Portlaoise hospital protest in 2011. Pic Denis Byrne
Nobody should have any doubts about the power and drive of health management backed by ivory tower doctors, remote politicians and Dublin civil servants, to downgrade Portlaoise hospital.
Such plans have been executed in Clare, Cavan, Monaghan, Tipperary, Louth, Cork, Roscommon and elsewhere. Cuts were made. Waiting list and trolley numbers spiralled but the recession, and not a downgrade policy, was blamed.
Recession over but still lots of trollies and 400,000 on waiting lists. HSE response - downgrade another hospital. The latest target - Portlaoise.
This time they've got the fancy new Dublin Midlands Hospital Group to prepare the axe. In turn the group has apparently roped in senior doctors or 'clinical leads' to sharpen it.
They produced two reports which are tied at the hip. One is specifically for Portlaoise, the second is a five year Strategy for hospitals in Dublin, Laois, Kildare and Offaly. The problem for Portlaoise hospital now is that the Strategy cannot be implemented if the Portlaoise specific plan is abandoned.
Minister Simon Harris could have shredded the Portlaoise report last December and sent the HSE back to the drawing board. He did not do this. He continues to give vague answers but will not come down publically on one side or another.
He knows the Portlaoise plan is toxic and maybe he is hoping it will all just go away - but the HSE will not go away and it appears to be single minded in its determination to downgrade the Laois hospital.
Dublin midlands hospital chief, Dr Susan O'Reilly is leading the chase, but there are many hounds and Portlaoise is the fox.
Their strategic planlacks a lot of detail and includes hardly any stated clinical evidence to back up its recomendations. What is clear though is that money is a big factor.
“Currently we do not utilise our resources in the most effective way, or optimise our complex care pathways because our hospitals offer too broad a range of services at multiple locations. Spreading our constrained resources in this way is not in the best interest of patient safety, is not cost efficient, cost effective or best practice,” says the report.
The trouble with this is that many services have already been stripped from Portlaoise - so why pick on the small, busy, efficient hospitals while St James and Tallaght are untouched?
Apart from cutting A&E, the report makes pretty clear that smaller hospitals - namely Portlaoise and maybe Naas - will offer services of 'lesser complexity'. They will be for diabetes care, geriatrics, elective surgery and a few other awkward areas.
Dumping ground? What is astounding is that the Dublin Midland Hospital Group values include to 'build trust through openness and transparency and to communicate openly and honestly'.