Wexford Hospital on life support

I’m shocked at the resignation of Dr Colm Quigley as as lead in the reconfiguration of hospitals in the south east region of the HSE. Earlier this week I met Dr Quigley at a meeting to set up a Community Alliance to support Wexford General Hospital. He didn’t convey the image of someone who was on the verge of resignation. So what has happened this week to culminate in his resignation?

A good old fashioned piece of journalism on the part of South East Radio. The leaking of a confidential document outlining proposals to downgrade A&E long with the planned transfer of maternity to Waterford Regional Hospital was a seemingly a step too far for Dr Quigley. The document set out that 2 hospitals in the region Kilkenny and Waterford would provide most of the regions general needs while Wexford would provide A&E cover on a 9-5 basis.

A&E is crucial to any hospital since most of the workload comes through the A&E department. For anyone in Enniscorthy, Gorey or Wexford the local hospital is the only alternative to a long drive to either Waterford or Lughlinstown. Dr Colm Quigley is a very strong advocate for Wexford and his role on the reconfiguration team did give a certain level of comfort to us in Wexford that the hospital would in some way have a future after services were reconfigured. Now all bets are effectively off and it seems that the gloves are quickly coming off and that just 1 week after the ending of Irish Rail services in to Rosslare from Waterford, Wexford is once more going to lose out.


The real effect of the resignation will be that morale among hospital staff will slump as Fianna Fail and the Greens stand back while Mary Harney and the Hse do their dirty work. The usual old guff about no cuts have been proposed and that money is ring fenced serves as the comfort blanket by government TD’s and councillors. The reality is that the reduction in HSE capital spending will mean that the service will be cut before the A&E in Waterford is built, an adequate ambulance service will not be in place to ensure that patients can access services and Labour will be left to clear up this governments mess.

Recently someone asked me will Labour force Irish Rail to re-open the Waterford rail line. I responded “Tell me what you want me to cut to provide the money?” That’s not to suggest I’m flakey on re-opening the line, I’m not. The wider reality is that there is so much damage done now it’ll take decades to undo the last few years of government.

Enough of Harney picking over the nation's carcass!

Few Ministers have presided for as long as Mary Harney in the history of the state. She’s spent 12 years in office continuously and add to that the period that she spent as a successful Junior Minister at Environment where she pioneered smokeless fuel. Her senior at the time was Padraig Flynn and the pair were nickname Smog n’ Smug!
When Harney transferred to Health in 2004 she told us that she’d bring her business like approach to health and shorten waiting lists, improve services and give us a first class health service. After the latest scandal at Tallaght Hospital she’s no nearer her goal than she was over 5 years ago when she took up the job. In 2005 she said she wanted a 7 year stint to complete her job. Her optimism is groundless, she’s brought us no nearer a better health service. It’s about time we as a nation heeded her advice from another issue and shopped around for another Health Minister.

She really has a dreadful record, Missed diagnosis at Port Laoise, Galway, Limerick, Hospital closures in Monaghan, Ennis, Dundalk as well as the infamous reconfiguration of the Mid-West, North East, South, and South East, the Co Location financing of private hospitals, PPARS, Failure to regulate the nursing home sector, A&E charge doubling in the last 5 years and all the time physiotherapy and psychological services for children services are long fingered as Ms Harney hones her taste for foreign travel. Her constant companion in clocking up the air miles is her FAS veteran husband. What happens in Vegas stays in Vegas, particularly if your on a waiting list for surgery on a vegas nerve.

The ire of most people is kept for her creation , HSE. Patients are glad of a service and appreciate the work done on wards, in operating theatres and clinics up and down the country. What they want to see is more. We are told that Ireland is striving towards best international practise and that at the end the HSE will be held up as a model for other small countries, consultant led teams treating patients in modern speciality hospitals. What we’ve mostly got so far is duplication of management and a Minister who fundamentally cannot distinguish between a social economy and a market. Since 2005 civil servants in the Health Department mirror the HSE employees who work in brand new offices on the Millennium Park HSE complex, leased from her good friend by tax payers. Amid the chaos Harney refers question on health the political section of the HSE. When the Head of the HSE Professor Drumm goes to meet TD’s its bedlam as about 100 deputies try to question him about the implications of his decisions in their own area in a limited amount of time.


I’m fed up with those who run our health system stumbling from crisis to crisis. Where will it be next month? Can we afford any longer Harney’s clichés? Fair deal or “If it was just a question of money it’d be solved by now”. The sad reality is that Harney has demoralised the staff and frightened the general public into an expectation of poor standards in our hospitals. The reality is otherwise. Recently one of my children broke their arm. I went to Wexford General Hospital at 5 PM. My son was x-rayed, diagnosed, treated and referred to a fracture clinic within 2 hours. There are good experiences in our health services to be had in spite of the quality of leadership at top.

So what is the way forward? The genie is out of the bottle, accountability is gone, every day Wexford gets closer to a re-configuration that will mean the service delivery in the South East is regionally based rather than local. If there is a change of government in the morning this roll out won’t change because management have been given control of delivery. It’s reconfiguration or nothing!

The forthcoming re-shuffle is fundamentally different to what Ahern did in 2004 when he morphed into a socialist who broke bread with Fr Sean Healey. That transformed FF in the polls and set them up for 2007. The forthcoming reshuffle is predicated against taxpayers being taken to the cleaners to keep bankers, developers and FF in clover. The most potent expression “There’s no NAMA for me” says it all. There’ll be no bailout for FF, Harney and the Greens.
Enough is enough, The health minister should return from New Zeeland to take control of the latest crisis. Then Harney should be shown the door at the reshuffle, accountability has to start.

Mary washs her hands of Pharmacists and medical card holders

For the past week many medical card holders in the state have had significant difficulties collecting prescription medicines because of a dispute between the Department of Health and the pharmacists association (IPU). Effectively the minister has unilaterally cut payments to those chemists who administer drugs to medical card holders. Nobody likes when a unilateral cut in income has been imposed by a minister, as any public servant paying the pensions levy will quickly tell you. Minister Mary Harney has been her own worse enemy on many matters for some time and she has lost the confidence of the people because she has no mandate from the people.
However that does not necessarily mean that the chemists have the full support in the community. For a few weeks I’ve watched from the sideline while their medical card patients have had to endure great hardship to get medication. Essentially the patients have been used in a row about money to see who’ll blink first and come to the table. The facts are that the state has got poor value for money from administering, purchasing and dispensing drugs to medical card holders. It seems that for a long time the gravy train chugged along merrily. At one stage restrictive practises prevented competition between chemists and pharmacies had to be located a minimum distance from one another serving a verifiable need.
The market has changed hugely since towns have expanded and farming has reduced somewhat. The increase in competition from chains like Boots or McCaughley’s, increased rents on Main St and the establishment of a new school of pharmacy increasing the number of entrants to the market have led to extra outlets in the business. To set up a chemists shop needs compliance with the law in terms of premises location as well as the need to provide a qualified pharmacist on site. There are enormous costs but as long as the population climbs there’s something there for everyone. As part of the business mix, toiletries, drugs to medical card holders as well as non holders of cards and veterinary medicines will contribute to the chemists income. A pharmacist is a business person first and foremost.

However it is not sustainable to continue funding the drugs scheme as it is. Other professionals providing services to the state have seen professional fees cut and in some cases payment deliberately retarded. Pharmacist revoked their contracts to provide medical card holders with drugs, as is their right, to protest against how the department had treated them. If teachers had gone on strike when the pension levy was brought in, we’d have been accused of holding the children’s future hostage (as we were once accused by a parent’ rep). Chemists say that their income will be cut by 34%. I accept that they have overheads, staff to pay and so on but any chemists who I’ve passed by in the last few weeks are doing very little business as most of their customers are down in Boots getting their medication. How sustainable is it to tell the bank that is itself crucifying business by refusing to release money that you’re paying staff the same amount to do less work on an ongoing basis? Chemists feel that they have the department by the throat and that to set up an alternative outlet dispensary the HSE must locate enough qualified chemists and suitable premises to comply with the law. A hard job for the department, but not impossible. During the 2001-02 teachers dispute the Department of Education found a way round our threats on substitution and supervision and I would argue that teaching has suffered since. Chemists should learn from the mistakes of others before they irreversibly damage their industry. Once changed it’ll never return to the way it was before.

My sympathies are entirely with the patients on this one. As long as the stand off continues the more likely it is that chemists will lose good customers and that rationalisation of the industry will see the consolidation of chains at the expense of family run pharmacies in Ireland. There are other issues such as the use of generic drugs in place of branded one and the relationship between the industry and the HSE but these won't get discussed during the dispute. It’s time for the pharmacists to re-open, take up their contracts again and offer to negotiate with the minister. Anything else causes hardship to those who need it least.