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Dublin: 6 °C Sunday 23 February, 2020

'It's strange that health managers never refer patients out of Dublin for treatment'

People must be willing to stand now in support of regional cardiac services and pressure their local and national representatives, writes Matt Shanahan.

Matt Shanahan Health Equality For the South East

THE SITUATION REMAINS that the Department of Health continues to move against the retention of emergency cardiac services at University Hospital Waterford, and a pending review this year is poised to formally mandate the cessation of emergency interventional cardiology in the south east.

The Department of Health is reported to have directed senior civil servants to look at “all means” to cater to the 170,000 patients, which the Herity report identified as being outside of 90-minute cardiac transfer time. This will most likely be addressed by the announcement of some new amalgam of helicopter cover and a prioritisation of ambulance cover etc.

Regardless of how it is achieved, it will seek to address regional cardiac transfer times and in so doing imply risk in supporting and continuing the existing south east 5-day interventional cardiac service at UHW. The consequences for regional emergency cardiac care, for other high level clinical services and for future regional economic activity, cannot be underestimated.

This will impact other health specialities

The loss of emergency intervention in the Waterford cath lab will result in the loss of the interventional specialist cardiology team based in Waterford, and will impact other health specialities. Among these will be some surgical procedures and particularly vascular surgery. This in time will downgrade UHW as a Regional Trauma Centre.

This downgrade will affect the recruitment and retention of clinical leads which will impact the rotation and training of medical students, and will further add to the spiral of reduced complex care.

It will ultimately affect services in the wider south east acute hospitals. All of these will be forced to refer more patients to centres in Cork and Dublin, thereby referring more medical spend out of the region.

That might appear acceptable on the face of it if improved care was guaranteed, unless of course one considers the difficulties that already exist in these centres, with long waiting lists and over-crowding already a significant feature.

Deliberate policy of centralisation

This desire to centralise health services in the large urban centres is a deliberate policy of both the Department of Health and the HSE for many years now. Despite the excellent work by senior clinicians in the south east region to expand cancer care services and treatment, the Department of Health is still clinging to its desire to reduce the national cancer centres from eight to five, and the south east centre is firmly in its sights.

This cancer centre has long been cited by senior health officials as one whose patients could receive adequate care from Cork and Dublin – strange that health managers never see opportunity in referring patients the other way.

All these desires appear easiest achieved in the south east where political consensus and influence are weak and where policy is not interrogated fully to account for costs and benefits, or the substantial impact on patients and family members.

The issue of money

Despite the south east region having 10.8% of the national population as recorded by the last census, recent research carried out in 2016 shows the region only receives 7.9% of available healthcare funding, and this is reducing year on year. In fact, the south east region’s public health system is short 1,450 health employees. This based on a “fair share” per capita resourcing.

This figure can be easily assessed by reviewing the combined budgets of the south east’s acute hospitals (South Tipperary General, St Luke’s, Kilkenny, Wexford General and the de facto regional hospital (UHW) in Waterford). The direct employee component in the acute hospital system in the south east are mostly professional jobs with higher incomes (doctors and nurses) and represent close to 5 or 6% of the regional economy.

The hospital system in the south east is the equivalent of a large strategic employer such as Intel in Lexlip.

We are consigning ourselves to limited healthcare access

The economic stakes resulting from the upcoming cardiac review for the region could not be higher, particularly as once new clinical pathways are resourced to divert patients out of the region, it will prove extremely difficult, if not impossible, to reverse the process.

Diverting patients out of the region for one high level speciality treatment will mean resourcing additional services onsite at these centres and this is where the regional budget will be negatively impacted further. We are consigning ourselves and our loved ones to increased hardship and limited healthcare access at a time when our demographic is signalling increasing need for regional accessible healthcare.

It also means impacting further the region’s ability to compete successfully in economic terms and therefore consigns our brightest and most talented graduates to say goodbye, as they feel the need to leave due to reduced economic and social opportunities.

Unless people are willing to stand now in support of regional cardiac services and pressure their local and national representatives to preserve and expand the present services as is justified, the future regional healthcare landscape will be broken beyond repair.

Matt Shanahan is a representative of Health Equality for the South East (HEFSE).

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About the author:

Matt Shanahan  / Health Equality For the South East

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