[Sinn Fein]

16th January 2003

Prospectus review of health service structures

More centralization is bad for patients and services - Ó Caoláin

Commenting on the leaked review of health service structures Sinn Fein Health spokesperson Caoimhghin Ó Caoláin said the proposals if adopted could lead to greater centralization of the health service, making it les accountable to the needs of patients and communities. Deputy Ó Caolain said:

``While we must await the publication of the full report to comment in detail, the proposed changes could lead to greater centralization which would be bad for patients and for the provision of services in an equitable manner. There is general agreement that there are too many health boards and too much bureaucracy in the administration of the health services. But it is also true that there is a lack of democratic accountability and these proposals would make the services even less accountable to the citizen and the community.

The Prospectus proposals would:

* Result in far greater levels of centralization

* Reduce local control over health and personal social services

* Maintain the current status quo in terms of who controls our health services and our hospitals.

``Local health boards represent the only countervailing power there is to the power of medical consultants. Medical consultants run the services as well as the hospitals. There is frequently a clash between the needs of medical providers and the needs of local communities, as the closure of the maternity services in Monaghan and Dundalk showed so clearly.

``As has been revealed in the North-East region, there was a concerted consultant plan to close the maternity units in Monaghan and Dundalk. Small units, like small hospitals, whose services are so vital to the needs of their communities, do not serve consultant interests. Denise Livingstone's birth took place at the side of the road because consultant obstetricians withdrew their labour from the maternity unit in Monaghan Hospital. She was a casualty of centralisation and consultant power.

``Reducing the number of elected representatives on health boards and replacing them with Consumer Panels would undermine local democracy in health and personal social services. Locally elected representatives build up significant expertise in these areas. Consumer panels have been tried in England and dismissed as toothless: they are simply an exercise in spin, pseudo-democracy, giving a veneer of consultation to decisions taken at a higher level.

``The North Eastern Health Board has taken more doctors to court in the last ten years than any other health board in the country. One such case concerned bed-blocking, one of the root causes of long waiting lists. Bed-blocking is a well-known and widespread practice, whereby a consultant maintains a private patient in bed, for no medical reason other than to hold on to the bed, until his next private patient can be organised to take it over. While this results in a streamlined private practice for the consultant, it leads to waiting lists as beds are needlessly tied up. It also results in huge wastage of scarce resources for the health board, i.e., the taxpayer.

``Significant representation of voluntary health groups and patient organisations, which unlike ``consumers'' have built up a range of expertise over the years, would be a far better alternative to toothless Consumer Panels.

``Health boards administer a vast range of health and personal social services, including care of the elderly, medical cards, home helps, occupational therapy, physiotherapy, speech and language services, disability services, and mental health services. We need to know how these services will be affected by the proposals.''

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