Politicians have to maintain the illusion there is no miracle they can’t perform

Events in Roscommon these past weeks show that politicians will never hesitate in making a step ladder of the people to get at a vote that could go to an opponent.

The proximate political problem about the decision to axe 24/7 A&E at the County Hospital stems from the reckless promise made by the Fine Gael health spokesman Dr James Reilly to retain medical, surgical and other services, and to reinstate 24/7 A&E if necessary; and the fateful decision of the party’s election candidates to campaign on a prospectus that everyone knew was flaky and most knew simply could not be kept.

The proximate problem facing the hospital, on the other hand, is that its legacy as a service-taker is now catching up with it. Ever since the Fitzgerald Report said that 9 in every 10 hospitals be closed over an 11-year period, Roscommon has provided only those specialist services the State was willing to support and no other services.

Regardless of the party in power or the election promises they made to secure it, the long slow transformation of a small County Hospital into a glorified County Home has been relentless. And recent events suggest the momentum is almost unstoppable.

It’s tempting to think that the wellspring of the hospital’s woes goes back to the pulling of the County Council’s teeth by Jack Lynch in 1977. In truth, those teeth were pulled when the Health Act 1970 stripped Councillors of their control over local health services and transferred it seamlessly to a new regional bureaucracy, the Western Health Board.

While Fianna Fail and Fine Gael might have huffed and puffed about blocking the transition, in reality they could not and would not have done so. Politicians of every hue knew they had a fight on their hands but believed they might succeed in time; and they played the issue for political advantage so as to hold the ground with their opponents.

The Department of Health faced them down when they tried to ‘save’ the hospital before the Health Board was set up in 1971. While the strategy bought time, it brought no new services. Throughout the 1970s, Comhairle na nOispideal steadfastly refused to sanction the consultants needed to develop full maternity and paediatric services at Roscommon. When the posts were finally approved in the early 1980s, they were never permanently filled because of the fiscal crisis that gripped and nearly sank the State.

Comhairle was all-powerful in this period: it saw no point in spreading maternity and paediatric services in two hospitals; and so long as it had the power of appointment of hospital consultants, it was well-placed to resist local and national political pressures. The Hospital Action Committee emerged precisely because local people worried, correctly as it happens, that their Councillors and TDs were powerless to deliver the specialist medical, surgical, maternity and emergency services local people wanted.

The Minister started a jihad when he decided to put a consultant-staffed psychiatric service in the mother-and-baby units of the County Hospital. Predictably, the politicians railed against it and the controversy itself led to the election of an Action Committee candidate to the County Council in 1985. Ironically, it was the delay in getting the psychiatric unit that encouraged the late Tom Foxe to stand for election in 1989!

Foxe was credited with securing a number of improvements: the psychiatric unit that nobody wanted a few years before; a new medical unit that had since been sought by the Health Board; and a number of consultants that were needed to keep the whole facility functioning as an acute hospital. Enough to get him re-elected in 2002.

But not enough, it seems, to prevent the standards watchdog, HIQA, from running the rule over the hospital a decade on. Whereas Comhairle resisted appointing new consultants because the workload might never be generated to maintain their skills, HIQA can now use the absence of a consultant skill-base to assert that the hospital is intrinsically (and perhaps objectively) unsafe. And that’s the noose that’s now getting ever tighter around Roscommon County Hospital, and which will surely strangle it.

So, like many a politician in the constituency before them, Dennis Naughten and Frank Feighan made a promise they shouldn’t have made, in their case didn’t need to make, and in any event couldn’t keep even if they wanted. This issue is about power and how it’s distributed. Voters want to believe their politicians are all-powerful, so the politicians have to maintain the illusion there is no miracle they can’t perform. It’s when they can’t deliver – because they don’t understand the balance of power – that they come unstuck.

Locals are now seething about broken promises and the two TDs they believed – or were led to believe – had the clout to settle the issue are getting it in the neck, while the bodies with the real power – the HSE which pays the piper, and HIQA which calls the tune – escape unscathed. Let’s not even mention the overlords writing the cheques!

Fianna Fail have been banished for the cuts they inflicted on local health and hospital services to feed the banks and satisfy the overlords, while Fine Gael worries about the fate that awaits it in Roscommon and elsewhere for the very same reason. And Ming – he’s doing as the others did for decades, playing powerlessly, praying for survival.

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  • pippakin

    A very good post. My sympathies are with Roscommon but I have to admit, as much as I’m against the closure of A&E I also think the fight to save it is a lost cause…

  • Neville Bagnall

    The establishment of HIQA at least improves the separation between the setting and reporting of standards and the implementing bodies.

    Provided a comprehensive and consistent set of statistics emerge, germane and internationally comparable, policy decisions can potentially be evidence based.

    However, if the evidence is really comprehensive I expect it is going to call for some significant changes in practices and investment rather than just consolidation and closure.

    In particular I think the concerns over both Roscommon and NW Cancer Care point to an issue with transport and the ambulance service, even more than the hospital service.

    Its an issue that will likely remain a political hot potato short of significant investment in helicopters and distributed ambulance bases. Even more to the point, going by international experience, the evidence if collected and reported would likely support the case for investment.