Controversy over Roscommon downgrade

Roscommon-South Leitrim TD Denis Naughten today lost the Fine Gael whip following his failure to support the party in a vote on the downgrading of Roscommon Hospital’s emergency department last night. Speaking after the vote, he said:

“My problem was that I had given my word based on a commitment that I had been given by the party. And I couldn’t in all honesty face the people of Roscommon and tell them that I was turning my back on them.”

The move to downgrade the emergency department has been a controversial one, not least because of commitments given by James Reilly TD (now Minister for Health) prior to the general election. In a letter addressed to the ‘People of Roscommon’, which formed part of Fine Gael’s campaign literature, Reilly wrote:

“I wish to confirm that Fine Gael has a very different view of the role to be played by local hospitals, like Roscommon County Hospital, than the Government, which seems intent on downgrading them through the implementation of the Hanly Report.

Yes, local hospitals must be safe, and patient safety must be our first priority. But on taking office we will immediately suspend the reconfiguration process.

While international research suggests that complex trauma and complex surgery is not appropriate in a local hospital setting like Roscommon, nobody is looking for such a service at Roscommon County Hospital.

However, there is also a very strong argument that Roscommon and other local hospitals have the ability to deal with complex medical conditions and less complex surgery.

Safety is not simply about surgical competence, but is also about timely access. Time to treatment, particularly in remote geographical locations, is absolutely crucial.

This is key to allowing Roscommon Hospital, which does not have complex surgery, to retain the skillset required to incubate and ventilate and to have the ability to undertake less complex surgical procedures.”

In another open letter, published in the Roscommon People, Reilly wrote:

“I would like to confirm that Fine Gael undertakes, in accordance with the Fine Gael Policy on Local Hospitals, to retain the Emergency, Surgical, Medical and other health services at Roscommon Hospital which are present on the formation of the 31st Dáil.”

Speaking in the Dáil on Tuesday, Reilly again cited international research on patient safety, saying:

“Smaller hospitals are not as safe as bigger ones in key areas. There is a wealth of international research to back this up. When it comes to multiple traumas, strokes and heart attacks, it has been proven internationally that one has a 25% better survival rate at a larger hospital which has a higher volume even if one is more than one hour away.”

The minister also cited the findings of an unfinalised draft report not yet available to the public, saying:

“One set of statistics shows that a patient attending Galway University Hospital has a 5.8% mortality rate compared with a 21.3% mortality rate in Roscommon, which is four times greater.”

Bill Tormey, Fine Gael city councilor for Dublin North West has said that, “The details of this claim need full ventilation” and asked:

“Is there a like-for-like comparison? Are the statistics taken from HIPE data validated from death certification? Is this 'in patients only at Roscommon hospital'? Is chronic heart failure dead at home included in both counts? Is this only acute myocardial infarction? Is primary angioplasty offered to every patient in Galway? What is the role of thrombolytics in the area? How accurate is the Hospital Inpatient Enquiry Data (HIPE) for both institutions?

Is the patient referral for cardiology from Roscommon prioritised in Galway?

Is primary angioplasty for Myocardial Infarction the norm at Mayo General, Portiuncula, Sligo and Galway hospitals? What are the death rates for each of these institutions within the same disease definitions?”

GPs have come out against the downgrade. In a statement released on Tuesday they said:

“Every GP in the . . . catchment area [counties Roscommon, Leitrim, Longford, Mayo, Galway, Westmeath and Sligo] is appalled at the proposed downgrading of the hospital and the effect it will have on patient care and safety.

"We are in no doubt that lives will be lost and patient outcomes will be adversely affected."

Below, Luke 'Ming' Flanagan, Independent TD for Roscommon-South Leitrim, addresses a protest against the downgrade outside the Dáil last night.