Health cuts hitting hard

EDITORIAL

THE planning application for the long-awaited extension to the Mid-Western Regional Hospital in Ennis had scarcely crossed the counter in the planning office when a report, prepared by HSE West, exposed how cutbacks and the recruitment embargo have had a devastating impact on health services.
The Ennis project is intended to deliver a €10m upgrade, which includes buildings and specialist equipment, but one must question if further cuts in health funding could mean that some of the new facilities might not be commissioned a few years down the line.
As the quality of health services continue to deteriorate, the mood in Clare is one of anger and frustration. This was quite evident at a public meeting in Ennis last week, organised by local councillor Paul O’Shea. He said he had a list of non-party political people who are willing to get involved in the Ennis Hospital Development Committee. There was a feeling among many at the meeting that a new health action committee, without any public representatives on board, should step up the campaign to oppose proposed cutbacks in Clare and the Mid-West, which is estimated could total €35m.
It is believed that cuts on the cards include ward closure at St Joseph’s Hospital in Ennis, the closure of the orthopaedic operating theatre and ward at Croom and ward closure at the Mid-Western Regional Hospital, Limerick. There would also be a reduction of overtime and use of agency staff, while junior doctor medical posts would be reduced through a reduction in locum cover.
The cuts, it has been claimed, are not affecting other HSE regions to the same degree as the HSE West area, which has seen an increase in patients being treated and must bear the cost of providing services over a large rural area.
Concerns are growing in Clare that waiting times for a wide range of public health services, including surgical procedures, will drift way beyond already unacceptable levels.
The Clare campaign to try to convince Health Minister Mary Harney and the Government to reverse plans to slash health funding by around €600m in December’s budget will be building from here on, joining a cacophony of protests from all over the country.
Details of the HSE West’s report, which has been leaked to the local and national media, should certainly inject a greater intensity into lobbying and public campaigning. It notes how frontline services in the west are worse hit by the recruitment embargo than management or specialist grades, as 67% of all vacancies arise in frontline staff grades. The report also highlights the fact that this situation could be reflective of the situation across the country.
The report is based on a survey of four main service areas – acute hospitals, community nursing services, mental health services and older people’s services. It highlights a reduced quality of care due to the cutbacks in these areas. Standards of breast cancer treatment have fallen and the risk of clinical errors has increased, it is suggested.
In acute hospitals, the ability to comply with Health Information and Quality Authority (HIQA) standards in areas such as infection control, decontamination, hygiene, breast cancer standards and care of the elderly has been seriously curtailed, the HSE report says.
The report details how cuts have affected specific services and how increases in adverse incidents were directly attributed to staff shortages and staff having to cross cover, which increases the risk of clinical errors by reducing continuity of care and increasing caseloads.
In maternity hospitals, “activity far outweighs the staffing levels, posing increased risks to mothers and babies”, the report states.
In mental health services, the report points to an increase in the number of violent incidents in the service, partly as a result of the low staffing levels and inexperienced staff. It notes that Mental Health Act 2001 regulations are being breached.
The report states that in public-health nursing, there is a risk to child health in the absence of core developmental assessments, so problems go unidentified and appropriate referrals to speech therapy and psychology are not made. The reduction in public health nursing services also pose a risk to post-natal mothers and newborn babies.
The report also refers to an increased risk of falls and adverse events for patients in older people’s services and a drop in staff employed to supervise elderly patients’ exercise. There are also longer waiting times for respite and rehabilitation beds for the elderly.
Meanwhile, the Irish Nurses and Midwives Organisation (INMO), has called for round table talks  at national level to discuss the crisis facing the public health service.
Setting a four-week deadline, the INMO wants a national health summit involving Minister Harney, her department, the incoming CEO of the HSE, other senior managers of the HSE and other staff organisations representing frontline professionals. 
“At this summit we will attempt to agree a more planned, co-ordinated, safe and appropriate approach to dealing with our budgetary difficulties, while maintaining safe and quality-assured services to the patients and wider public alike,” general secretary Liam Doran said.
Just like the HSE West report, the INMO has concluded that the level of cuts currently being imposed upon the public health service, are compromising patient care, lowering standards and greatly increasing clinical risk to patients. Frontline nurses and midwives say they are having their views ignored and every effort they are making to highlight real and significant risks to patients, are being simply set aside.
The INMO intends to raise the failure of the Minister for Health and Children to respond to its alternative proposal for a better health service at this health summit.
Such are the complexities of the various issues at stake that a national health summit would offer the best chance to talk things out fully and, where possible, make compromises. All parties must come to the table with a positive outlook so that there is a chance this could be achieved.