As published in the Sunday Independent on 13 October 2013
WHILE there has been appropriate criticism of the standard of clinical care delivered to the late Savita Hallapanavar by frontline professionals in Galway, another group of people bear substantial responsibility for her tragic death and that of her unborn child. These are Brendan Howlin, Michael Woods, Michael Noonan, Brian Cowen, Micheal Martin, Mary Harney, Mary Coughlan and James Reilly.
These are the men and women who have occupied the office of Minister of Health in the modern era, and who are responsible for the HSE West having the lowest number of obstetricians (the doctors who deliver babies) per head of population in Ireland, which is in turn the country with the lowest number of obstetricians per head of population in the developed world. Please also remember that we also have one of the highest birth rates among developed nations.
We have 126 obstetricians, or about three per 100,000 population. The UK has 11.5/100,000 population; the Netherlands, with half our birth rate, has 7.6/100,000; Poland has 13.5/100,000; Sweden has 14.7/100,000; Switzerland has 17.2/100,000; and Germany has 19.5/100,000.
All of these countries have lower birth rates than Ireland. They have a mixture of different types of health systems. In some of them, doctors are poorly paid, in some, like Ireland, they are well paid. Some of them have government-run systems, others have mixed public/private models. Some countries are richer than Ireland, others are poorer.
Ireland, of course, also has the lowest number of medical specialists in all specialities per head of population of any OECD country, despite the fact that we have the highest number of medical schools per head of population.
Ireland has, amazingly, contrived to be the leading exporter of medical graduates in Europe at the same time that it is the leading importer of medical graduates in Europe!
As in all other areas of our mediocre public healthcare delivery system, the shortfall in obstetricians is made up by inappropriate reliance on the labour of trainee doctors.
If you do read any of the reports into Dr Halappanavar’s death, do a little exercise. Any time you see the words “registrar” or “specialist registrar” or “senior house officer” delete it and insert the word “trainee” and the deficiencies in the care this poor lady suffered will become more understandable.
Politicians who would be horrified if the ESB despatched an apprentice electrician to fix a pylon in their back garden are perfectly content for their constituents’ children to be operated on or delivered by trainee doctors.
The problems have all been flagged many times over many years. Far from operating a closed shop, every professional organisation representing medical specialities has clamoured for increased appointments. The people who have stood in the way have been politicians, civil servants and quango-crats.
They blocked appointments when we were rich. They are still blocking them now that we are poor. They blocked them when we paid doctors poorly, blocked them we paid doctors very well and are now surprised that doctors aren’t applying for the paltry number of overworked jobs currently on offer for reduced pay.
In 2007, I wrote the following in the Sunday Independent following the Michael Neary scandal (as readers will recall, Dr Neary was an obstetrician in Drogheda who needlessly removed the wombs of many women): “There has been appropriate scrutiny of the failure of the Medical Council to censure Neary — but much less scrutiny of the abnormal system in which he worked, one which lacked many of the resources that were necessary for high quality obstetrical care.”
Dr Neary worked in a two-doctor unit. In a large well-staffed unit with appropriate peer-review his unusual statistics would have rung alarm bells earlier.
All these years later, the resources are still missing. We let women labour and deliver in dismal, understaffed units without appropriate senior specialist cover. Too many units have rudimentary back-up in terms of blood banking and intensive care.
Even flagship institutions like Holles Street are desperately short-staffed. To meet UK guidelines for the number of deliveries per consultant, the number of obstetricians in that fine hospital would have to be trebled. Holles Street has only three neo-natologists — the paediatricians who specialise in the care of newborn babies. It should have 10.
Outside Dublin it gets worse — much worse.
All the while the pressure on maternity services is increasing. Mothers are older, and older mothers face increased risks. Immigration is increasing the demand on the service. Our maternal mortality rates, while still very good, have risen in recent years.
The recent HIQA report states that “there are a relatively low number of obstetricians” in Ireland. By this logic, the Titanic had a relatively low number of life boats.
Instead of waiting for the most recent expensive, highly spun HIQA reiteration of the bloody obvious, when is someone going to act?