How many times over recent days have we heard that there were ‘governance issues’ with Tallaght Hospital as an explanation for the unbelievable saga of X-ray results not being properly monitored and thousands of doctors’ letters remaining unopened?

This is typical establishment speak to obfuscate the reality that, while there was a disastrous failure in a crucial area of hospital management, lack of resources and the policies of the Government and the HSE were major contributory factors.

This brings into sharp relief the need for a fundamental change in how public hospitals are run. In previous articles, I have argued that the staff at all levels of the Health Service should be brought to the heart of a democratic management structure, both in individual health service institutions and in the service itself. That argument is more confirmed than ever in light of this latest failure.

What is very significant is that many patients of Tallaght Hospital, while shocked at the current revelations, in interviews, were loud in their praise of the actual treatment they had themselves received when they were patients there. This shows that the frontline staff, nurses, attendants, junior doctors and household staff are doing their best to provide appropriate care for their patients.

Who knows best how a public service can be improved but the workers providing it and the persons receiving it?

What this means is that large hospitals like Tallaght should have structures which would enable the care workers and patients to regularly discuss the improvements needed to the service with a view to changing what is inadequate. This could allow an immediate transformation.

One can hardly imagine thousands of unopened letters being left lying there for long if the workers whose job it is to handle those letters had a democratic forum in the workplace to discuss what would immediately be seen as a major problem. Even more so, if patients and local doctors and community nurses were involved in such a structure. It would be the same with the problems evident in Accident & Emergency Services around the country and in the matter of hospital hygiene.

Tallaght Hospital in particular has a great fund of goodwill in the immediate locality and in the extended catchment area. For many years residents in these areas mobilised in defence of services in their hospital and against cuts, organising themselves in the Tallaght Hospital Action Group. This is the kind of goodwill that is undermined by the shortage of resources and the bureaucratic methods of the HSE.

Of course the present Health establishment and their political masters and mistresses will never create such democratic structures as they would point up glaring injustices and inadequacies in how the health services are run as a result of their policies. The question of resources would come immediately onto the agenda.

Never mind the mantra that we are spending €15 billion a year on the public health services, giving the impression that this is an outrageously high sum. It is, of course a substantial amount of money but mentioning it as if it were an absolute fortune is simply an attempt to halt a probing analysis of the fact that this State spends less per head of population on our health services than most of the advanced economies in the European Union and that the savage cull of thousands of public hospital beds in the 1980s was never reversed or made up for.

Resources are a particular problem in the case of Tallaght which has the highest throughput of patients in the country but less radiologists and consultants per patient than many other hospitals. Incredibly the hospital was ‘fined’ €12 million by the HSE in 2009 because it didn’t achieve an acceptable ‘case mix’. The Hospital pleaded that its extremely busy A&E didn’t allow them the luxury of meeting the case mix demanded. To no avail.

There have been many calls for Health Minister Mary Harney to cut short her long St. Patrick’s Day visit to New Zealand and return home forthwith in response to the Tallaght crisis. For what purpose?

Ms. Harney’s policies are part of the problem in the health service not the solution. The wide, freezing expanse of the Antarctic lies south of New Zealand. Better advice to Ms. Harney would be to head south and keep going in that direction to spend the southern hemisphere winter among the penguins.

The bias toward private, for profit, health care which has been pushed at every opportunity by Minister Harney and Fianna Fail over the last twelve years has done enormous damage to the achievement of a reliable and efficient, one tier Health Service. The reversal of those policies and investment in a one tier decent public health service with full democaratic structures is what is urgently needed now.

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