totally undermined.''

Duffy's organisation, the IHCA, had recommended an increase of 1,000 hospital consultants for the health service. This figure now seems a bit conservative, he says.

Another recommendation is for further integration between the health services north and south of the border. This would lead to greater efficiency in poorly serviced border areas. One indication that integration can improve the Irish health services is a mock incident that was conducted on a cross-border initiative during the Christmas of 1999. ``It showed that cross-border cooperation could save lives,'' he explains, ``but it isn't simple, there are also complications in that area.''

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