Roscommon protesters are right to fight to retain services

The replacement of Roscommon hospital's Accident and Emergency Unit with what's effectively a minor injuries unit is a major blow for health facilities in the county. The reality is that the hospital is quietly being reduced to the status of a long-stay unit for elderly patients. Current commitments to ensure the hospital has a future through the strengthening of other facilities there should be treated with the same cynicism as the much-publicised pre-election commitments of Fine Gael and Labour. The issue has understandably become a boiling controversy with emotions running high and, at times, common sense going out the window. The crux of the problem, though, appears to be standard spin, obfuscation and poor management which characterises the running of our health service. The HSE and the Minister for Health James Reilly have hung their hat on the issue of patient safety at the hospital. But there is no published report by HIQA into Roscommon hospital, simply a report into Mallow hospital, which cited significant risk issues at similar sized-hospitals including Roscommon. People in Roscommon could justifiably ask why Accident and Emergency Units in other similar hospitals have not been closed down as swiftly and ruthlessly as their unit. HIQA has become a convenient mudguard to shield politicians and the HSE from criticism for difficult political decisions. In Athlone, a HIQA report was used to justify closure of Loughloe House, when with investment it could have been kept open. The reality is that HIQA simply outlines the steps needed to ensure a facility, be it a nursing home or a hospital service, is up to standard. The decision to close or to invest, lies with the HSE and its political masters. Investment is the solution to most of HIQA's concerns. In this case, the exact opposite has occurred. Governments (the last included) have deprived Roscommon hospital of the resources needed for it to remain efficient over recent years, and then cites negative performance statistics to justify cuts. For that reason, the core of this issue is purely financial. This is a cost-saving exercise on behalf of the State. And attempts to portray it as anything else are unfair to the hardworking staff of Roscommon hospital who have toiled in difficult circumstances in recent years and now find their efforts being thrown to the four winds. Admittedly in the case of some hospital services, the issue of whether there is sufficient throughput of patients to ensure the skills is important. But where there's a will, there's a way. And in the case of Roscommon A&E those concerns could have been alleviated. Instead, there was no will to retain the service there - in fact, it's been abundantly clear for some time that the HSE West has its plan of streamlining the UCHG, Portiuncula and Ballinasloe well and truly mapped out. In this case, as well as being a financial issue, the closure of the Accident and Emergency Unit became a real political battle, not least within Fine Gael. Denis Naughten took the brave decision to stand over his commitment to the hospital and to vote against the Government on the issue. Questions might well be asked over his political judgement; twice in the last year he has found himself well offside. Initially, he backed a failed putsch against then Fine Gael leader, and now Taoiseach, Enda Kenny, when he along with countless others was unable to recognise the extent of the utter hatred against Fianna Fáil and the inevitability of Kenny's subsequent election as Taoiseach. And coming up to the election, he made promises on Roscommon hospital, which in purely electoral terms, he probably did not need to do. Naughten would probably have been elected even if he didn't promise to resign if Fine Gael failed to live up to its commitments to support the hospital. Yes, Naughten was hung out to dry by the Government, which reneged on promises made by Kenny, Reilly and others, including Tanaiste Eamon Gilmore. But did he have to give such cast-iron guarantees? It may have been personally admirable but was it politically astute? Having said that, Naughten's eventual decision to vote against his own party in the sure and certain knowledge, that he would be expelled displayed an integrity, honesty and bravery that is truly commendable. Naughten is, understandably, at a low political ebb this week, exemplified by his admission to this paper that he was considering his future in politics. But he should be buoyed by the popular support for his actions from his constituents. Political fortunes can turn around just as quickly and we would like to see Naughten knuckling down with his characteristic energy to the task of representing the people of South Roscommon as an independent in Dáil Eireann. The country needs politicians with his decency. Overall, the issue will be remembered for chaotic crisis management of the worst kind. To attempt to close the unit at five-days notice as was initially indicated was pure political pantomime. To do so at a time of serious shortage of junior doctors was nonsensical. The failure to get the GPs on board before the closure was another political own goal and the attempt to brand the unit as an urgent care centre also added to the confusion - medical experts say it's clearly just a minor injuries unit. After all this, Roscommon people are understandably sceptical of assurances from the HSE regarding access to A&E services in other hospitals in the region for urgent cases. The fact that, on the very first day of the closure, patients were transferred to the Midland Regional Hospital in Mullingar which was seriously struggling to deal with the patient load, only served to underline their disquiet. This was a mess from start to finish, mishandled by the HSE and the Government. In the end, the people of Roscommon are entirely justified in fighting to retain their A&E. The track record of previous hospital downsizing exercise around the country suggests that the commitments made for replacement and back-up services do not always materialise. Protesters believe the A&E issue is the thin edge of the wedge. And, in the context of all the failed promises, it's entirely legitimate to ask how anyone could have any confidence that the other services in the hospital will be retained.