A slap in the face doesn't begin to describe the outcome of the review into cardiac services at University Hospital Waterford, at least as seen from the southeastern city.
Not only has the independent clinical review said Waterford should not get its desired second cath lab, but it suggests many services should be transferred to bigger hospitals in Dublin and Cork.
This won't happen in the present political climate, where the Government is so dependent on the vote of Waterford TD and Minister of State John Halligan, but the result is still a disaster for the city's long-cherished hopes of upgrading local health services.
Parish-pump politics
That campaign is now worse off than when it started, notwithstanding promises by Minister for Health
Simon Harris
to extend the opening hours of the existing cath lab slightly and throw in a few other sops to assuage anger in the region.
Seen from Dublin, and possibly many other parts of the country, the deal demanded by Halligan as his price for joining the Coalition government left a bad taste in the mouth.
Here was yet another example of parish-pump politics, with the stability of government made subservient to local political interests. At the time the Government was formed, Halligan got his promise but failed completely to nail down the terms of its execution. As insisted upon by previous minister for health Leo Varadkar, the provision of a second cath lab was made contingent on the outcome of a clinical review.
That review, based on terms of reference drawn by the department, has now produced the result the Civil Service mandarins desired.
Campaigners in Waterford are crying foul, but the inept handling of this saga by Halligan is impressing no-one.
Safety issues
The sense of grievance in the city about its political isolation and health facilities is long-standing. Without a cabinet minister since Martin Cullen’s days, the city has declined while others, such as nearby Kilkenny, have prospered in relative terms.
When the health service was reorganised into groups in 2012, Waterford hospital was lumped in as second fiddle to Cork rather than heading up a group of its own in the southeast.
It might be a “university” hospital in name but there is – still – no university in the city and many of the promised academic appointments have yet to materialise.
The pity is that there are real issues of clinical safety around the prevention of serious heart attacks when they are suffered by patients living far away from a centre of cardiac excellence.
Everyone agrees services work best when they are consolidated in fewer centres with greater patient throughput and, consequently, higher clinical competence.
Cancer services have been improved in this way by reducing the number of centres from 30 to eight and providing more sub-specialties.
Fairness
An analogous review of cardiac services is under way at present within the HSE, and is due to be completed next year. Removing services from Waterford to Cork or Dublin will leave patients in areas such as south
Wexford
with a journey time of over two hours for treatment of a heart attack, in some cases.
In the interests of fairness, this imbalance of services will have to be addressed one way or another.