Out Of Control

18 February 2011 No Comments by The Northern Standard

A shared declaration of the party leaders who performed for the public on Monday’s night’s televised General Election debate was radical reform, to a greater or lesser degree, of the structures responsible for health service provision in this country.
The contemporaneously unfolding news that the availability of out-of-hours’ GP services in the north-east region was to be drastically curtailed because of a cost-cutting measure by the Health Service Executive added powerful impetus, and urgency, to the arguments being advanced.
It was, however, local political vigilance rather than national electioneering rhetoric that cast what was undoubtedly intended to be a furtive fait accompli, cloaked by the distractions of the election, into the public spotlight.
Sinn Féin TD for Cavan/Monaghan Caoimhghín Ó Caoláin, who sounded the first alert on the Doctor on Call changes set to come into force on March 1, and Independent member of Monaghan Co Council Paudge Connolly, who reacted to the news by tabling an Urgent Business Motion for discussion at Tuesday’s meeting of the county authority, acted commendably in ensuring that a decision with considerable implications for the well-being, both in physical health and ease of mind, of Co Monaghan people was brought to their attention – and made the subject of proper protest and calls for the measure to be halted and redressed by the incoming government administration.
That the efforts of our local representatives are unlikely to succeed in provoking anything other than outrage and condemnation makes a point about the urgency of health service reform with much more forcefulness than the party manifestos.
It exposes further the profound democratic deficit that has allowed decision-making in the health sector to become autocratic and led by considerations that pay only token acknowledgement to what in any humane society should be the foundation of a health care system: the needs of the patient.
It is bitterly ironic that the availability of the services of general practitioners out of normal surgery hours should be the subject of the latest callous economies to be introduced at the behest of the HSE.
The inadequacy and inconvenience of the existing service available to the people of Co Monaghan, especially those living in the northern parts of the county, has emerged over recent times as a matter of escalating public concern.
The members of Monaghan Town Council have been prominent in endeavours to have the existing Castleblayney-located Doctor on Call service augmented by a supplementary provision located either at the St Davnet’s Hospital complex for which such a service was initially planned, or at Monaghan General Hospital where there is copious capacity to accommodate it. They have also sought, without any appreciable success to date, to ascertain the views of GPs from the Monaghan area on how the existing service can be improved.
The Monaghan councillors will be particularly alarmed to find that, instead of the Castleblayney service being extended or enhanced, it is now to operate with only one doctor up to 11 am, and have the doctor on duty from 11 am until 7 am removed completely, with one doctor operating from Cavan expected to cover the needs of the entirety of both his own county and Co Monaghan throughout the late night and early morning hours – the time when the sudden onset of illness is the most alarming for any sufferer, and when the reassurance of having medical advice and assistance close to hand is most essential.
In a statement to this newspaper, the HSE seek to justify their decision to curtail the service with reference to a statistic. They say that, “This level of cover is deemed appropriate to respond to the average thirteen treatments provided each night in the north-east.”
It is profoundly shocking that the availability of services that could mean the difference between life and death for the people of this county is founded upon such a rationale. Who deems it appropriate? Is it an accountant sitting in an office with a brief to slash budgets and produce savings that won’t impact adversely on administrative personnel? Or is it an experienced medical professional who is acutely aware from experience in general practice of the random occurrence of medical emergency, and how the suffering of the sick and their relatives is allayed or exacerbated by the ease or the difficulty with which the services of a doctor in the early hours of the morning can be accessed?
The answer to this question is patently obvious from the recent experience of the people of this county, who have seen important medical services taken away from them on the insulting pretext that they will be much better off as a result.
That this trend can continue at a time when the activities of Ministers and the functioning of the Government is to some degree on automatic pilot because of the General Election process only serves to illustrate how beyond the control of the normal checks and balances of democratic accountability the health service in this country has been allowed to stray.
The party leaders were right about one thing on Monday – the health service is badly in need of changing. But it is doubtful whether any of them without recent experience in government realise just how out of control this particular administrative behemoth has been allowed to get, and just how difficult it might be to bring it to heel.
Abolishing or radically rationalising the existing executive structure is the easy part.
The much more difficult task will be restoring to the processes of health service administration the ordinary, decent principles of humility and humanity, a respect for human dignity and a willingness to give patients the best possible level of care even if it is not always in conformity with the balance sheets or the career preferences of a gilded medical professional elite.
That is long and hard work for the future, and the people of Co Monaghan in particular, regardless of their political affiliations, will wish whatever government is bequeathed the task every success in carrying it out.
In the meantime, it would behove the Minister for Health, if we still have one, to exercise early some of the wing-clipping that is being promised by all political voices for the health service in the brave new post-election world.
Deputy Coughlan should tell the HSE to curtail their Doctor on Call cuts until her successor in office can adjudicate upon their merits. It would be a timely reminder to the out of control administrators of the service that they are still the servants of the people.

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