Amidst all the controversy in our health service, it's difficult to see what is going to happen
29 January 2007
George Fegan, one time Professor of Surgery in Trinity College and for many years a well known Dublin consultant working in Sir Patrick Dun's Hospital, died recently in Lamu. I worked for him for many years and recognised the dynamic effect he had on health care in Ireland. He was mainly known for his innovative treatment of varicose veins, compression sclerotherapy, which brought such relief to the patients, especially those with varicose ulcers, here and internationally. He carried out research work into the cause of both varicose veins and varicose ulcers.
While George was best known internationally for this, the fight going on about the siting of the new Children's Hospital made me remember the work he and Professor Paddy Fitzgerald of UCD and others put into formulating a plan for hospital services in Ireland in the early 1970s. There were numerous meetings of the working party involved, trips around the country to see hospitals by very, very busy hospital consultants and the others. Eventually a plan was produced known as the Fitzgerald Report. As I recall, the people of Ireland would, if at all possible, be within 60 miles of an up-to-date, acute hospital.
This all seemed very acceptable until the denizens of the areas whose hospitals were not part of the designated planned acute hospitals got going - and "political interference" kicked in. To cut a long story short, as they say, it was agreed that the acute hospitals had to be within 30 miles of all Irish people and the rest is history.
History resurrected itself a couple of years ago when the Hanly Report appeared. It seemed to me to be very like the Fitzgerald Report but, what the hell, imitation is the sincerest form of flattery. (This does not mean I do not feel Mr Hanly did not work hard and make a good case for his plan - he did both.)
Once again, those whose hospitals were to be "downgraded" - and not changed, improved, adapted for a different use and so on - went bananas. I think I earned some gratitude from the then Minister for Health, Micheál Martin, when I supported the plan. No skin off my nose, you may say, and very little likelihood of it coming to fruition.
Did a Hanly marque two plan emerge? It all seems so long ago that I can't remember. But I do remember very clearly two subsequent events which I found very strange because although they were Government policy there did not seem to have been even a nod given towards the Hanly reports or indeed to each other.
The first of these events was the National Spatial Strategy produced on 28 November 2002 by the Taoiseach and then Minister for Transport, Martin Cullen - this was all about hubs and spokes and gateways and so on. Some towns were to be developed more than others and, of course, those who considered they were to be less favoured than they should be got mad and I heard that certain politicians were most helpful in putting paid to this plan. Certainly it was not obvious that towns which were to have an acute hospital would necessarily be included in those for development which might have seemed a good idea, but I must not be rude about my political colleagues' plans.
I am presuming someone decided against hubs, spokes and gateways (although Dick Roche, present Minister for the Environment used the same terminology when talking about the new National Plan) because the next thing we had was the announcement by the then Finance Minister, Mr Charlie McGreevy, of "decentralisation" during the budget in 2003.
That decentralisation is a good idea is not in dispute. It is unfortunate that the Organisation for Co-operation and Development (OECD) is now specifying Dublin as an international example of how not to expand a city - the expansion was certainly not planned. The problem seems to be to each Minister it was chaqun à son gout and each member of the Government could bring his own department or part of it to his constituency and before the next election, to make the project really exciting. For example, the Free Legal Aid Board is in Cahirciveen, hometown of the then Minister for Justice John O'Donoghue.
The decision as to where some departments or part of departments would go defied logic. For example, Irish Aid is to go to Limerick despite the fact that 90 per cent of the NGOs with which it deals are in Dublin, and not to mind the embassies of developing countries. Most of those working in Irish Aid have refused to go as well but that's another matter. The scheme was to be voluntary although there was some hint that one's promotion prospects might not be so good if one didn't concur with the relevant Minister's ideas. Many civil servants higher up the line did not wish to move, probably for very good personal reasons, such as their spouse working in Dublin.
A recent report from SIPTU talked of a "worst-case scenario" emerging where 3,000 principal officers and assistant principal officers - paid between €70,000 and €120,000 per year - want to stay in Dublin. At what these people are to be employed in Dublin I don't know but there will be 3,000 promotions down the country paid for by you and me, the Irish taxpayers. I am not going to consider how much the extra accommodation down the country will cost us or the additional transport backwards and forwards to Dublin. Couldn't decentralisation take place at the usual pace things happen in Ireland? It might be beneficial in this case.
By this stage it is hard to know what will happen about the Children's Hospital. The Government and the Ministers are "adamant" but that can be a very soft word. The worst thing is we have so much political interference in decision making regarding hospitals (Roscommon, the North East - I won't go on) as well as every thing else the general public will not believe it isn't happening in this case.
Senator Mary Henry, MD
