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| Postpone Your Sickness. issued 06-Feb-2012 | reply to | About 3,500 workers in the Health Service will accept the terms offered for their early retirement and sign out for good at the end of February. There are also big numbers retiring from other Departments and sections of the Public Service and these will leave a huge gap in the ability of that service to continue offering the same level of service as in recent years. Where this may not have an instant impact and cause major problems in some departments the effects of such a loss of frontline personnel in Health will be immediately felt by the patients and staff.
Consultants working in hospitals and nurses at the coalface have warned that patients will suffer and lives will be lost but they are ignored as having their own agenda for ‘scaremongering’. The Minister has acknowledged that frontline services will be effected but seems to be pointing the finger at the staff, even before anything does go wrong. The Minister for Public Expenditure, Brendan Howlin, is reported in a Sunday newspaper as blaming the HSE managers if anything goes wrong. Talk about setting the scene and blaming someone before the event happens!! Does the Government forget that they are ultimately to blame; they must take the responsibility, the buck stops with them?
However Minister Reilly has offered the solution to any problems that might arise – each patient should just sit tight and wait as he/she will be treated within 9 months and in an emergency room you will only have to wait 9 hours. Somehow an old adage comes to mind about a ‘cat having 9 lives’ but then a sick cat would be seen and treated within an hour of arriving at the Vets or the Vet arriving with her. Does the Minister remember Susie Long, who had to wait but was too late when she was finally diagnosed? It was promised then that such would never happen again but it has and it will again unless this Government begins to get their priorities right. We can all recall a relative or friend who was diagnosed and only lived a couple of weeks – now patients will die without even getting the diagnosis. We all know a relative or friend who survived because they were diagnosed early – well fewer patients will be diagnosed early with the resultant outcome. We may know a patient who has had to wait for weeks in severe pain before they could get treatment to relieve their pain – now that type of patient can wait for 9 months but that is OK – we all must make sacrifices in these tough economic times as we must repay the gamblers who thought they would make a fortune by buying bank shares but lost – we cannot have them suffering the mental anguish of losing their money – aaaargh! – maddening, isn’t it?
Behind all this there is a plan and one that we need to see implemented. The Croke Park agreement was agreed in order to reduce the Public Service numbers and to reorganise work practices. That process was moving too slowly and this is an ideal opportunity for Government to force new work practices where a smaller workforce does the same amount of work in a shorter space of time – we get increased productivity for the same or less money. It might be easier to achieve the objective this way instead of taking on the Unions. The old, the infirm, the sick, and those who depend on the public health system are easier targets. And just a word of caution – Private Health Insurance companies are offering a reduced Health Policy at the same premium for those having trouble maintaining their Health Insurance level. You may discover that the very illness you get is not covered by your policy and you have been paying big premiums for something that has little chance of befalling you. One example of this is where you now have to pay about €2,000 to get a hip replacement even with the same Health insurance policy that covered it two years ago.
Back to Top | | Told Them So! issued 02-Feb-2012 | reply to | Back in 2006 we told the policy makers that the Public Health System was heading for collapse but they did not listen. We told them that more and more people would rely on the public health system in the future (or as they would say – ‘going forward’) but they did not listen.
Instead they pandered to the private investor and offered all sorts of incentives for the private industry to build hospitals and dictate the policy. They pandered to those who wanted only to build little empires for themselves using the illness of people. They allowed costs to spiral out of control and they allowed the staffing levels of administration to expand till every manager had a team of assistant managers and each of those with assistant assistant managers yet so many of them were unable to do the work assigned. Now they have to hire in, at huge expense, outside consultants to show the managers how to manage and do the jobs they were employed to do.
All the while the front line services were being starved of resources and staffing. Public hospitals and services became inefficient and, in places, unsafe. How do they solve the problem? – they closed the service down as the managers could not manage to recover it without further problems. They did not listen to us when we told them that International evidence did not support the policy of centralising all acute care into what they called ‘Centres of Excellence’ (I don’t hear much mention of Centres of Excellence these days). They paid spin doctors huge salaries to counteract any statements we made and, using an agreeable national media, they bombarded the public into believing that closing these ‘unsafe hospitals’ was the only way to improve the health services in this country. ‘Patient Safety’ was the buzz word for everything they did.
The public at large sat back and allowed this all to happen. There was plenty of money for the middle and upper classes and they were able to afford the cost of Private Health Insurance. They were able to get silver service in the private hospitals and did not have to wait very long to get into the bed. But the Susie Longs of this country did wait and paid for it with their lives. Susie’s family was promised that all would change and that there would be no more deaths because of delays – like all the other promises, it was forgotten about.
What people with Private Insurance seemed to forget was that Private Insurance means nothing when you have an emergency – you just need to get to the nearest hospital as soon as possible but now you find that that hospital is closed for emergencies and you must take you chances and wait for treatment just like the public patient. It is now all about budgets and saving money but patient safety no longer seems important. However there is less money in the country now, there are less jobs, there are less hospital beds, there are fewer nurses and doctors, and your chances of survival have decreased dramatically. Not only that but with all the increases in the cost of the Private Insurance, you cannot afford to have it and you are once again dependent on the Public System – yes the system you sat back and watched disintegrate and fall apart and to be taken from your local hospital. Susie Long’s story will be repeated over and over again in the coming months and years.Back to Top | | NO answers. issued 25-Jan-2012 | reply to | The response to the highlighting of James Reilly’s empty promises to the people of Monaghan and the people of Ireland has been nothing more than we expected. We were reminded of all the enhancements which have taken place and are currently taking place at Monaghan General Hospital and the setting up of a Sexual Health Clinic was hoisted as a main sail for us to gloat over. Were we expected to genuflect to the HSE, the Department and the Minister because this Clinic is going to be held in Monaghan? Are we to forget all the people who will suffer added trauma, have further inconvenience heaped on them or die needlessly, as James Reilly himself predicted in that speech on the courthouse steps, just because we will be able to have all our sexual problems examined in Monaghan, close to home? Will some research unit in the future months be able to state that a greater percentage of sexual problems are dealt with in Monaghan than in any other county in Ireland but that a greater percentage of patients with emergencies in Monaghan die as a result of the delay in getting to a hospital?
The fact that there is a delay in the announcement of the budget for the HSE does not give us any confidence in the future provision of treatment at the Minor Injuries Unit in Monaghan. It is obvious that the budget is going to be less than last year and that further millions must be saved to pay the bondholders. To save this money areas like the Minor Injuries Unit in Monaghan will be obvious targets and will likely close and James Reilly will allow a further service to be taken from us without an alternative. We also have the problem that the policy of not filling vacancies in staff will lead to the closure of the Unit as they will claim that they cannot get staff to replace retirements and relocations.
Back to Top | | Distances to A & Es issued 20-Jan-2012 | reply to | NUI Maynooth’s National Institute for Regional and Spatial Analysis has developed a mapping tool by which you can discover the distance you are from services like GPs; Fire Station; dentists; airports; hospitals and a range of other services. The ability to find out how far you are from a 24 hours emergency department has been the one to catch the public’s eye and it is getting fair coverage on radio and papers. Now this is something which we in the HSAG (Health Services Action Group) brought before the Oireachtas Committee on Health back in 2003 and we have passed on detailed information on distances to A & Es to various groups of TDs and senators but it has always been ignored.
This particular system of determining the distances seems to be somewhat inaccurate as places known to be further from an A & E gets a better rating than a place which we know is closer. For example it would claim that Emyvale is 39 minutes whereas Tirnaneil is 41 minutes from Cavan and that is only an example. However the principle is still very important - that the length of time it would take an emergency getting to the A & E is too long for many.
Of course the times which this tool presents do not take many things into consideration – things which will impact heavily on the times. These include volume of traffic, road conditions, weather conditions, or indeed closed roads like the road from Clones to Cavan, which is closed regularly. It also cannot take into account the length of time it takes the ambulance to get to the scene and again our experience of that would not be very heartening. Similarly it does not give consideration to the length of time it will take the ambulance crew to get the patient loaded into the ambulance and again this can be a lengthy process in some cases. We could also add time for the space between the occurrence of the accident or incidence and an emergency call being made and the ambulance called.
Based on all this we would put the times for Main Street, Emyvale, as more likely to be: Call to ambulance 5minutes +; arrival of ambulance 25 minutes +; time at scene 15 minutes +; time to Cavan 41 minutes +; thereby giving us a total of 86 minutes +, which is almost half an hour over the ‘Golden Hour’ and these times are minimum and could stretch another hour. What then for an incident further North in Monaghan or to the West or East, where narrow country roads have to be negotiated. Having to go to Cavan does not give you a great chance of survival as Prof Nicholl, Head of Medical Research Unit in Sheffield University, stated at a lecture in the Royal College of Surgeons in Dublin last Friday – that every 6 miles you have to go in an ambulance your chances of survival reduce by 1%. He also says that closing the local emergency departments (like Monaghan) is wrong and will cost lives.
Modern methods of delivering safe services are being used in other countries to provide rural and isolated communities with emergency care and acute in-patient care. They have found that in-hospital times reduce when the patient is nearer home and in familiar surroundings. As well it is easier for the services to discharge patients, when they are aware of patient background and home conditions. But the big question is – how do we get this message across to the policy makers and how do we get them to look at the bigger picture.
Back to Top | | Are Promises Made To Be Broken? issued 18-Jan-2012 | reply to | That is the question asked as the heading of a clip on Youtube at this link - http://www.youtube.com/watch?v=CDY9dG89iBU – which features part of a speech delivered by the now Minister for health, when he attended a Protest March organised by the Community Alliance on May 6th 2008. There is certainly a message there for all would be politicians – don’t promise something unless you are 110% sure that you can deliver.
We wish to make comment on some of the things Dr James referred to during that speech.
1. He said that he was after coming from Monaghan Hospital where he saw a terrific A & E, a state of the art theatre, highly qualified and hard-working staff, and a great facility under-used. He also referred to documents from consultants in St. James’s Hospital praising as ‘excellent’ the results of a medical audit carried out in 2007 in Monaghan. He stated that the outcomes for Monaghan were excellent. With all of this he asked why any of these services should be taken away when the people of Monaghan will not get as good as a replacement. If this is so we ask – why would he not put those services back into Monaghan when he came into power.
2. He asked the people at the protest to let Fianna Fail know that the people of Monaghan would not forget what that party did to Monaghan General Hospital when in power. It is now the turn of the Monaghan people to let Fine Gael know that we will not forget what they did to our hospital, and did not do, when they were in power.
3. He then made a promise to the people of Monaghan and the people of Ireland – that Fine Gael would fight with us for our hospital. We now know that he has reneged on that promise and will not meet with our Councillors or ourselves to discuss the future. However he has been quick to lay off the blame but this time it is the fault of the HSE and not Fianna Fail because he is now using the same language as Mary Harney, Brian Cowen and Michael Martin did when they were Ministers of Health. The very health policy which he condemned in his speech and for which he disparaged Fianna Fail, has been continued by himself since taking office.
4. The 2012 HSE Service Plan has a range of cuts which will seriously effect frontline services in this area and there are further severe cuts coming during 2012 and there are no replacements or alternatives to these but he seems to expect us to accept them as necessary evils and forget that he promised to retire from politics if his Government did this. He may claim that the economy, the Troika, the IMF, the EU, the bondholders, and lets add the Bankers too, have all forced him into this position and that this is all the fault of Fianna Fail’s failed fiscal policies. Well we say – he was at the heart of Government and should have known what was happening and should have known what was ahead as Brian Lenihan made it very clear long before the General Election. The dogs on the street knew. However in his speech he stated that one of the first things he was going to do was to find the ‘Black Hole’ where the money for health was disappearing. He referred to the numbers of Grade 8 managers rising from 6 to almost 800 in a couple of years and the amount that was costing. Has he found that Black Hole and how many of the 700+ are still earning the wages of Grade 8? Has he looked at other sections of administration where money can be saved, and at other areas of Government where savings can be made - like the massive tax-free pay-outs to TDs and Senators? Patients, the sick, the aged, the young are easier targets.
5. He may say that the reconfiguration of services is necessary for patient safety. If that is the case then why have we experts to claim the opposite. Why did Professor Nicholl, head of the Medical Research Unit in Sheffield University, state in a lecture in the Royal College of Surgeons of Ireland last Friday, that research shows that it is wrong for the Government to close the local A & Es except for the very severe and major trauma. He claimed that your chances of survival diminish by 1% every six miles you travel by ambulance to a hospital and that many lives are lost for relatively minor reasons because of the delay in getting to a local hospital – not a big hospital or a teaching hospital or a very high-tech hospital – just your local hospital. Why was the opinion of the Doctor, who resigned from HIQA, ignored as he claimed that there was no research, which proved that centralisation of all acute care was the proper policy. Where is the research which proves that all acute care must be centralised?
6. In his speech Dr. Reilly asked – ‘How many more have to die on the road to Cavan?’. There have been some and more that we cannot prove but we can say that these were not given the best chance of survival. There have also been some whose lives have been saved by Monaghan General Hospital and in some cases the serious outcomes have been averted by the excellent staff in our Minor Injuries Unit. We cannot name them but many families know the benefits they have received due to the services still available in Monaghan but which are now under threat. This threat has been imposed, not by the HSE but by Dr. Reilly’s Government and its policy. He is the Minister, he must accept the responsibility, the buck stops with him, that is what the taxpayer is paying him for and his name will be added to the others who have been responsible for taking our excellent services away.
Back to Top | | Expert Opinion issued 16-Jan-2012 | reply to | Since we began this campaign we have continually claimed that the policy being pursued by the Government, the previous one and the present one, is based on faulty evidence. On many occasions we have highlighted that the evidence is not there to substantiate the claim that all acute care must be centralised for safety reasons and for better outcomes.
We have also pointed out on many occasions that having to travel a long distance to an A & E is very dangerous and can be fatal in certain circumstances. We drew attention to research in the USA and the UK which claimed that you had a 50% better chance of survival if attended to by an emergency medical technician rather than an Advanced Paramedic. The AP feels compelled to carry out all the lifesaving procedures at the scene before transporting the patient to a hospital but by then it is too late.
We have also claimed that 95% of the ambulances cases taken from Monaghan to Cavan could have and should have been treated in Monaghan. In the past we have brought needless deaths into the public domain when patients died on the way to or shortly after arrival in a distant hospital. It is very difficult to prove that the delay was the cause of death but research would support our claims here. We have a number of suspect cases recently where it could be claimed that the patient was not given the best possible chance of survival because of the delay in reaching a hospital and we also have the proof that Monaghan can save life and limb even with the reduced Minor Injuries Unit.
Last week a Professor Nicholl, who is Head of Sheffield University Medical Care Research Unit, gave a lecture at the Royal College of Surgeons in Ireland and it is reported in the Sunday Business Post that he stated that according to their research the closure of local emergency departments will cost lives - that your changes of survival decrease by 1% every six miles you have to travel to get to the A & E. Research showed, he said, that the further a seriously ill patient had to travel by ambulance the more likely they were to die. There are many seriously ill patients, who need emergency treatment but do not require specialist care and that these patients have a better chance of survival in the local emergency department. We claim it is also more efficient and less costly. These patients do not require the high-tech teams of specialists standing by and the need not clutter up the specialist departments leaving them available for those who really need them.
Of course whose with vested interests and those who want to make sure their own hospitals get everything going will argue against this but the evidence is there and the Government needs to listen to experts like Professor Nicholl before more die needlessly. Back to Top | | More Scaremongering. issued 12-Jan-2012 | reply to | I decided to do a little more ‘scaremongering’ as some like to call ‘facing reality’ but then we are used to that from the previous Government. Nothing has changed really – when we highlight further cuts to services in Monaghan, we are ‘scaremongering’; when we request a meeting with the Minister we are told he is too busy as his diary is full (the exact same excuse we received ad nauseum from Mary Harney); when we ask the Minister to do something about the removal of services we get Mary Harney’s letter saying that the HSE is responsible and that the Minister cannot intervene; when we ask our local Government TDs to do something about it they write a letter to the Minister and get the same reply.
However it is good to hear Cavan people beginning to realise that their hospital is suffering cut-backs and reduction in services and that this could be the beginning of the slippery slope for them too. But why are the Cavan people not up in arms and shouting loud that their hospital has very high numbers on trolleys, mainly because they have to accept Monaghan patients? The dangers of the delays in treatment have been highlighted by medical consultants and the Cavan patients are being put in the same danger as the Monaghan Patients.
Now the HSE, and once again to save money and not to provide better services, has decided to reduce the outpatient clinics and day surgery in both hospitals. They claim that this will not impact on patients but they are wrong. Monaghan patients will now be expected to travel to clinics in Cavan where before they attended Monaghan. This is extra cost and huge inconvenience to most patients who use the services referred to. However the delay in receiving treatment could end up having massive repercussions for patients and could have fatal consequences. Waiting lists will grow and appointments will be delayed and health will deteriorate and that cannot be good for patients.
Back to Top | | Cross Border Hospital Planning. issued 02-Jan-2012 | reply to | Over the past few years we have been keeping in contact with the Centre for CrossBorder Studies Group (CCBS) based in Armagh as they were involved in research in relation to the feasibility of Health services being provided on a Cross Border basis, and this was of real interest to the Alliance. We contributed to that research and participated in some discussion groups during the early research. However in 2009 a company, HBC, was appointed by the CCBS to carry out further research ‘to identify how cross-border hospital services can provide mutual benefits for the people of the border region’. The resulting Report of that research were launched at a conference in Belfast prior to Christmas and I attended.
As far back as October 17th 2004 the Alliance proposed that a Regional Hospital be built in this area to provide specialist services and acute in-patient services generally to the people of this area and, on a cross-border basis, to the people of West and South Armagh, South Tyrone and East Fermanagh. Taking the population of that region together with Monaghan and part of Cavan would ensure the viability and sustainability of such a facility. We were ignored. Again when the New Regional Hospital for the North East was recommended and submissions on its location were sought, the Alliance proposed a cross-border hospital in this region and again we were ignored. The decision was made that it would be sited in Navan but the recession meant that the decision was never announced and the plan was put on the back burner.
The outcome from this recent study would support our proposal except that things have moved on and the money has gone and the possibility of a new major hospital anywhere on this island during the next 15 years is about nil, except for the new children’s hospital in a Dublin car park. However the HBC report seems more interested in the development of the new Erne Hospital outside Enniskillen, which would provide full in-patient and emergency care for the people of Fermanagh, part of Tyrone, part of Donegal, part of Sligo, part of Leitrim, part of Cavan, and North and West Monaghan but taking in as far as Cootehill. Daisy Hill in Newry would be developed, with 26-County financial assistance, to serve most of County Down, most of Louth, part of Meath, part of Cavan and South Monaghan. Altnagevlin in Derry would offer services to the people of Donegal as well as its own catchment area. The question is – what happens to Sligo, Letterkenny, Cavan and Drogheda? It seems they will have more of the minor stuff and the outreach clinics.
However there is no need for alarm as it also seems that the two Departments of Health are not very eager to progress this plan. Both of them were unable to participate and contribute to the research it seems. But the Erne Hospital will depend on patients from the South to make it sustainable and economically viable and it is opening next year – so I can forsee a badly thought-out and ill-conceived plan being rushed through to make it work, irrespective of the benefits to patients. The Report claims that ‘cross-border acute healthcare services should aim to generate a two-way flow of patients across the border’ but it seems that the big stuff goes North and the minor stuff to the South and we must ask – an emergency in Cootehill or Corcaghan, Doohamlet or Newbliss being brought to the Erne in Enniskillen leaves many exposed to huge risk. We will likely be promised an extra Advanced Paramedic and a Helicopter but surely they don’t think we will swallow it a second time.
Back to Top | | Further Issues Raised by the HBC Report issued 02-Jan-2012 | reply to | The HBC Report goes to lengths to claim that consultation must take place with all stakeholders and their views taken into consideration yet when ones looks at the list of people they consulted with there is no patient representative or service user there – only Health professionals and Health Policy makers and managers.
For us the outcome of the research was always suspect as this company seemed to be basing its starting point and conclusions on the same evidence that the HSE and Government use to push through their reform programme, and we claim that this is faulty evidence and based on false figures. This issue has been raised this week by Senator John Crown, a highly respected oncologist, when he questioned the evidence used by James Reilly to remove the A & E from Roscommon. There are a number of ways of collecting data and arriving at conclusions and John Crown suggests that the figures used by the Minister conflict with data which he has seen. John Barton, an esteemed Cardiologist in Portiuncla has also questioned the evidence as has a doctor, who resigned from HIQA because, as was reported, he was not happy with the decision-making based on this evidence.
We have often asked for the evidence to show that Monaghan was unsafe but it has never been produced. Indeed an Audit of Medical Services in Monaghan, which was carried out in 2008, clinically vouched for, and which was accepted by clinical experts as being above that of some of the major hospitals, was ignored by Government and HSE. But then Horwath Consulting (this Report was produced by Horwath Baslow Charleton – same firm) produced the reports for the reconfiguration of acute services in the MidWest and South of Ireland and it too seemed to be based on what we call the faulty evidence used by Teamwork in the NE and evidence which we have asked to see but which has never been produced. Maybe it is because it does not exist or as HBC says –‘it tends to suggest ‘ which is far from the proof which should be needed before major decisions are made based on it.
This report would also claim that the South is lagging behind the North in many areas. One is that the clinical standards and governance in the South are lower than in the North, our legislation is different, we are more expensive, we have different methods of accreditation, we have different grades and responsibilities, and the political arena is not yet ready to accept moving towards large scale cross-border services. All of these must be ironed out, and that is possible but will take time, before progress can be made.
Back to Top | | Will The MIU Close? issued 28-Nov-2011 | reply to | On July 22nd 2009 what was left of our A & E in Monaghan General Hospital was reduced to a Minor Injuries Unit with specific restrictions on what could and what could not be treated there. No ambulance would take patients there and only those walking or in private transport could go there. All emergencies would be responded to by a First Responder, who would have a special car and get to the scene of the emergency first, would stabilise the patient, who would then be transferred to Cavan or Drogheda by ambulance. In serious cases the First responder would accompany the patient in the ambulance to the hospital. This system was offered to the people of Monaghan as an alternative to the excellent service, which was taken away from us. This was to be a ‘better and safer service’ for us.
Now two years plus later we know that the new system did not work as many occasions proved, when the First Responder was not the first or even the second to arrive at the scene and at times did not arrive at all. There were also times when a local GP had to be called in to help keep a patient alive and capable of the long journey to a distant hospital. There were times when ambulances had to pull in along the roadway in order to treat the patient and keep them alive. We know that this type of care is not good for patients and causes great difficulty for medical people to maintain life and causes greater difficulties in achieving a satisfactory recovery, though it can be very difficult to prove beyond doubt that the delay was responsible for those who are DOA or who die shortly after arrival, but the question must be asked. Consultants in Emergency Medicine, who know what they are talking about, tell us that there are more deaths due to overcrowding in A & Es and delays in treatment than road deaths each year yet these conditions have been imposed on the people of Monaghan.
On October 7th this year a new system came into operation – The First Responder Car was withdrawn from service, the First Responder (the Advanced Paramedic) was now allocated to an ambulance when determined by the Advanced Medical Priority Dispatch System (AMPDS - a computer which determines the gravity of each emergency call,) and the Minor Injuries Unit was reduced to a 9 to 5 five day week operational roster. This, do we need to remind people, is the ‘better and safer services’ we were promised and has happened under the watch of two political parties who promised the people of Monaghan that all services in Monaghan General Hospital would be retained. Except that these changes were brought about not because of patient safety or a better service but to save money. We have also been told that the MIU hours will be reviewed ‘next year’ and may then be returned to 12/7. So at long last we have the proof that the saving of money is more important to them than patient care and patient safety. Oh how they fooled us into believing that they cared for us and wanted something better for us!!
However, even with all that has gone before and despite the stealth and double talk and secret planning there are politicians who still believe that we are ‘scaremongering’ or try to convince others that we are scaremongering. There are still councillors, who believe that the Minor Injuries Unit will return to 12/7. There are some who cannot take our word for it even though we have been proven right in all that we have foretold and warned of. So, for their benefit, we lay out the reasons why the MIU will likely close next year and how the hospital will take another step closer to the ‘Glorified Nursing Home’.
First of all we ask - who out there thinks that there will be a return of the Celtic Tiger before the Summer of 2012? Very few? Correct. Since there will be no money then, there can be no return to 12/7 for the MIU. Why? We have been told that the reduction in hours will save over €400,000 annually. Now they want to save all of that €400,000 badly, which means that there will be no review of the hours in the MIU until next November. By then they will be looking at ways to save the next €3.5billion in the 2012 Budget and so Monaghan will still be in their sights as an easy target and will not be given the €400,000 back to return the MIU to 12/7.
Worse still – a big part of this saving is got from transferring staff from Monaghan to Cavan, which has already happened. Now where is the money going to come from to pay for the new posts needed in Monaghan to return any service? They cannot take the staff back from Cavan as very powerful people there would object and it just could not happen and so the hours cannot return. However since its downgrading the numbers attending Monaghan will have decreased and it will be then claimed that it is not sustainable to maintain a Minor Injuries Unit in Monaghan at all as so few people attend ever day and that another €400,000 can be saved by closing it altogether -- Q.E.D – unless you know different or unless you can persuade the Minister to order the HSE to restore the services to Monaghan in the interest of patient safety and to save the money by cuts to administration instead of frontline services – and we do not accept promises.
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