Concerns over ICU

EDITORIAL

THE loss of the Intensive Care Unit (ICU) at the Mid-Western Regional Hospital, Ennis would be detrimental to the future of the hospital as a medical facility of any standing.
Suggestions that removal of the ICU at Ennis hospital and the withdrawal of associated full anaesthetic cover could be on the cards has prompted renewed concern about the future of the acute facility.
A year on from the elimination of 24-hour accident and emergency facilities in Ennis, to close the ICU would be a catastrophe and further enrage people around the county who feel cheated of their right to easy access to health services.
People with an interest in the hospital share the concerns of all hospital staff about whether or not Ennis hospital would effectively become a geriatric facility or a fully functioning day hospital with acute medical services.
While 8pm to 8am A&E is centralised at Limerick Regional Hospital, doctors can still refer medical patients with non-life threatening illnesses to Ennis hospital after 8pm, where a doctor would see them. There have been constant complaints about long delays in being attended to in Limerick or some patients having to return home or seek treatment in private hospitals.
According to national HSE director, John O’Brien, the authority had not made a definite decision about what medical services would remain in Ennis and Nenagh hospitals. He said the HSE also sought help as part of this process from the clinical director in Beaumont hospital and another senior consultant in the South-East.
The Clare chairman of the Irish College of General Practitioners, Dr Michael Harty, has warned that the delivery of medical services and surgical services are not mutually exclusive. He warned that the viability of standalone acute medical services in Ennis and Nenagh will be further undermined when anaesthetic services are withdrawn from these hospitals in July.
It is ironic that, as a backdrop to these concerns, it is expected that Health Minister Mary Harney will officially announce a €10 million refurbishment project, delivering 50 replacement in-patient beds in Ennis, in the near future. This is in addition to other major investments at the hospital in the past couple of years.
There’s little point, however, in having a hospital brought up to top standard if it is denuded of vital services.

Public service agreement

TAOISEACH Brian Cowen and his Cabinet will be waiting anxiously over the next couple of weeks for the results of a round of votes, which will no doubt be interpreted as a judgement on their governance.
The draft public service agreement, which took so long to emerge in the first instance, could well be rejected in a series of ballots to be conducted by several trade unions.
While the executives of four public service unions are proposing acceptance of the agreement, the queue of unions opposed to the deal is considerably longer. What has stumped many union members is a clause in the agreement that says that its implementation is subject to there being “no currently unforeseen budgetary deterioration”.
The proposal on the table includes guarantees of no further pay cuts until at least 2014, no compulsory redundancies and a mechanism for potentially restoring original pay rates in return for widespread work practice reforms.
Mr Cowen has made it clear that the Government has not contemplated any public sector pay arrangements other than the deal formulated at Croke Park. However, based on the best available evidence at the moment, Mr Cowen, Finance Minister Brian Lenihan and the Cabinet team better get prepared to go back to the drawing board.
Perhaps there was acknowledgement of this when, on Wednesday, the Government adopted a conciliatory tone in stating the process requires time for consideration and discussion and it will be for individual members of the unions to decide whether to accept or reject the deal.
Asserting that the draft agreement represents the best deal that can be negotiated, the Government confirmed its intention, on ratification, “to enter into and operate the agreement in absolute good faith, including the provisions relating to the review of public service pay”.
Earlier this week, the executives of the Civil and Public Services Union (CPSU), the lower-paid civil servants group and PDforra, the representative body for personnel in the Defence Forces, recommend rejection of the deal.
Blair Horan, CPSU general secretary, although not quite certain, said it is beginning to look as if the deal overall may be rejected, based on the recommendations that have emerged to date.  He is of the view that this wouldn’t necessarily be the end of the matter and that there could be renegotiation. This is far removed from the Government’s take on matters and further evidence that the Government should have a fallback position.
The nurses added to the Government’s woes on Tuesday.  The INMO, which has some 40,000 members, said it is not prepared to recommended acceptance of any agreement, which it “sincerely believed would not reverse pay cuts but would materially damage an already struggling public health service”.
General secretary Liam Doran has claimed that acceptance of the deal could involve a further 6,000 posts being lost from the health sector and a reduction of some3.500 hospital beds. Far from guaranteeing no further pay cuts, he said the deal allowed for the Government to reduce pay in the event of staff failing to accept or implement what he called the “fundamentally flawed” proposals for the health service.
Minister for Finance Brian Lenihan, in response, said he believed the deal on the table is “a reasonable agreement with real opportunities for both sides”.
There was an important rebalance on the issue, from a Government perspective, when SIPTU’s national executive decided to back the proposal. This will not, however, give Brian Cowen et al reason to jump around the place as still to come is a directive, if any, to members from IMPACT, the largest of the public service unions.
In the meantime, frustration for members of the public trying to deal with healthcare services has reared its head again. On Wednesday, IMPACT reinstated its ban on answering phones in various areas on a rolling basis. The phone ban, which is part of the union’s action over pay cuts, ran in the HSE West area from 9am to 1pm on Wednesday and is due to affect the south on Thursday and Dublin/Mid-Leinster on Friday.
Discontent among workers in the public service sector is set to rumble on and is an issue large enough to undermine the stability of the Government.