The ongoing fight for Health Equality

Health Minister Simon Harris: astoundingly indifferent to health equality.

Health Minister Simon Harris: astoundingly indifferent to health equality.

Hoping that ill people in the south east could be treated just as patients are in any other region when it comes to cardiac care provision doesn’t strike me as an excessive demand.
Well there’s an easy explanation as to why that’s the case. Because it isn’t excessive. It simply isn’t.
A report can be dressed up, framed and presented in whatever way the Department of Health or the Health Service Executive (HSE) want it to read, and it is to both those bodies that our primary frustration should be aimed at, rather than, I feel, towards Dr Niall Herity.
On Tuesday morning last, I re-opened two reports: one being Dr Herity’s Independent Clinical Review for the Provision of a Second Catheterisation Laboratory at University Hospital Waterford (UHW), dated July 2016.
The other was an Irish Academy of Engineering’s (IAE) Report (May 2016) titled ‘The Atlantic City Regions: Development & Connectivity’. Please bear in mind both were published barely six to seven weeks apart.
On the third page of Dr Herity’s report, the sixth recommendation he reached read: “Patients arriving to the emergency department at UHW should be considered as within a 90 minute drive time of Cork University Hospital and should be transferred there for primary PCI (Percutaneous Coronary Intervention) without delay, irrespective of the time of day or night.”
In Chapter 5 of the IAE’s report (Infrastructure Analysis), under the Cork-Waterford subheading, the report reads: “The principal connecting route between both cities is via the N25, a total distance of 125km, with journey times in the region of 110 minutes…Delays are common on this route.”
So here are two reports, published weeks apart, with a 20-minute time differential in the average trip between Waterford and Cork. And it’s telling that the IAE’s report acknowledges delays on the N25. Dr Herity’s doesn’t.
Twenty minutes doesn’t matter a whole lot in the wider sense if you’re travelling to Cork, say, for a match, or to The Marquee.
But if you’re in the back of an ambulance, grasping for air, with one’s chest seemingly on the brink of exploding following a heart attack, every minute matters.
Just hours after the Power family’s loss, three friends messaged me about their recent drive time experiences between Waterford and Cork cities.
1: “Took us two hours and 10 minutes from Waterford City to Cork Airport leaving at 7am recently. Same coming home. The days of it being an hour and a half are long gone. A lot more traffic on the roads and road works popping (up) wherever.”
2: “Clocked it over the last Bank Holiday – no traffic in Killeagh and yet it still took 88 minutes to Castlemartyr.”
3: “One hour and 40 minutes to Ballincollig with no traffic leaving at 5.30am.”
The aforementioned are real time experiences behind the wheel. Granted, it may well be possible to get to CUH quicker with an ambulance’s lights aglow, but Dr Herity’s own recommendation about primary PCI includes the phrase “without delay”, seemingly over-looking the in-built and unavoidable delay when transferring a patient from UHW to CUH.
The Herity Report suggests that the effective catchment area for UHW comes to 222,134 people.
And while nobody can logically suggest that all that many cardiac patients in, say, Nenagh, are going to travel to UHW for a procedure, referrals from St Luke’s in Kilkenny ought to be travelling southerly. There’s a clear logic at play here, all the more so since the M9 came into play.
But that has been undone by breaking up the South East as a Health Board region, a move which also led to the removal of ‘Regional’ from the name of our hospital, catalysing the formal creation of “professional linkages” between St Luke’s and St James’s in Dublin.
The IAE Report notes that there are 195,920 people living both in and within 40 kilometres (25 miles) of Waterford city.
Bearing in mind that this doesn’t take the populations of Kilkenny city (27,751) and Wexford town (20,188) into account, when one does add these tallies to the IAE figure, one arrives at 243,859. So this relatively minor level of research arrives at a population estimate that takes in 21,000 people more than Dr Herity’s report catered for.
And considering the smaller population pockets between both towns but outside the IAE’s 40-kilometre radius, suggesting that we’re inching closer to the 250,000 mark is not outlandish.
While the North West region, with a similar population to the aforementioned (and examined on a standalone basis), does not have 24/7 cardiac care, patients in that region can at least access the full-time lab across the border at Altnagevlin (Derry) Hospital.
A Derry Journal report in April 2015 stated that 385 patients from the Republic would benefit from its cath lab service annually (which opened last Autumn), therefore underlining that the south east’s case is specific to this region in an all-island context when it comes to Irish health infrastructure.
This surely and plainly states that even if the population catchment area we were referring to in the south east was no more than 250,000, then the argument that we are being disserved and discriminated is inarguable.
But try telling that to Health Minister Simon Harris, who suggested that the Herity Report had answered “the question once and for all”, adding that “the evidence of the Herity Report is very clear”.
Minister Harris is right: the evidence from the Herity Report is clear but it is based on a deeply flawed hypothesis according to UHW’s Clinical Lead for Cardiology, Dr Patrick Owens.
I’d like to have a chat with whoever devised the terms of references for Dr Herity’s Report and what agenda he/she was showing deference to. Because one thing is clear: cardiac patients in our region, who want a fighting chance for life, were not at the top of that individual’s agenda. Shame on whomever that individual is. Our lives DO actually matter.

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