Transparency will not be a keynote of the policy of sending patients to "step-down" facilities, judging by the saga of Killarney Community Hospital.
A step-down facility is a private or health board nursing home to which patients are sent from acute hospitals to convalesce.
Killarney Community Hospital, run by the Southern Health Board, has been functioning as a step-down facility for decades.
But an investigation last year found serious lapses of standards and practice. For instance, patients sometimes had to go to the toilet in the hospital dayroom and guidelines on the administration of drugs were breached. The investigation arose from a complaint from independent Cllr Brendan Cronin. But the investigation report contained only 29 lines of findings.
Hoping to learn what lay behind the skimpy report, The Irish Times asked, under the Freedom of Information Act, for documents connected to the inquiry.
There were about 400 documents in all - but The Irish Times has been denied access to more than 370. Though this newspaper said it does not want to know the names of staff (some of whom complained about conditions at the hospital), patients or relatives the SHB says the records "contain other personal information" and must be withheld "to protect personal details of individual citizens". It says its ability to conduct inquiries would be prejudiced by the release of the records.
Ironically, if Killarney Community Hospital was a private nursing home it would be inspected twice yearly by the health board - and the reports would be released under the Freedom of Information Act, with identifying details blanked out, to anyone who wanted them.
Wherever patients from Ballinrobe, Co Mayo, are sent to convalesce under the step-down policy it won't be to Ballinrobe. According to Mr Rory O'Neill, chairperson of Ballinrobe Active Retirement Association, the town has been campaigning for a nursing home for 30 years, without success.
The Western Health Board says it bought a site for a nursing home in the 1980s but that the cutbacks at the time meant it was not built. Ballinrobe did not make it on to the priority list for the National Development Plan.
Achill got on to the list ahead of Ballinrobe and the justification for a nursing home on Achill is hard to argue with. But unless the Department of Health and Children provides money for the project outside the National Development Plan local people will have no local step-down facility to go to.
And quite apart from convalescence, the absence of a nursing home in Ballinrobe means local people in long-term care have to end their days in exile from their own community.
Satisfaction levels of over 90 per cent have been found in an independent survey of patients admitted to the general hospitals in Tullamore, Portlaoise and Mullingar, says the Midland Health Board. Eighty to 92 per cent of people admitted through casualty were seen by a doctor within an hour of arrival.
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