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Situation at Tallaght merits urgent attention

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Triona Murphy, Chairperson, Tallaght Hospital Action Group;

Dr Fergus O’Ferrall, Adelaide Lecturer in Health Policy in TCD;

Prof Ian Graham, Cardiologist, Chairman of the European Cardiovascular Prevention Commitee, and former Vice Chair of Board of Tallaght Hospital

 

Tallaght Hospital is rarely out of the news. Worrying issues have arisen in relation to radiology services, GP referral letters, care in the emergency department (ED), and the outsourcing of patient correspondence. Superficially it may appear that such concerns are due to poor management and governance. However, closer analysis demonstrates clearly that these serious problems are symptoms of a more serious disease: The dysfunctional system used to allocate human and financial resources to meet healthcare needs. The following facts bear out this analysis. Since it opened in 1998, Tallaght Hospital has, at least for its core activities, become the busiest hospital in the State.

Recent figures obtained from the HSE through a Parliamentary Question show that Tallaght Hospital sees more ED attendees, treats more inpatients, and sees in excess of 30 per cent more patients in the outpatient department than the next busiest hospital. This is in spite of having the fewest numbers of consultant doctors of the four Dublin teaching hospitals. A shortfall on the requisite number of consultants was one of the fundamental issues identified in the Tallaght Hospital Review, conducted by Dr Maurice Hayes in September 2010, when he inquired into the issue of radiology reporting. He reported that, relative to other Irish hospitals, “the degree of understaffing in Tallaght Hospital in 2009 was substantially greater than in the other sampled hospitals.”

It is not just in radiology that the HSE has poorly served patients at Tallaght. The number of approved permanent consultant posts in the other Dublin teaching hospitals are: St James’s, 154; Beaumont, 139; St Vincent’s, 117; the Mater, 114; and, lastly, Tallaght, 100. It is now accepted that a properly functioning acute hospital depends on appropriate health service provision in primary care and in continuing nonacute care beds. The Tallaght region is seriously under-provided in both, leading to extreme pressure on the Hospital. To illustrate the comparative shortage of GPs, one might compare Galway city and the Tallaght urban areas: Both have similar populations (more than 70,000), yet Galway city has more than 40 GPs, compared to 26 GPs for Tallaght.

Further, the absence of an out-of-hours GP on-call system means people have nowhere to turn except the Hospital’s ED. Tallaght Hospital is funded by the HSE to service a population area of 350,000. In reality, the HSE has required the Hospital to service 500,000 people. Taking into account their HSE-assigned catchment area populations, a breakdown of Dublin hospitals’ annual financial allocations yields startling figures. Tallaght’s allocation is €176 million, compared with St James’s €220 million and €200 million at St Vincent’s. This equates to €800 per person in St James’s, €727 in St Vincent’s – and €350 for Tallaght.

The Hospital has, in fact, a strong track record of providing quality care in the face of almost insuperable demands with inadequate resources. It has constantly advised its funder, the HSE, of the staffing and other resources required to rectify obvious imbalances. No wonder the Hayes report found the relationship between the Hospital and the HSE “seemed to be more fraught than most” when it expressed concern at “the length of time taken over the years by the HSE and its predecessors in responding to the need for additional radiologist consultant posts to meet a steadily rising workload”. Good management and governance are of course crucial in ensuring patient care. Steps have been taken to address deficits perceived in Tallaght. The Hospital has an outstanding new chief executive in Eilis Hardiman.

There is now in place a new, smaller board with the full range of corporate, legal, medical and other expertise recommended in the definitive Madden report on patient safety. Indeed, this “smaller board” has been in place since March 2010.This did not prevent concerns arising over patient care because no manager or board will succeed unless the underlying causes of entirely foreseeable problems are addressed. Health Minister James Reilly has appointed a “special delivery unit” to address the real issues of hospital performance and to ensure “money follows the patient”. Tallaght Hospital surely merits its urgent attention.

 

 

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