All politics is local, as any politician seeking to close or downgrade a hospital will find out very quickly. No issue provokes such emotion in local electorates and no hospital has caused such political consternation as that in Roscommon.
It is 25 years since the independent hospital candidate Tom Foxe shocked the political establishment by unseating Fianna Fáil's Sean Doherty, and in the intervening years, the issue has never gone away, as evidenced by the recent altercation between Fine Gael TD Frank Feighan and hospital campaigner John McDermott.
The closure of the emergency department at Roscommon Hospital in July 2011 was a live issue in the October by-election. Prior to the last general election, Fine Gael promised to keep it open and then promptly closed it within five months of entering Government, citing safety concerns arising out of a Health Information and Quality Authority (Hiqa) report into similar-sized hospitals.
Denis Naughten, a rising star in Fine Gael, resigned. Accusations of betrayal continue to hang around his old party.
All the by-election candidates, with the exception of Fine Gael's Cllr Maura Hopkins, pledged to work to reopen the emergency department, but it is likely to be a forlorn hope. The newly elected TD Michael Fitzmaurice prioritised its reopening. Long-term hospital campaigner John McDermott got 8.8 per cent of the vote in the by-election and finished fourth.
Those at the forefront of the hospital services say reopening Roscommon Hospital’s emergency department is not only undesirable but impossible.
Dr Gerry O’Mara, one of three consultant physicians who worked in the emergency department, believes the closure was not only the right decision, but the only one that could be made given the circumstances. He was seeing an average of 1,300 acute admissions a year; the average in bigger hospitals is 400. He is blunt in his assessment that the hospital could not attract the calibre of staff to make the emergency department work properly.
“What broke us in the end is that we just could not recruit staff. We had half our complement of junior doctors. We’re a small hospital in the middle of the country and we’ve always had trouble recruiting. Every morning there was something. The list of mistakes was very long. It was completely unsafe. In the old days you could have an intern, a first year or a second year on call doing a 36-hour shift.
“You could come in the next day and find that [a patient] has been poorly managed, not because the doctor is a bad doctor, but because they were too junior.
“Twelve years ago when I came first [to Roscommon], there was very little comeback if mistakes were made. People just accepted it. Everything is changed. People demand a higher standard now.”
Consultant surgeon Dr Liam McMullan believes it will simply cost too much money to restore the emergency unit.
“The days when the local surgeon looked after casualty are gone,” he says. “You have to have three casualty consultants, you’d have to reopen the intensive care unit and put in intensive care physicians, plus the nursing [staff].”
He goes further. “Nobody in their right mind,” he says, would put a hospital anywhere else in the midlands except in Athlone if they were starting from scratch.
“The answer is to put a 600-bed hospital in Athlone . . . There isn’t a prayer that will ever happen, but it should happen.”
Day surgery
This is not what campaigners for Roscommon Hospital want to hear. Neither is his belief that other similar sized hospitals will equally have to lose their emergency departments. Since losing its emergency department, Roscommon Hospital has reinvented itself as a Model 2 hospital, which allows it to carry out extended day surgery, elective surgery and a large range of diagnostic services.
The emergency department has been replaced by an urgent care centre which is open from 8am to 8pm seven days a week and sees about 5,000 patients a year.
Two years ago an air ambulance service based in Athlone was set up. It ferries an average of one patient a week who would previously have gone to Roscommon to other hospitals, usually University Hospital Galway.
Less urgent patients are going to the nearest emergency unit: either to Sligo, Castlebar, Mullingar, Ballinasloe or UHG.
Since 2011, the hospital has become an approved centre for colorectal screening. It has a new plastic and reconstructive surgery unit and a new ambulatory care and diagnostic centre (ACAD), which specialises in surgery under local anaesthetic.
The hospital is building a €5.5 million endoscopy unit, which will be opened next year. It is a big construction project that will take a year to finish and will provide for 6,000 procedures a year.
Early approval has also been given for a 20-bed rehabilitation unit attached to the National Rehabilitation Hospital in Dún Laoghaire, and an eight-bed hospice unit attached to the hospital is also planned.
Significantly, though, future plans for the hospital do not include the restoration of emergency services.
McMullen says this is the way it should be and smaller hospitals should concentrate on reinventing themselves.
“Roscommon seems to be the bellwether. There are several other hospitals that are going to have to do this and do it quickly otherwise they will go to the wall altogether,” he said.
"We're getting referrals from much farther afield; from as far away as north Tipperary. People are discovering that you can get your scope done very quickly in Roscommon where you might be waiting months for it in Galway. That takes a while for GP referral patterns to change."
Losses
The loss of hospital services is perceived as a matter of life and death to communities. There is also the loss of economic activity and the loss of prestige. The hospital is the town’s biggest employer. Since 2009 its head count has been reduced from 381 to 306 and expenditure is down from €24.6 million to €17.8 million. This is an undeniable loss of economic activity in a town and county bearing the brunt of the recession.
The hospital's general manager, Elaine Prendergast, says the changes the hospital has had to make are now paying off and employment numbers will grow again.
“We are three years down the line now and we have a really vibrant hospital working here again. If you were running a shop or a hotel, you’d be delighted with the feedback that we are getting.”
