Dr Susan O’Reilly went to great pains to praise staff at the Midlands Regional Hospital, Portlaoise during an extensive interview with the Leinster Express. From the outset, she was also adamant that, at present, services are safe.
However, at no stage did did she show any signs that there would be any u-turn on the 160-page plan to reconfigure the hospital.
She has no problem holding these apparently contradictory positions and, from her perspective, it fits into a strategy for the future.
Her bottom line is that the regrading of Portlaoise as a Category 2 hospital must be implemented to have a sustainably safe hospital service for the midlands.
Before meeting the Leinster Express she met Portlaoise hospital’s management and a few doctors. The hospital consultants had written to her beforehand calling on her to quell a campaign against the hospital which, they said, was a risk to patients.
“They were expressing their hurt and concern about being perceived as perhaps not being seen as safe.
“Now, I want to state unequivocally that you have a hospital where you have a very committed excellent staff.
“They are very dedicated to patient care. The services are safe,” she said.
But in the very next breath, Dr O’Reilly hones in on the key shortcoming with Portlaoise hospital - the critical care provided by the Intensive Care Unit (ICU).
For Dr O’Reilly this unit is not busy enough to be deemed safe.
“The areas that we have been asked to address by Hiqa are complex very low volume services and whether or not they can be sustained.
“Critical care where there is one patient ventilated every eight days. There are very good anaesthetists here right now who maintain these patients. They refer complex patients out if they have got very complex needs.
“Having said that, the challenge here is that if you have multiple serious issues arising simultaneously, like a child deteriorating and an emergency caesarian section.
“That is an area money can’t fix” she said.
She said the group has already withdrawn complex surgery.
“The Director General of the HSE directed the Dublin Midland Hospital Group to pull out complex surgery. We did that, it took us a few weeks to plan it. We had to meet the surgeons and had to review the data. We had to meet the supporting hospitals, Tallaght, St James’ and Tullamore who took a weekly no refusal roster for complex surgery. But we still have to transfer them out - they are still coming in the front door of Portlaoise hospital.”
Ambulances will bypass Portlaoise if there is major trauma but paramedics have the right to go the nearest hospital in any emergency. Acutely ill patients will also present to Portlaoise because it has an A&E.
Dr O’Reilly wants to end this practice but, to do so, ICU will have to be removed. The knock-on is that maternity, paediatrics and some surgery will automatically follow.
The plan put together by Dr O’Reilly and others sets a four year time frame on implementation of downgrade. It estimates that about €100 million will have to be spent getting there.
The Leinster Express put it to Dr O’Reilly that the timeframe and ability to get the money stretches credibility beyond belief.
Dr O’Reilly understands this and admits that some of the spending is 'catch-up'.
“I can appreciate why they would have that concern. I really appreciate and understand that. Let me be clear. The €100 million capital is already funding we have officially prioritised.
“That €100 million was not contingent on any reconfiguration of Portlaoise. It is contingent on the fact that we need capacity across the entire group.
“It is catch-up money for critical care, beds and some elective.
“There is another component which is the Tullamore hospital extension. It needs to be done anyway but it would be a bigger extension to develop some additional Emergency Department and inpatient bed capacity,” she says.
Dr O’Reilly insists that no unsafe risks will be taken.
“We know from our discussions with the HSE that this is a four year implementation plan and we are committed to not closing any services in a way that is going to create more risk.
She uses the term the balance of risks for maintaining services in the medium term.
“If we were to suddenly try to shift one third to one half of patients to anywhere else, I think we could incur greater risks. We are very committed to doing things safely.”
She accepted that the ability to implement the plan is out of the DMHG’s control, but said it is a priority.
“It was significantly influenced and prioritised in the HSE and the Department of Health. I do feel that I have some clout here in terms of getting capital, but there are no guarantees,” she said.
If Portlaoise is downgraded maternity services would go to the Coombe Hospital in Dublin. It is managing Portlaoise hospital. She acknowledged that the current Coombe theatres have been regarded as not fit for purpose by Hiqa.
Dr O’Reilly is confident, however, that the Coombe hospital’s upgrade will happen ‘soon’ but said this was also dependent on ‘capital assignment to be decided by the Department of Health’. She said the Minister for Health, Simon Harris has to get ‘capital approval for all of this’ from the Cabinet.
“The Coombe moving to the St James’ Hospital site with the National Children’s Hospital will happen but it could take up to 10 years. Any refurbishment of theatres and beds in the Coombe won’t go to waste because if the Coombe moves they will be used for elective surgeries of other sorts,” she said.
The Leinster Express asked Dr O’Reilly if she believes there is capacity in Dublin hospitals to take anything more from Portlaoise or anywhere else.
“There will be as long as we get the resources. Don’t forget paediatric beds are moving from Tallaght in 2020. That will free up some space for more beds, but not enough. We have another capital plan in evolution right now for an additional building for Tallaght. They are in dire need for beds.
“We are coming out of a financial crisis and years of decisions, particularly to reduce (hospital) beds.”
She wants to expand community care to increase what she terms 'admission avoidance.'
“I think everybody knows that we need more people treated in the community but everybody knows we still won’t have enough beds. That has got to be addressed and we are addressing it.
A lack of public consultation on downgrade has angered many people. Dr O’Reilly is adamant that doing so was not a decision she could make. She insists that the Department of Health insisted on confidentiality. However, she is now willing to engage with the public, politicians and the Portlaoise Hospital Action Committee.
“I have not had any correspondence with any groups representing members of the public. If I was contacted I would offer them meetings and not great big public forums. I would welcome that they would come and meet with me. It would be a positive thing to do.”
She does not want to ‘have a big argument'.
“I think there is a tendency to cause a great deal of alarm by misrepresenting some of the information. For example, the hospital is very well funded but gets talked about as if it was starving,” she said.
Dr O’Reilly is also ready to meet with politicians.
“Politicians, whether they are TDs or councillors are advocates for their constituency. My strong recommendation is that they take advantage of engaging with us and I couldn’t before because we were awaiting the completion of the Minister’s review and the plan was confidential within the Department of Health.
“Now that it has been leaked, not by us, it is out there and is causing consternation and misinformation so I now have a duty to inform. So I am very happy to meet with any of the elected representatives,” she said.
When Portlaoise was about to be downgraded in 2011, the carrot was that a range of other services would be developed in the hospital making it busier. Dr O’Reilly’s plan contains an almost identical proposal.
“I am looking at expanding the very high volume services - medicine for the aging, chronic disease management, elective surgery, endoscopy, outpatients more variety of services.
The plan estimates that €20 million would have to be invested to recalibrate the hospital. She says limited resources mean these cannot be patched onto existing servics.
“We have to be able to have the capacity to do that as well. I would have been happy to patch it on if I could find the resources,” she said.
This is already holding up one of the expansion areas.
She said the DMHG is on the track to expanding the endoscopy services.
“There is going to be huge business in medicine, care of the elderly which is a burgeoning population and also for elective surgery. That is absolutely where the growth will be taking place. It has to be planned.
“Between 60 and 70% of existing services will still be delivered in Portlaoise,” she said.
The removal of services from Portlaoise is for many people part of a pattern of rural Ireland losing out.
Dr O’Reilly said she understands the “fear or sense of loss” but insists she is responsible for sustaining services for the midlands.
“For me it is very important that we have a spectrum of services in the midlands - both Portlaoise and Tullamore - that address the comprehensive needs of the population.
“There are services (in Portlaoise hospital) that nobody is going to apply for a job in because there is not enough work to retain skills. What we are looking to do is how do we address that long term,” she says.
It has been stated that Dr O’Reilly is pushing the reconfiguration because she wants to leave a legacy. She rejects this and says she is living up to a mandate.
“Quite honestly, this has been hard and difficult.
“My only concern is sustainable safe treatment for all patients in all hospitals and making sure that they get the right treatment, in the right place by the right professionals who have the opportunity to maintain their skill by doing high volume services.
“I have no legacy that I need to leave here. Hopefully I have enough legacy by working in cancer services in Canada and in Ireland.”
She said there are other people who can drive the plan after she retires in January.
“I think it needs to be said that this isn’t Susan O’Reilly’s plan or even a personal crusade. This was me bringing together teams to do a thoughtful analysis of what would be the best way to address very complex issues.
“I have delivered on that mandate and I am very happy to be retiring in January and looking back on a career in medicine that I have enjoyed and I am hoping that the work that the Dublin Midlands Hospital Group has done and that this hospital does and other hospitals in the group do will flourish.
“I hope that other resources will flow, capital in particular to expand capacity,” she says.
Dr O'Reilly is not aware if a replacement chief executive has been lined up.