For years, politicians of all hues have traded on saving the local hospital.It may be a far more potent political platform now, writes Mark Hennessy, Political Correspondent
Back in the 1980s, Fianna Fáil's Mr Willie O'Dea did much for his popularity in Limerick East when he opposed the then government's plans to close Barrington's Hospital.
In last year's general election, a number of Independent TDs, such as Cavan/Monaghan's Mr Paudge Connelly, won their seats having fought to defend their local hospital.
In Wexford, Dr Liam Twomey attracted votes after he fought on a ticket demanding better services in Wexford General Hospital and a cancer therapy unit for the south-east.
Others, such as Dublin North Central's Mr Finian McGrath, caused the major parties grief after their Independent Health Alliance ticket attracted the attention of voters.
Given such success, the latest draft of the Hanly report, which has been seen by The Irish Times, will provide much food for thought for politicians, serving and budding.
The current number of hospitals, big and small, failed to impress the taskforce, which warned they had developed to cope with local needs rather than serve a coherent national plan.
Too many services are being offered in too many places. Instead, large hospitals should work closely with smaller ones in their areas in a team effort.
"A repeated concern expressed was the influence of politics, whether local or national (political, medical or other) on decision-making in the health services generally and hospital services in particular.
"Many of those who spoke to us, from all parts of the health system, indicated serious dissatisfaction that some of the more important decisions about the location and type of service provision appeared to be made on the basis of narrow sectional interests rather than on objective measures of service need quality and/or patient safety," says the taskforce.
If implemented, the recommendations would mean that medical departments, such as maternity, accident and emergency units, in smaller hospitals will be closed and centralised in "centres of excellence".
"Only those hospitals with the volume and complexity of cases to support the required teams of seven consultants in each of medicine, surgery and anaesthesia will be able to maintain acute services as non-consultant hospital doctors' working hours reduce," says the report.
The staffing and patient levels set by Hanly will provoke fears in places such as Mallow and Bantry general hospitals in Co Cork, which have, respectively, just 23 and 22 medical staff of all grades.
The Minister for Health is banking on his belief that voters will tolerate disruption and new ways if they are convinced that services will be improved.
Patients simply want to get well, he believes.
However, local hospitals hold a special place in the hearts of the public in major towns, often standing as a mark of their distinction over their less fortunate neighbours.
Interfering with them is a high-risk political strategy. The closure of the North Infirmary in Cork in the 1980s, for instance, created a wound that, for some, has still not healed.
Monaghan Hospital's difficulties were at the top of the local political agenda long before the death of baby Bronagh Livingstone brought the issue into the national headlines.
Her mother, Denise, was turned away from Monaghan Hospital last December. The baby died in an ambulance on the way to Cavan Hospital.
The hospital's maternity unit was closed when the North Eastern Health Board refused to allow the resident obstetrician-gynaecologist, Mr Alphonsus Kennedy, to renew his malpractice insurance.
Thrust into the middle of a national controversy, the Minister for Health warned that consultants had to see a minimum level of cases to keep their skills up to standard.
Monaghan has three surgical consultants, supported by seven junior doctors; two medical consultants backed by eight junior doctors, along with three anaesthetists and one radiologist, without junior doctor back-up.
So far, Monaghan locals in need of medical care remain unconvinced that their lot has been improved by the reduction in services in their own patch.
Cavan was operating at full capacity before they arrived in the waiting rooms, they complain. "Some Cavan people are even giving out that they are coming," says one TD.
The Minister for Health is, perhaps, banking that the National Hospitals Office in the proposed Health Services Executive will be in the frontline when hard decisions are announced.
Certainly, the formation of the new agency will make it more difficult for the Government and local politicians to support the retention of services in the hospital down the road.
However, the buck will still stop with him. The "dexterity" of politicians in tight corners should never be underestimated, Mr Martin declared in Government Buildings on Wednesday.
It is a skill that he will need if he is to force radical and necessary change on the health service and still emerge as a viable political figure from the Department of Health.
