By Jim O'Sullivan The government has run out of low hanging fruit, so the hunt is on for the next best thing---soft targets.
As the Marco Polo of the new government, James Reilly, Minister for Health, was touching down on his second home coming from China, his mandarins were putting the final touches to a plan that in effect announced that those in need of medical care and attention could no longer rely on the department of health to provide it. Some of those in need of medication under the general medical services scheme, the elderly---who worked a lifetime---and the disabled, who need a few hours home help each week, can go suck a lemon as far as Marco and Co are concerned. Truth is, nothing is sacred, nothing is beyond the pale---morality has been sidelined.
Before this furore broke, we had already seen evidence of a government withdrawing from its obligations in a dangerous and haphazard way. People are having letters dropped through their doors abruptly telling them that their medical card has been withdrawn---this is being done with little or no effort to establish if doing so might place the person in any danger or distress and right across the spectrum, the vulnerable, the voiceless, are being ruthlessly targeted and made carry the burden of the economic turmoil.
What these extraordinary episodes tell us is that for this government there is now no such thing as a moral obligation or even a moral dimension which must be factored in when decisions are being taken on such matters. The entire focus is now on “cost” rather than the “need” to provide caring supports etc. ---and that is now regarded as acceptable.
This focusing on the narrow “money” factor removes the provision of vital services from the proper context and fails to see them as investments in the creation of a strong, vibrant, cohesive community which in turn will produce a sustainable economy---not to mention that the provision of such services underpins our desire and ambition to live in and create a civilised place.
The government, and it must be said at this stage the entire “Dublin establishment”, is putting the cart before the horse---and with potentially disastrous consequences for those caught up in the groups that rely on supports, for those who fall ill and for the future of communities and the populous as a whole.
Sligo General is caught firmly in the grip of this maelstrom. In truth, it has been at the bottom of the priority list of government for the past number of years. And the hospital is not in as good a position to fend off attacks as it might appear to be. In 2002 a review found that the infrastructure was outdated and not in line with European standards with regard to the prevention of infections and their spread. The current ward sizes are out of line with recommendations as are the numbers of single bed wards. The remedy was to build an extension which when complete would allow large wards to be closed in rotation and modified into multiple small wards. The plan was long fingered. It was resurrected by the last government to deflect criticism on the cancer issue but since the election, not a word has been heard of it. We also know that promises to bring other services on stream have also foundered.
Information that is coming from the facility would suggest it is a miracle that it is still functioning as a hospital at all---that it is, is down solely to a heroic staff, who despite repeated provocations, remain dedicated and loyal to patients. Much of the information emerging may be exaggerated but that is inevitable given the HSE policy of refusing to engage openly when asked simple straight forward questions---either by the public or their own staff. This KGB approach to information sharing is unfathomable---after all it is they who are in our employ.
There appears to be major problems with under-staffing which is creating strains and stresses that are now nearing dangerous levels and hardly a month passes without stories of another service having to be temporarily shifted elsewhere in an effort to relieve the pressure. Indeed the hospital appears to be drifting along from day to day under a “management” that is totally pre-occupied with reacting to issues as they arise--- “fire-fighting”---and it is well known that it is only a matter of time that such a management, and the entity it oversees, falters. The problem with this approach is the “fires” become more frequent and inevitably more than one occurs at once which completely overwhelms the system. The consequences are usually dire.
The great danger now is that the hospital is wide open to the Harney tactic of first starving a facility of support, fail to maintain necessary manning levels and then, at the most inappropriate moment for the hospital, send in HIQA which “finds fault” and highlights what it describes as a “dangerous” situation for patients. From that position it is all downhill and given the now known attitude of the government---that providing healthcare is no longer a moral imperative but merely optional---it is hardly wise to assume that they would react positively to any such report. The fact is that the facility is rumbling along with bits falling off as it goes. If allowed to continue, eventually the accumulated damage will become more and more difficult to repair and the argument to apply the coup de grace
will be almost irrefutable.
The importance of a fully functioning general hospital to the region cannot be overstated. It is a large part of the critical infrastructure of the community. Vital, not only for the safety and well-being of citizens who fall ill, but also for the economic vitality, quality of life, and livelihood of the entire community. The silence surrounding the very serious problems that are now arising at the hospital makes it a very soft target for a marauding Minister who now seems to think that his remit is to “cut” rather than “provide” adequate healthcare services. He is a “caring” Minister making the mistake of trying to “save” money to placate a fiscal ideology that has no value or allegiance to providing services or “care”. When taken in the round---the prioritising of “small government” polices and indifference to suffering---it can hardly be outrageous to suggest that Sligo General Hospital is now standing at a crossroads and, with no friends in high places, is on very precarious ground.
Hyperbole? Remember, there is no moral compass now- discount nothing, expect anything---but doing nothing is hardly an option. With recent attacks on the caring services in the area, we cannot say we have not been forewarned.