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Roscommon On The MarchGoodbye MallowFrustratingWhat Kind of Nation are we?The inarticulate will carry the burden.NHS and HSELeadership in England?Dear Dear Deer.Cuts and More CutsThe ‘HSE and YOU’ and me.Apply this to the Irish scene. Frightening?Frontline weakness.ClonmelChickens arriveSuggestion.Question?Cross Border Hospital ServicesAbandoned !!?? Letter re: Bed Closures et alHere Again ...Trolley FiguresCrocodile Tears.Volunteers...Double Standards ??Transparency??Clones leads.DISGUSTINGNo HospitalCanada as an example?More from CanadaWhy scrap 'best services'?Response to Dr. Rory O'Hanlon.We warned about this.Free treatmentProblems Cropping UpAnother good readA Must ReadResignationsSligo Press ReleaseExperts can differ and contradict each other. “BIG BRA`PROTEST EVENT”A bell that tolls for us allFinal Day.Change of PlanParamedics cannot replace doctorsDo Not Let the Hospital Die Alone.We Are At Risk From Today.Dr. Elmo de HoedtDeath of a HospitalNew Low for some..The Night in the Dail.Date Has Been fixed.Public Notice.Here we go too.Gateway to close.Stay of Execution.Big Mistake.Ambulance Delay Unacceptable.No Response..Statement from Community Alliance 12/05/09.Declan Ganley Impressive.How long until ..Removal before May 31st ?Sad news ...Money talks..Explanation please..Response to Ennis Report.Making a mockery of Monaghan?Stuck in a groove.Health Stats??Prof. O'Keeffe V HSECross-Border Cooperation.Respect or profit?Reality - or spin No. 2Maybe Not Just Yet..More Double Speak..Total Closure?Monaghan Rejected - Again.Must 'Spin' always win?Trust is gone..Getting rid of the fat cats..Press Release 19/02/06Hanly in a new rhinestone tuxedo...Peep at the real truth..Essential Reading....Interesting or what?Letter to the public..Another letter..THE PARROTING OF 'PATIENT SAFETY'Typical HSENot Safe..How silly?HSAG ReleaseMedical OpinionNo Meeting..More Stealth....?The HIQA Hygiene report..Meeting with HSEWorries !!....Alliance Statement – Dec 17th 2008.Powerof Prayer...In-Committee meeting..PoliticsProposals We demand.Hospital closures serve privateersPublic Meeting130 jobs to go in Monaghan.Closer and Closer...Ready, Steady, Go....Power of People Power.Ministerial Meeting.Third AmbulanceCentralisationNational Rally –Dublin – Oct. 11th 2008.DublinAmbulance times.Dublin ProtestProtest in Dublin.Closure..More comfirmation..Where does the blame lie?Another Life Saved.MEPSignal is Clear.What is Public Health CareNo ConfidenceU-Turn or Not?Slow DownStill HereReply to Prof. Drumm Post Lisbon.More of the same again..StatementsLisbonNew Junior Minister gives hopeMarch for HospitalWere we animalsDesperationHospitals on Government hit list named ahead of Monaghan rallyAnother Speaker'Go' for Protest..Caoimhghin In The Dail.Protest MarchUpdateAre bigger hospitals better?Another Document - Same Plan.Flawed DocumentWarning !!!No evidence for centralization, conference toldPrehospital InterventionsVolume V OutcomesHealth Conference.More ProtestThe Cancer ScandalsHere goes anotherAnother Black DayGreat NewsReprieveRegional Hospital LocationHealth Costs coming soon..One More Step..Dublin ProtestTrades Council Rally, Dublin, March 29th 08.Mass ProtestRally is GO..Travesty of the 1916 ProclamationMore SupportInvite to Minister..Proof PleaseMore Cuts.Monaghan Hospital Madness We Must Say NO Now.Whitewash...NTPFA service under siege Volunteerism !!Another Leak..?Regional Hospital..What is planned for 2008?World Class Health ServiceSenior Citizen's Plea.One Year On...North east reforms are blueprint for rest of countryWorth publishing againRural hospitals in jeopardy.Glorified Nursing Home Indeed!.Could we get something similar?The battle goes on and can be won.Is there a lesson here for Ireland?Could this happen in Ireland?Another lesson?American styleRegional HospitalPlease ExplainHere We Go ...Death of a Great Friend.Cross-Border activity.I understand but do you, Mary?Breach of Privacy?Oireachtas Briefing No. 2.Refurbished Wards.Government plans just one A&E for 400 000 people'Emergency' on UTVNational MeetingWhat is happening?Cut Backs!Please identifyCall for HSE to be replaced by local health authoritiesScotland leads the wayPress release from HSAGCampaignPenny DropsTeamwork again..Gordon Brown?Can we not learn?Not in Ireland thoughIt will not happen in Ireland??Letter of the week.Teamwork will not work for patients.We are not aloneSame conclusions about the NHSBook LaunchBricks and MortarTeamwork?Cavan - 'to be or not to be' is ?Independent ??More proofCorrectionInteresting QuoteWe are criticised.Protest Report.Change of PlanCavalcade Ready.Consultation, consultation, consultation.Review of Management called.Nothing New in This.No One Listening.Have a HeartHope Springs EternalConfusion reigns.Whose 'self-interests'?Hospital LocationMessage from the Midlands.More downgradingHygiene Audit resultsThe Observer -- Sunday September 24, 2006More evidence...Interesting !!..Does Practice Really Make Perfect?Are they deaf?Who takes responsibility?Dublin TuesdayHSAGOn the road again..MRSA and hygieneHollow WordsTeamworkProtest againProtests..Play it again Mary.Big Tom praises MonaghanReality - or spin?HSAG MeetingMore Protests..Interesting LetterPatient Safety?On message but off kilterNo TakeoverNews of the World CampaignAre bigger hospitals better?Outcomes/Effectiveness ResearchBusy HospitalKeep our NHS Public - Tuesday 17th October 2006Maine Rural Health Research CenterEveryone Activecommentor: JDCposted:It happened beforePress Release issued 20/09/06 by SRPC.More evidence!!!Health care centralization risks safe maternity care and community sustainability The safety of small maternity units confirmed in landmark Australian study Dec. 2005.Democracy ???Another ViewCompare this..Poem for our CampaignInsult or what?Double standardsMeeting with TaoiseachInsultProtest RallyMore promises..Protest.ConsequencesPublic MeetingPress Release 03/09/06Public Rally....What will it mean to you..Response to HSE..Public Meetings..We met Prof. Drumm..One Year On.Private Hospitals ...............Public Meetings.Patients in 2nd place..Do they listen to experts?Chairman's Sympathy..No GiveNon-Political...Hygiene Audit...Ours is NOT dirtyVery good summaryRush for InvestorsNeed is thereEU ReportFurther chaosHSAG Press Releases ...Initial Reaction to Review??Still no Common SenseLetter to the TaoiseachWill they not listen?Sunday TribuneBaby Joy..Meeting with Enda KennySad, Sad, Sad, ...Christian Leadership?The Truth is coming out..Good Timing..A Recall?...Review Group...Off-loading ResponsibilityWe ARE RIGHT?Good Common SenseBack on the streets..No Crisis - No emergency?Invite to Liz Ryan..Irish Rural LinkWe told you so...More Valium Needed ..Who do we believe?Facilities for what?...Refurbishment:Stupid Questions or what?More Valium?No Change.....Finger Pointing...Emergency!!!!????Reports a nd Reports...Quote of the week..Broken promises NOT AGAIN?Who is our Health Service for?Resign Prof. Drumm...Letter to papers..Ministerial Meeting.Rotary Letter...Late Late Unbalanced....... Interesting Quotes..............No Report needed .....31/01/06Against Private? .........Huge Costs........What are hospitals for?...........Evidence for Enquiry ..Evidence is building..Honesty at last !!.NO ANSWERWarning for Cavan.Imagining obstetrics in Monaghan 5 Days on TrolleyVested Interests..Press Release..............................Expert recommendations.More quotations.............Patient Care?....Another Report?.....Patient Safety??.........The Truth comes outWhere to now? .Protest Report ..Press Release ............Monaghan Hospital Mortally Wounded.....On the Capital Streets again .........Thanks but NO ThanksCampaign Goes On ..Lives at Risk Not Another Report !!.............Pure Mess ..............Cavan Private?......Double Speak ..Another Unworkable Plan ..Public Meeting Call for Support.................Common Sense?....Public Meeting ................No Solution ................HSAG Press Release...........False report ......Press Release ...............Interesting Quotes from Experts.......Disbelief .......................Running for Cover ........Two Issues ..............Anger Boiling Over ..............Another Needless Death? ...............Where to from here?..............Statements ................Consultation ........Bungling Ineptitude? No Plan .....................Unbelievable .NE Abandoned Again..............Hard to believe ................Consultants Call for Action ..One Year On ...............Please Listen Minister..Stealth Again.......................Against Privatisation..Alliance Statement 150805.Alliance Statement 240805HSAG Press Release..........FIELDS FAMILY STATEMENT ......Alliance Statement ...................Forgotten People .Sad and shameful........HSAG Release ..........Another Release from HSAG.....Disaster .........Praise for Monaghan More proof...........Brain Drain ..Other regions must wake up .Lets Say NO Now .............New CEO .We are being DUPEDPrivate, Private, Private......Another Broken Promise .......More Problems.WARNING? ......CEO Resigns .Hanly Proposals in full flight .............HSAG Statement............Who gets what ...?Press Release from HSAG ...........Steering Group to Blame ....?Broken record .................Coroners Verdict .We do not want to hear...............Good News .............Out of Touch ..............Private Medicine ????...Politiical decisions or what???Making an offer .........Press Release 1.........Press Release 2.........Common Sense Offer..........Good V Evil................How right we were..........Good to Hear !!..Reasons why ......Meeting with Joint Oireachtas Committee.....Future Strategy .................A & E Need ..............HSAG Press Release ...........Praise amidst the tradegy...........HSE Statement ................Fooled Again.......National Committee .................Alliance Statement.................More Mist ...................LOGO Gone??................The Mist Lifts..Scandal National News ....Crisis ............................Good but not good enough .....Back On Call ..............Driving Hanly .........Nothing Has Changed ...........Another Roadside Birth ................Rally Postponed ................More Confusion......Protest .............No Christmas Cheer............Protest ...................New Lease of Life.........What price for a human life?The Truth Is Out .......Confusion Reigns .......It Just Gets WorseMore services lost...........National Meeting........Another tragedy.......Steering Group Report..Action Needed........Small V Big........Proposal............More tragedy...Disappointing.....Silence...Danger and Hope....Correction.....Positive.....Glimmer of hope...Madness takes over ..Health Services Action Group.......National CampaignAnticipation !!! Chaos Reigns Health Board Response.......Successful RallyCommunity Call............Back to the Streets............Public Rally ..More Confusion..............Update Against All the Odds......Good Samaritan.HRI Report on Monaghan.High CourtAnother ReportRural IrelandHanly will 'slash' maternity facilities by two-thirds Minister's Offer.........Steamrolling alongNational plans..........DIRECTIVES ..National Committee . 28/04/04ATTENTION OF ALL MEMBERS OF HOSPITAL ACTION GROUPSConfusion.....................National ConferenceMore ProblemsNational Conference..............UpdateGood StoriesNational Conference...............Baby Born in Monaghan.......Baby born ...............National Conference..Press Conference......Problem Solved.......?Wake Up Ireland.................Not Acceptable..Another Risk?..More support Latest Protocol 21/01/04Life After Politics.....16/01/04Comment 14/01/04.Process Almost Complete......... 14/01/04Hospital Signs... 8/01/04To Whom it Concerns.Response to Fianna Fail Councillor08/01/04Update 07/01/04Update .....18/12/03Reply to Gerard Loftus.18/12/03Statement from National GroupA year on .................10/12/03Nenagh and National.. 02/12/03.Mistake . 25/11/03The Hanly Effect.23/11/03Risk or Not. 23/11/03Good and Bad about Hanly Report...Comment .. 18/11/03Disappointing 16/11/03Reined In........15/11/03Monaghanisation of Nenagh .. 11/11/03Minister's Support .. 11/11/03Grateful Patient.More from the expertsAnother Roadside Birth .. 4/11/03Expert Opinion .. 4/11/03Another Strategy from the HB .. 30/10/03ICA President Visit 29/10/03Alliance to stay out of politics. 26/10/03Deadly Silence. 26/10/03Candidates ..17/10/03Oh Holy Day15/10/03Comment .. 13/10/03.Doctors Differ 8/10/03More of the Same 8/10/03 TPS 3/10/03The Dr. Neary Case Explained?New Alliance 20/09/03Dear Minister 06/09/03Update 04/09/03Who is in charge? 04/09/03 Support 1/09/03Acceptable deaths 30/08/03Statement 25/08/03Update 18/08/03 Update 13/08/03Statement on Bonner Report 31/07/03Bonner Report. 25/07/03Another Roadside Birth 24/07/03.Economics??? 19/07/03Monaghan Busy 15/07/03Green Party Visit. 15/07/03RSCI Charter 11/07/03Reaction 05/07/03Urgency NeededBritish Government on our side.Health Reforms. 23/06/03Government PlansHealth Changes 17/06/03Statutory Powers.CavanInfo 28/05/03Thoughts 25/05/03Update 25/05/03Get Ready.Restructuring 21/05/03There is 'no crisis'.Update 15/05/03Confusion ReignsKinder is No Kinder to Monaghan.Waiting for Freedom.Update 29/04/04Downgrading Goes OnUpdate 13/04/03Monaghan TargetPolitics or HealthUpdate 21/03/03Update 9/03/03Ridiculous or WhatUpdate 04/03/03National IssueDon't Get Sick. 25/02/03Update 26/02/03Review of Report from Facilitators.Press Release to Regional PapersFacilitators Report.Update 07/02/03CoverageWelcomeTime for actionAnother Life Saved.WorldwideUpdate 25/01/03Update 17/01/03Update 10/01/03More SupportCountry-wideMonaghan a 'HUB'Update 2/01/03Damning Evidence.WorldwideUpdate 30/12/02Death of Bronagh Mary Livingstone.
| Roscommon On The March issued 15-Aug-2010 | reply to | A big number turned out for the Protest organised by the Roscommon Hospital Action Group on Saturday, August 14th. There is obviously an anger there and a willingness to fight this to the end. Of course the HSE gave the usual reply - 'there are no plans at present to completely close Roscommon Hospital'. This will fool some of the people into believing that Roscommon Hospital is safe. How many times did HSE officials, Health Board officials and Government Ministers and TDs tell the people of Monaghan that they had no plans to close the hospital? How many times were the people of Monaghan promised extra consultants, staff and equipment? Where are those promises now? Perhaps the people of Roscommon should recall what happened to our promises.
For the past couple of years their hospital has been reprieved by the intercession of Michael Finneran, Fianna Fail TD for the area. He secured the hospital services at the time of the last General Election through Bertie and Mary. Now there is no way they can claim that the decision to close, downgrade or enhance any hospital is taken on any basis other than political expediency and when we apply that to our own situation we can only ask - where were/are our Fianna Fail representatives who have let us down in such a serious matter?
The people of Roscommon and other areas know now that the predictions of our chairman, Peadar McMahon, given in 2003, are coming true all over the country and many are now regretting that they did not join forces with Monaghan. We say it is never too late and on that note we would once again warn the people of Cavan that the fate of their Hospital will be determined soon.
Roscommon are giving serious consideration to the possibility of entering a Hospital Candidate in the next General Election. We would suggest that all areas under threat should do likewise as Independents could then hold the balance of power, which we think will be needed to persuade other parties to change the policy and restore the public health services in our public hospitals. Even then it might be too late as the Private Investors will have gained a stranglehold on our health services which will not be easily wrestled from them.Back to Top | | Goodbye Mallow issued 09-Aug-2010 | reply to | Having read the terms of reference for the investigation of Mallow Hospital it is clear to us that this is the method used to produce a report recommending the removal of A & E, Critical Care and emergency surgery from Mallow, thereby reducing it to a day hospital with clinics. This will be the outcome of this review. The terms of reference make it impossible for them to come to any other conclusion since this is a replica of Ennis. One solution which would be to staff the hospital appropriately and modernise the equipment and structure of the hospital, will not be a viable proposal since the hospital has been starved of resources over the past two decades. So 'lets remove the services as they are unsafe for patients'. We heard it here in Monaghan, in Ennis, in Nenagh, in Dundalk, in Navan and more to come. That is the way these unaccountable and faceless instruments of the Government work - the HSE and HIQA.
If we put this along with the revelations in HSE West we can see just what is driving this agenda - certainly not the patient but there are vested interests at work here and the public has been lulled into acceptance by the constant 'spin' of 'patient safety' and 'better services'. Before long we will discover the real consequences of current policy and we sholud be ashamed of the type of health servcies we are leaving for our children.Back to Top | | Frustrating issued 07-Aug-2010 | reply to | It is so frustrating to see what is happening and what could have been done had people believed the warning given by the Monaghan Alliance. How often have we foretold that the number of acute in-patient hospitals in Ireland would be reduced to 12. All the others would be as Monaghan is now or closed completely. We told Roscommon, Ennis, Nenagh, Ballinasloe, Wexford, Clonmel, Loughlinstown, Portlaoise (When Brian Cowen goes), Castlebar, Bantry, Mallow, Cavan, Sligo, Navan, Dundalk, etc etc and it is happening or has happened. Why did they not stand with us and stop it at an early stage? Why did they believe thier Fianna Fail TDs and Senators, why could they not see through the double speak of the HSE and Government, why did they not see through the constant spew of 'spin' from the highly paid spindoctors? Why did the media succumb to the spin and assist the Government and HSE to convince the public that they were implementing a good policy when it is now proving to be a total failure? Letterkenny can protest and march, Mallow can protest and march, Clonmel can protest and march, Wexford can protest and march and Cavan can keep its head down but the same fate is now in store for all - downgrading for all and complete closure for some.
There is only one thing to stop the wildfire - join together and have mass protests and make it clear that the people of Ireland do not agree with the policy being pursued by this Government in order to privatise the Health Services of this country because that is what is happening and the reason why it is happening. The planning permission for the new Beacon Hospital in Sandyford is a clear example, the planning for the new private Clinic for the North East, the private involvement in the setting up of Primary Care centres. Once the Private sector kills off the Public service then the prices will go through the roof and only those with money will be able to afford treatment while, for certain eligible citizens, the tax payer will pay the private fees. Is that what you want?Back to Top | | What Kind of Nation are we? issued 03-Aug-2010 | reply to | We must be one of the meekest nations on earth to put up with what is happening in this country. Different action would have ensued in other countries long ago. However we just sit back in armchairs or bar stools and criticise, complain, threaten what we would do, lambast, run down, talk endlessly, point the finger, claim to have the answers, castigate, condemn, slate, belittle, ridicule, mock, blame and all the while do nothing except expect others to do it. I refer particularly to our Health Service and the public service at that.
When they were taking services away from Monaghan they gave the world to believe that unless it was done immediately then many people would suffer because of the unsafe situation in Monaghan Hospital. It had to be done straight away for patient safety and to provide better services. We knew that this was totally false but the HSE set themselves up as the champion of the patient - making things better and safer and our leaders backed them up. How could meer mortal be right in the face of such opposition?
But we were right and now a report, carried out for the HSE themselves, shows that there are more patients suffering, that there are longer waiting lists, that there are more mistakes, that services have disimproved, that the old are not getting proper care, - all the things we already knew but were told we were wrong. This is the HSE who was so concerned for our safety and our 'unsafe services' that they have now succeeded in making them worse. This is the HSE, put in place by Mary Harney and led by Prof, Drumm, who keep telling us that the Health services have improved? This is the HSE, Minister and CEO who seem to be deaf to the real stories from patients, from doctors or from families as they pursue and chase after a dream which for us is a nightmare. Not only that but they are prepared to even make it worse by cutting more money and cutting more services and cutting more frontline staff and adding more names to the list of sufferers. They seem prepared to allow frontline and essential services be cut/curtailed/downgraded/centralised/privatised - all to achieve the impossible dream.
How sad it all is but is anyone prepared to do anything?Back to Top | | The inarticulate will carry the burden. issued 01-Aug-2010 | reply to | I quote from Michael Clifford in Sunday, August 1 Sunday Tribune: 'the capacity to wield power rather than the contribution one makes to society defines who prospers and who struggles' and 'Those who can shout loudest, who wield the greatest power will be least discommoded (in the forth coming cuts by Government). Others, who suffer in quiet desperation will have to take their medicine'.
That sums it up and is something that has been proven time and time again. The Old Age Pensioners proved that point. If enough people shout loud enough then the Government will listen - otherwise take your medicine.
Too often throughout our campaign for Monaghan Hospital we called on people to come out and they did in what was referred to as big numbers but when taken as a percentage of the numbers of people who were going to be discommoded these numbers were small. When it came to shouting the loudest - we were whispering. When it came to wielding power - we were sucking instead of blowing.
The administrators in the HSE have strong Unions to represent them, the Doctors and Consultants have strong Unions, the Nurses have strong Unions but Carers have no Union, Home Help has no Union, parents have no Union, bereaved families have no Union, and the patients have no Union. The Unions will shout for their members but who will shout for patients?
Since 2002 we have been urging people from other threatened areas to get behind the campaign and stop it before it found its own dynamo but no - they left it to others. Peadar McMahon addressed public meetings in Roscommon, Ballinasloe, Ennis, Nenagh, Clonmel, Portlaoise etc etc but was told he was wrong - that it would never happen to them. Is he still wrong? We have told the people of Cavan and we tell them again - you need to start shouting with Monaghan as you are going down too. The staff will tell you that the writing is on the wall. Three weeks ago Paudge Connolly in Monaghan called on our two Fianna Fail TDs to resign. We have heard not a squeak since, we heard none of the other Independent candidates back the call, we heard nothing from other voices who have been vociferous for the hospital in the past, we have heard nothing from Fine Gael or are they afraid that they will support something which could backfire on them if/when they get into power? Again if the shout was loud enough, if enough people joined the call - we may not have to take the medicine. Back to Top | | NHS and HSE issued 12-Jul-2010 | reply to | There is such a likeness between what is happening in the NHS in England and the HSE here in Ireland. There are various groups fighting the privatisation of the NHS and there should be a greater fight here in Ireland but the Government has been able to isolate each area and the result is that each area is fighting their own little battle and have little hope of success but if all were to come together then there would be a very strong lobby. We have tried through the HSAG to get other areas to come together and Wexford are now trying to do the same thing but not enough areas realise the seriousness of what is happening. Again we call on Cavan people to sit down and talk to us about the future because the future for Cavan is 'downgrading' and of that there is no doubt. Just speak off the record to members of Cavan staff and you will soon realise what is happening, under cloaks at the moment but when they are ready they will pounce on the services in Cavan and then the Cavan people will say - why did we not listen.
You see this country has been running on untruths and stealth. The public has been convinced by the Government spin doctors and accept what they are told without question. The sooner the questions are put and truthful answers received the better for our future.
However we give you here anextract from a document produced by the Campaigners in England and we should listen to them as we are on the same road but a few miles behind them. There are turn-offs that they missed but we would need to take. Who will lead us onto this new road?
Extract:
Responding to today's publication of the NHS white paper, the health pressure group, NHS Support Federation, accused the government of favouring commercial business over patients and cast doubt on plans to save money by restructuring.
Federation director Paul Evans said:
"Patient power will be overwhelmed by the influence of unaccountable companies. No matter what individual patients want, profit-motivated firms will now have a huge say in what care is available and much of the fairness, value and public trust in the traditional NHS will be lost."
"GP commissioning will create a spaghetti-like snarl of conflicting interests, where profit will inevitably come before patients. Paying companies to spend the huge NHS budget on other companies is a recipe for scandalous waste and the sort of shady deals that the public must be protected from."Back to Top | | Leadership in England? issued 06-Jul-2010 | reply to | Unite will work with KONP to defend services
Trade union, Unite, passed a resolution at its conference in early June naming KONP as one of the organisations it would work with to defend the welfare state and public services. The motion said (in part): "This conference believes that public services are a social necessity and should not be a vehicle for private profit. The fight for public provision of public services is fundamental to the industrial strategy of Unite, not just part of a political wish-list...
"[Unite will] build the biggest possible campaign in defence of public services, seeking to publicise and build this fight across Unite as a whole. Unite will play a leading role in organising a coalition of unions, public service campaigners (such as Defend Council Housing and Keep Our NHS Public) pensioners, disability, patients, unemployed and other such groups to take action to defend the Welfare State and public services . . . , while not limiting our own campaign where other organisations do not fully share our policies."
Back to Top | | Dear Dear Deer. issued 29-Jun-2010 | reply to | The real truth is being proven once again – patients don’t matter but deer do. The Greens and this Government hopes to put an end to deer hunting as it causes distress and stress to the deer. However removing acute health services from within reaching distance of humans is OK. Forcing sick people to travel to distant hospitals for treatment, forcing people to drive long distances to be with their loved ones who are ill, forcing patients to attend hospitals which are overflowing already, forcing patients to lie on trolleys in corridors while hospital beds lie idle in Monaghan, forcing patients in dire need of urgent treatment to suffer a long journey and risk dying on the way, forcing people to pay the extra costs involved in travelling to these distant hospitals, forcing the elderly and the young to go to strange environments with strange carers miles from home, forcing people to accept an advanced paramedic as an alternative to A & E and then doubling the area to be covered by that paramedic thus putting more people at risk, – these are all ‘better services’ and totally appropriate methods of providing health services according to this Government. Such treatment would not be acceptable for animals and the Greens would be first to say so.
This is the Green Party which gave assurances in writing to the people of Monaghan prior to the last election that they would ensure that services were not downgraded in Monaghan General Hospital. This is the Green Party which is so concerned about carbon footprints and carbon emissions yet make the people of Monaghan drive further and further to access acute health services in distant hospitals and at the same time put a carbon tax on fuel. This is a Green Party so concerned about the environment that they have extra ambulances driving about our roads. This is a Government which listened to experts yet allowed this country go into meltdown economically. This is a Government which will bail out banks, building societies and developers but not sick people. This is a Government that will make the poor poorer and the rich richer.
It will also make the sick sicker with the type of health policy they are pursuing. This is a Government being led astray by ‘health experts’ who will benefit from the new transformation programmes. This is a Government doing untold damage to our health services – damage which will take decades to rectify.
Yet the people of this country are more concerned about wild life and hunting, or so it seems from the amount of time that has been spent in the Dail, in the media, and at various meetings, discussing the issue of deer hunting. Meanwhile the health services continue to blunder along. Services are removed from Dundalk exposing the people of Carlingford and the Cooley peninsula to serious risk at times of emergency. Monaghan has already suffered that fate but we did not get the ‘better services’ that we were promised. Our excellent in-patient medical services are gone. Our saviour in times of heart attacks is gone and now our ‘advanced paramedic’ will in future be based at Castleblayney. This is to share the paramedic with North Louth. Now it has been with a prayer that only one call-out at a time has happened in Monaghan so far but sooner or later the paramedic will be needed in two places at one time but where will he/she go? Sooner or later the paramedic will be needed in Clara but he/she will have to travel from Castleblayney or North Louth. What hope for the Clara patient? Perhaps they will demand what Doc-on-call does – take the patient to meet the paramedic in Castleblayney.
And they try to tell us that this is a ‘better service’? They try to tell us that this is ‘safer for the patient’? They try to convince us that what they are doing is ‘good for us’? There have been too many lives lost and extra trauma and suffering for us to believe them any more – but then they have the support of the Minister and this Government and these people who are making these decisions and making others implement them are untouchable, lacking in accountability and have no mandate from the people of Ireland to do what they are doing. We need a Government which will take control of the affairs of this country and make decisions that will benefit people first and, when that’s done, we can then look at the animals.
Members of the Alliance, with party representatives from Monaghan County Council, met with Dr. James O’Reilly, Health spokesperson for Fine Gael on Monday night last. Earlier in the evening he had visited Monaghan General Hospital and met with administrative staff there. He was informed of all the enhanced services there – physiotherapy, Speech therapy, and a whole host of therapies but he was not impressed. He stated to us that acute medical services with an Acute Coronary Care Unit was essential for Monaghan and that Fine Gael, if in power, would work towards returning those services to Monaghan. However he did warn that it would get more difficult to do so as time went on and that two years hence it might be too late to be able to restore the services. We hope that this is party policy as we were given to understand from a previous interview by the Northern Standard with Enda Kenny that Fine Gael would not restore these services. Since the Alliance came into existence in 2002 we have been fed promise after promise by many people but we still lost our acute in-patient services. At this stage we cannot allow our hopes to be raised again unless we see practical evidence of a promise being fulfilled.
Back to Top | | Cuts and More Cuts issued 10-May-2010 | reply to | Money is the ruling king in this country and it matters not who must suffer and how serious that suffering is as long as someone somewhere sees it as a means of saving money to be spent on something else it will happen. It happened in Monaghan - purely to save money which has not happened. The present system is costing more money but it is also costing the patients of Monaghan and their families more money top pay for transport to and from a distant hospital. These costs have risen further recently with the introduction of the Carbon Tax on fuel. As we said before they make patients and families travel further to get hospital services and they clutter the roads with ambulances and doctors travelling about and this is all adding to the carbon emissions which they are trying to cut down on and are charging us extra because we are doing the journeys. What a contradiction.
Beds being closed in hospitals like Beaumont which needs more beds, not less, and many other areas the same thing happening and we are only at month 5 of the current budget year. wait till we get to October!!
Now the European Working Time Directive is kicking in and there are not enough Junior doctors to keep services going. They knew about this eight years ago and did nothing about it except change the Consultant Contract but that was not sufficient to make up for the loss of Junior Doctors. Now the scarcity of doctors is a good way of closing services and the blame can be pointed elsewhere than at the Minister or Government.
The scarcity of money is the other excuse for closing services and hospitals and the A & Es are in line for the chop. Loughlinstown is going to close within weeks and more to follow. If any hospital or group asks the HSE if their local hospital is in danger the answer they get is - there are no plans to close services in your hospital. That means - we are going to do it in a couple of weeks and then try to draw up a plan. That seems to be the way they work. How many times were we told that 'there are no plans to downgrade Monaghan Hospital' yet look what happened.
Every hospital area needs a Michael Finneran. He has saved Roscommon Hospital. They are afraid to touch it because he made a pact with Mary Harney and his party. Oh that we could have solid representation to act likewise and put our case like Michael did. He need not worry about a General Election - he will top the polls for what he has done for his area.
The other hospitals are playing little games quietly to save their own skin. In 2002/2003 we had representation from the Group to Save Loughlinstown Hospital as part of the National Group - HSAG. They disappeared sometime around 2005 on a promise that their hospital would never be closed and they believed what they were promised. We told them of the promises made by Minister Michael Martin and Bertie Ahern and our own TDs but they could not be convinced that promises change direction just like the Volcanic Ash in our skies and, when it comes in your direction, all closes down. Clonmel and Ballinasloe have gone so guiet - why we ask? Have they been promised too? Then all this protesting is old news and media need something fresh and dramatic to catch the readers eye and the spindoctors continue to issue their blurb and the media prints.
Back to Top | | The ‘HSE and YOU’ and me. issued 10-May-2010 | reply to | In last week’s edition of the Northern Standard there was an article regarding the public consultation document issued by the HSE ‘seeking the input from people from all parts of society as part of a public consultation for the development of a ‘Patient Charter’ for the health services’. It is entitled – ‘HSE and You’ and I asked myself – who is this ‘YOU’ they are referring to. However I decided to read on.
It claims – ‘this public consultation is an opportunity to have your views heard and to contribute to a new Patient Charter that will define what service users can expect from the HSE and what the HSE can expect from service users’. Now when did the HSE ever ask me what I thought of anything to do with the health services before, though I did offer my opinion regularly. However, and more importantly, they have never before listened to my views and have totally ignored my expectations and the expectations of the majority of the people of Monaghan. Not only that but they continue to ignore our expectations and those of the people from many other areas of this country, like Clonmel, Ballinasloe, Loughlinstown, Mallow, Bantry, and many others. The one exception is Roscommon where they did a U-Turn after listening to the representations made by the now Minister, Michael Finneran. No one has challenged the HSE or the Government on yielding to Minister Finneran and ignoring the rest of us.
The article goes on to tell us that this document ‘aims to inform and empower individuals, families and communities to actively look after their own health and to influence quality care in Ireland’. Yes of course they want us to look after our own health. They want to close down hospitals and make them a thing of the past. Let families treat their own sick at home and learn how to carry out the basic life saving procedures and if the patient dies – well everyone dies eventually. They introduce another aspect of current policy – ‘arrangements for a partnership of care between everyone involved in healthcare – patients, families, carers, and healthcare providers’. Notice that the healthcare providers are mentioned last. That is in keeping with policy that, in the vast majority of cases, patients should be treated at home and that family must accept responsibility.
They tell us that this document has been developed by the HSE, the Department of H and C; in consultation with patient advocates. We have wondered before where these patient advocates come from as we never seem to be able to find out who was consulted.
The article names nine key areas of responsibility and the first is ‘access’ – something they removed from the people of Monaghan. If any of you decide to fill in this questionnaire then it is your opportunity to let them know that they have already removed your access to hospital care without any consultation – in fact against the wishes of the people of Monaghan as demonstrated ostensibly on numerous occasions.
I could respond to all other eight areas but it would be futile as the HSE are masters at ambiguity but I will point to two more – ‘respect’ and ‘being heard’. The wishes of the people of Monaghan were not heard or respected and that makes this document suspect as I have no trust that anything that might be written in this questionnaire will be respected and listened to. The seven areas for patients are similar but then who is listening?
The HSE Director of Advocacy tells us in the article that much consultation from many quarters has already been incorporated into the document and now the public at large will have an opportunity to make their contribution and have a say in how health services are delivered. I am convinced that the public contribution will be overwhelmed by the contribution of ‘experts’ as these ‘experts’ have framed policy in health during the past decade or more.
Not ever person will have their say here, as you have to be able to go on-line to a web site to answer the questions or you can go on-line and print out the questionnaire and then fill it in and post it back to the HSE. Surely that is removing the possibility of contributing from a huge number of people? Not everyone has a computer, not everyone is computer literate, not everyone is on-line, not everyone has the confidence to read and answer the type of questions contained in this document, but then not everyone has equal access to health care either.
Peadar McMahon
Back to Top | | Apply this to the Irish scene. Frightening? issued 31-Mar-2010 | reply to | Why we need to stop NHS commercialisation
THE EVIDENCE
The quality and safety of private treatment centres is in doubt
The BBC’s Panorama programme uncovered shocking evidence of three men who died after gall
bladder surgery and another death in North West England, all in private sector treatment centres.
In one tragic case Dr John Hubley died after surgery because the private Eccleshill treatment
centre in Bradford did not keep enough blood on site. In a damning comment by Michael Parker,
President of the Association of Leparoscopic surgeons, he said would not want to be treated in a
private treatment centre because of the lack of emergency facilities. The Care Quality Commission
is now carrying out safety checks at all private treatment centres.
People having hip replacements at private treatment centres are up to 20 times more likely to
need painful and expensive repair work. Many operations are having to be redone in NHS
hospitals, at great cost and with serious staffing implications for the health service. A study by
orthopaedic surgeons in Cardiff found that of 113 hip operations on patients sent from their NHS
trust to Weston-super-Mare NHS Treatment Centre between 2004 and 2006, two thirds showed
clear evidence of poor surgical technique, such as poor cementing of the hip.
http://www.timesonline.co.uk/tol/life_and_style/health/article6843637.ece
NHS market creates huge waste as funding is frozen
PFI is draining billions from frontline health services. Over one hundred hospital trusts are
stuck with huge repayments after using private companies to build operate and finance their
new hospitals. From 2011 to 2014 – their PFI costs will reach £4.18 billion, almost £1 billion more
than current levels, according to documents sent from the Department of Health to the Treasury.
The steep increases come as the NHS prepares for its annual budget to be frozen, meaning cuts in
real terms as PFI and other costs rise. As a result, hospitals have been ordered by Sir David
Nicholson, the NHS chief executive, to make "efficiency savings" of at least £15 billion over the
same period.
Private sector treatment centres are paid above the odds. The Department of Health admitted
that across the first 20 private treatment centres the cost of work carried out is 12% more
expensive than doing the same work in the NHS.
www.publications.parliament.uk/pa/cm200708/cmselect/cmhealth/1190/1190w118.htm
...then pledge to stop NHS commercialisation
Research by Prof Allyson Pollock of Edinburgh University estimates that around £927m of the
£1.5billion spent on contracts with private treatment centres in England could have been paid out
for operations that did not take place, she said: "This is a really big issue. If the private sector is not
doing the work this means the NHS gets a triple whammy - less money, more patients and dealing
with complications from the private”
http://www.bmj.com/content/vol338/issue7702/press_release.dtl
PCT spending on management consultants has more than tripled in the past two years as NHS
chiefs throw millions at the private sector, a Pulse investigation has revealed. Each
PCT is now spending an average of £1.217m on external companies. The cost of legal and
professional fees has also risen dramatically bringing the total paid to external companies to an
average of £1.568m per PCT. The revelation comes a month after PCTs were ordered to cut
referrals and follow-up outpatient appointments to save money.’ Pulse, 20th May 2009
financial goals are coming before patient care
The priority of NHS managers should be the care of patients, but incentives and rules within the
healthcare market place financial success as a competing objective. This had a direct influence of
over events at Mid Staffordshire hospital where the death rate ballooned unnoticed by managers,
who were according to a Health Commission report distracted by their financial goals.
An Investigation into Mid Staffordshire NHS Foundation Trust by the Health Care Commission
March 2009
A number of studies have shown that competition in health care appears to be associated with
lower quality (higher death rates) and that on balance the relationship between competition and
quality of care appears to be negative. Commentators suggest that competition in health care too
often works to the detriment of improving patient care with restrictions to the access of care,
gaming, theshifting of costs on to fellow providers and the stifling of innovation. (Propper, C,.
Burgess, B., Green, K. (2002) Does Competition Between Hospitals Improve the Quality of Care?
Hospital Death Rates and the NHS Internal Market, unpublished mimeo, University of Bristol, CEPR
& CMPO)
Increasing patient “choice” will not improve health service fairer
Introducing choice to health care is a key aim for the current government and one of the reason
behind the market reforms. But the evidence suggests that choice is likely to increase costs, is
probably more likely to increase than decrease inequalities, and may or may not increase
efficiency (Fotaki et al. What benefits will choice bring to patients? Literature review and
assessment of implications J Health Serv Res Policy Vol 13 No 3 July 2008)
NHS staff disagree with treating NHS patients in the private sector
Eight out of ten doctors are concerned about private companies profiting from the NHS, the most
recent poll of NHS staff shows . www.lookafterournhs.org. Many NHS staff organisations oppose
NHS commercialisation and actively campaign against it; including UNISON, UNITE, BMA, RCN,
GMB, Royal College of Midwives, Society of Chiropodists and Podiatrists, Community and District
Nursing Association, Chartered Society of Physiotherapy, Society of Radiographers, British Dietetic
Association, Hospital Consultants & Specialists AssociationBack to Top | | Frontline weakness. issued 30-Mar-2010 | reply to | We were very disappointed with the Frontline programme of Monday night last as far as Monaghan is concerned. It was not what we expected and was not a forum to debate the issues involved. The fact that the programme was so well scripted beforehand and certain people 'miked' (fitted with a microphone)giving them access to speak at any time. The rest had to keep a hand upright and/or try to shout loud enough to be given an overhead microphone.
Health in Ireland is a massive topic and it would take weeks to discuss even a samll number of the issues, However we were given to understand that thisprogramme was specifically about 'hospital care' but much time was spent talking about Primary care and GPs. Of course these are connected to hospital care but separate to the topic of the night and would deserve a night on their own.
We also got the distinct impression that the producers of the show were more interested in getting emotional stories from individuals than getting involved in serious debate. There were so many taken in for contributions that it was always going to be a disjointed journey through the maze of problems facing us in the Health services.
The programme did give us a clear picture that our Health Service is in serious crisis. The speakers from the HSE and the Minister herself showed that they are totally removed from the suffering and trauma being suffered by people all over the country. They follow blindly, it seems, and are involved in the implementation of a policy that is causing untold suffering to patients, that is heading for even greater problems, and that has not worked in other countries. It is more expensive, more inefficient, and less safe than what we had yet they are determined to impose this policy on the people of this country. They do this by any means necessary and their favourite is 'double-speak'. They try to disguise and confuse the public by the type of language they use. Typical examples - they claim 'we are not going to close Monaghan Hospital' - but while saying that they are taking the acute in-patient and emergency services away. For Monaghan you can read any of the 40 small hospitals in Ireland that have been designated for closure/downgrading/reconfiguring/transforming/enhancing/changing. Another - when the HSE issued a statement on Saturday last re. Portiuncla in BVallinasloe, they stated that 'no services would be taken from Ballinasloe' and then added quietly 'this year'. They hoped that people would not hear those last two words. Another - they say that 'no decisions have been made in relation to services in ??? hospital but that a review of services is on-going'. This means that they intend to take acute services away but that they have hired an 'Independent Group' to say that it should be done and then they will do it. That is the type of language being used again during this programme and the amazing thing is that they could say it with such a convincing manner that you would almost think they were compassionate. A lot of people in the audience did not feel the compassion.
The Minister's performance was typical of her. She sat like a robot which was programmed to spew out the same old answers and try to divert attention away from the serious matter needing attention. Does she really expect some poor patient lying on a trolley in pain, or a relative standing beside that patient, to forget their problems and think of the positive, the advances being made, the good things about our health service? It is small comfort for a patient being bumped around in a speeding ambulance for an hour while suffering a heart atack or bleeding profusely to say to themselves - 'not to worry - sure our health service is now providing a better service for breast cancer'. This Minister and her HSE cohorts are really out of touch with reality and so too are the Government TDs in Greens and Fianna Fail for sitting back supporting this disastrous policy. Lets hope that they nor their families feel the problems in real life.Back to Top | | Clonmel issued 27-Mar-2010 | reply to | Clonmel is learning a lesson the hard way. Why did the people of Clonmel not listen to Peadar McMahon when he spoke at a public meeting there in Nov 2008. Here is what he had to say regarding the future of Clonmel: 'Future for Clonmel: So what of the future of your hospital in Clonmel. For the moment it is safe but how long is a moment? If the Government succeeds in closing Monaghan, they will move on to Nenagh, Ennis, Roscommon, Mallow, Loughlinstown, Bantry, Ballinasloe, Navan, - about 40 acute hospitals in all and in there will be Clonmel. The sad thing is, and it happened in Monaghan, people did not believe that it would happen – that the Government would take away acute services from Monaghan, that the people would be put at such risk, that there would be an acceptable mortality rate for any area, that our communities are being devalued and isolated, but it is happening as we speak. We were assured by our Government representatives that they would not allow it to happen but they are powerless to do anything about it. If Clonmel wants to hold on to an acute hospital they must help to stop the erosion now in Monaghan or it will be too late to save your own later.' They are now complaining that other hospitals do not see the danger but unfortunately they did not see the danger when it was spelt out for them in 2008.
Minister Harney is meeting the committee on Wednesday - we ask - why has she continually refused to meet the Monaghan Alliance? Who is so important around South Tipperary?Back to Top | | Chickens arrive issued 09-Feb-2010 | reply to | Chickens are coming home to roost. Almost two years ago we forecast that capital had been earmarked for expenditure at Cavan General Hospital but that it would not be announced until after the dust settled from the removal of acute services from Monaghan General Hospital. Things were going to kick into gear last Autumn but it was felt that the injury caused by the removal of acute care was still too raw and the project was put on hold. However it now seems as if the dust has settled. The Alliance has been silenced and the public representatives will mildly write a letter now and again but the capital expenditure can be announced now without fear of questions being asked. Not that we object to improvements to hospitals, where ever they are but we still object to the fact that Monaghan patients have to languish in Cavan when they could and should be treated in Monaghan. We are also somewhat puzzled by the fact that work is expected to begin within weeks, which would seem to us that the planning and design and all the other preparation work, which normally takes months if not years, has already been done, and would indicate that all this was going on but that the announcement was withheld until 'the time was right'
Prof. Drumm made a very contradictory statement recently in that he explained that the HSE is trying to treat as many patients as possible as close to home as possible. Is that why he closed Monaghan General Hospital and forced Monaghan patients to go to Cavan for the slightest problem? Is that why there are so few Primary care teams in North Monaghan? Is that why Community Care has been neglected and homehelp has been cut? Is that why a GP would refuse to do a house call? Is that why North Monaghan Patients have to travel to Castleblayney to see the Doc-on-call and then travel on to Cavan for further tests? Is that why the Greens forced the Government to increase the price of fuel as a Carbon Tax (Joke) so that it will cost the people of Monaghan more to get treatment? Is that why he gets so well paid and a bonus thrown in for good value? They continue to fool the people of Ireland and we just accept it. Back to Top | | Suggestion. issued 05-Feb-2010 | reply to | The Monaghan County Councillors have decided, it is reported, to replace the policy of holding protests during the visit of a Minister with one of handing in a letter to the Minister in question. Unfortunately we do not see the point as many letters on many topics have been given to Ministers and that is the end of it.
It was reported that at the Council meeting one councillor stated that things should be progressed by 'dialogue'. Unfortunately again the Ministers are not in 'dialogue mood' as they have constantly refused to sit down to discuss the hospital issue. As far as the Alliance is concerned we have never been able to get a meeting with Minister Harney and we constantly ask - WHY?.
But taking 'dialogue' as a way forward we now suggest to the County Mayor that a Forum be organised with urgency to which the relevant stakeholders be invited to plan a policy for the future. Councillors should be there as they, their families and the people they represent are at risk; the GPs should be represented as they are at risk in many ways and have to make major decisions effecting people's lives; the sporting community should be there as they are organising major gatherings of people and may not have proper medical cover because of the distance to the nearest emergency hospital; the Chamber of Commerce should be there as their members are suffering enough from the economic crisis without the added problems of fear by investors and residents to set up in an area without proper emergency cover; the farming community should be there as they very often need emergency services to deal with farm accidents where speed of hospital treatment is of the essence; school principals should be there as the responsibility of care for their pupils demands their interest; the Church leaders should be there as they cannot separate the spiritual wellbeing of the flock from the physical needs and especially in emergency, and then there are many other organisations e.g. social groupings, voluntary workers in health needs, support groups etc etc and they too should be there to represent the people they are involved with. Lets get a common strategy and agreed method of trying to get the Government to listen to the people - to at least sit down for dialogue.
Can we put forward an alternative to the removal of acute services from Monaghan? Yes and there are many examples of how this can be done and in a safe, economic and efficient manner. One of the latest reported is the link up between Naas General Hospital, Tallaght and Mullingar, where the one Stroke Specialist only is needed on duty to cover the three hospitals to manage stroke patients who arrive at any of the three locations. This system could be used to link an A & E in Monaghan with Cavan and a major hospital in Dublin utilising the equipment and saving on the number of emergency specialists needed on duty at any time. Would the Government agree to a pilot scheme of this nature in Monaghan with a view to rolling it out for the other hospitals where the only solution they can find is to close them down? Would the people of Monaghan, despite the hard times currently, be willing to raise capital to assist the Government in the setting up of this pilot? Many things are possible if people sit down with open minds and try to come to an agreed solution. To date that has never happened in the North East in so far as the provision of health services is concerned. It has always been a case of 'we will tell you what we are going to do and the sooner you agree the better for yourself as we will do it anyhow'. Our method could be a new beginning for health reforms and a new way forward for Government - if only!Back to Top | | Question? issued 05-Feb-2010 | reply to | Due to a story which we have been given, the full facts of which we have yet to establish, we have very serious questions to ask.
The story - a person gets pain in the chest and upper body. Fearing a heart attack an ambulance is called. A paramedic and an ambulance arrives. The Paramedics questions, talks to, examines and tests the patient but decides that there is no heart problem but that the patient should be taken to hospital nonetheless. On arrival it is found that the patient is suffering a heart attack, sufficient to do irrepairable damage, and gets the thrombolysis immediately. The patient is then transferred to a Dublin hospital for major surgery and is now doing well. However the damage has been done and the patient has been told that they were very lucky to survive the event.
The question - could this be regarded as a misdiagnosis? Can it be called a medical adverse event? Is the paramedics mistake logged? Is any action taken in such circumstances? Can anyone be held responsible if it had been fatal? Would anyone have been told that a mistake had been made if it had been fatal? Are mistakes being made? How many have been logged? What is the HSE policy in relation to such scenarios?
There are chilling thoughts arising here.Back to Top | | Cross Border Hospital Services issued 05-Feb-2010 | reply to | Meetings have been taking place all along the border and on both sides to look at the provision of Hospital Services on a cross border basis. These have been very interesting and some of the work already produced by the Cross Broder Studies Group in Armagh has been very productive and of definite interest to all Monaghan people who want proper emergency services for the people here. The current research programme underway by the group is wide ranging and will take time but the outcome might have significant impact on the future provision of services in Monaghan, East Fermanagh, south Tyrone and west Armagh.
We are not sure just how widely these meetings have been publicised but the attendance was somewhat disappointing and the absence of local leaders would make one ponder as to their motives.Back to Top | | Abandoned !!?? issued 03-Feb-2010 | reply to | The actions of some public representatives during the entire campaign to save Monaghan General Hospital has been a puzzle to many of us in the Alliance. It was difficult at times to ascertain which side they were on and what they were actually saying. Very often what they didn't say or do spoke loudest.
Monaghan County Council passed a resolution, as far as we can understand it, not once but a couple of times, to hold a protest when any Government Minister visited the county and refused to meet with the council to discuss the removal of services from Monaghan General Hospital. Now in our scheme of things - when a committee passes a resolution the committee accept the ruling of the majority. However with Monaghan County Council it appears that only those who vote in favour of a motion must comply with its contents. We cannot remember one protest at a Minister's visit which was attended by all members of the Council? People just abstained themselves.
Then through secrecy and backdoor arrivals, it was impossible for protests to be organised in time and so from the very beginning, thanks to the support of local intrigue, this policy had little hope of success. Once again the Hospital was a political football and was played out as a party political issue rather than the serious issue it is for the people of Monaghan.
This past week, once again, the policy came up for discussion at a Council meeting. We hear that the vote ended ten all with the Mayor casting the deciding vote to abandon the policy. Now we know that TDs from various areas of this country would wish that those objecting to the so called hospital reforms (centralisation and privatisation) would just go away and shrivel up. The two main parties of Fianna Fail and Fine Gael, joined by the lone ranger Minister and Tonto Greens have teamed up to defeat this rabble and this has now filtered down to local level. Mr Kenny did make it clear that Fine Gael would not restore the services were they to get into Government. Of course we knew that and it was why they refused to use the words 'retain and/or restore services' in their promises to the people of Monaghan before and since the last Election. Hughie McElvaney seems to be the only one on that side of the house who has stood firm for the people against this injustice.
However we must accept that since the Council as a whole was not going to adhere to decisions made at their meetings and since each party could decide for themselves what to support and what not to support, it was useless to continue with the Protest policy. BUT and this is a BIG BUT - what are they going to do instead. They now seem to have no policy in relation to the hospital and seem to have abandoned the people of Monaghan to whatever might happen to them in an emergency. We are sure that those who have suffered already because of the need to travel to Cavan, Drogheda or Dublin will remember who abandoned them and who indicated that it was OK for them to have to suffer that. When someone dies in that Ambulance on the way to that distant hospital we are sure the relatives will remember who did what to prevent it happening.
So Councillors - we are calling on you to come up with an agreed policy to protest at the removal of acute services from your local hospital and to demand the restoration of same immediately. This should be an urgent issue for all of you since you are our representatives. Do it now before it is too late.Back to Top | | Letter re: Bed Closures et al issued 29-Jan-2010 | reply to | HSE spokespeople seem to equate low hospital admission rates with "quality effective service". This is delusional. Fewer people, an estimated 53,000, will receive care they need if admissions to acute public hospitals are cut as planned. Better co-ordination will not solve problems of scarcity. It is absurd to talk of "timely access" to "clinical decision-makers" when doctors are in such short supply. Ireland's per-head ratio of hospital specialists is extremely low, as is the country's complement of family doctors. Primary care is a mirage. Of the planned 200 primary care centres, only 50 will be operational by 2011. Of the 530 primary 'teams' promised, only 110 were in place by May 2009. These were denounced by leading GPs as "virtual". Even if these cyberspace teams had an earthly existence, "moving" care from hospital to the community is a vast and untried experiment. Central to this is the culling of 2,000 acute public beds -- in a country with one of the lowest bed-to-head ratios in the developed world.
Although there is little evidence they work, US models of chronic disease management are now being implemented in Ireland under HSE's so-called "transformation programme". A new internal market is being created under the banner of "integrated" care. Public hospitals may lose significant funding unless they can "compete". Chronic diseases, such as cancer and diabetes, are being brought to market -- patients will effectively be sold in batches to the lowest bidder. The new disease contracts will "integrate" primary, hospital and continuing care, while destabilising and disintegrating public hospitals. Private hospitals in receipt of public monies hitherto reserved for public institutions will be the only winners.
The HSE's spin on privatisation, aka 'modernisation', badly needs exposing; when will the media begin to question it?
Marie O'Connor
Press and Public Relations Officer Health Services Action Group
Author: 'EMERGENCY: Irish hospitals in chaos'
086 81 80 254
Back to Top | | Here Again ... issued 20-Jan-2010 | reply to | Just in case someone might think we had gone away completely we decided to make a few comments on our current Health service.
1. As far as the people of Monaghan are concerned it is certainly not a better service we have been left with. So many have now experienced the extra trauma, inconvenience and distress of having to use the facilities in Cavan or Drogheda. Many have told us that if they had known they would have been more militant in their protests. Our answer - we told you so but you did not listen - however you may get another opportunity soon as pressure is growing to get the campaign going again. Would we get support? - we certainly would from those who have experienced the problems since Monaghan 'closed'. However Monaghan people have been lucky so far. There have been no Benny McCullough type deaths YET but sooner or later it is going to happen. Indeed the HSE was lucky during the freezing days recently that there were no real emergencies in North Monaghan. Of course if a needless death had occurred they would have blamed the weather but that would not be accepted. However the point is - had a big emergency arose it would have taken much longer for the ambulance and/or paramedic to arrive at the scene and then to get the patient to Cavan or Drogheda. The extra miles to those hospitals would have been even more crucial in those circumstances. As it was, many had a terrible experience of getting there to visit a family member and in one case they were lucky not to end up as patients themselves.
2. Monaghan Treatment Rooom has been a busy place recently and many were delighted to have it so close to them over the Christmas period to deal with the injuries received from falling on ice and other emergencies that arose. More and more people are beginning to realise the benefits that are there for patients and hopefully more and more people will make it their first point of call.
3. Throughout this campaign we have always claimed that there are alternative methods of providing emergency services to the people in isolated areas without demanding that they travel huge distances to get hospital treatment. We have always been ignored. However what has now been set up between, Naas General Hospital, Tallaght Hospital and Mullingar Hospital shows what can be done. They have a telemedicine system, whereby a Stroke Specialist is on duty at all times in one of the hospitals. When a patient arives in any of the hospitals the doctor there can link up with the specialist who can see the patient, talk to the patient, examine the scan and x-rays, talk to the doctor, make a diagnosis, decide on treatment and administer treatment using a robot remotely. Three hospitals now have an excellent service and the patient did not have to travel for tests, for scans, for treatment or to be seen by a specialist. This cuts down on the delay in getting treatment, improves the outcome for the patient, is more patient and family centred and friendly, ensures the sustainability of the hospital and will likely work out much cheaper. We asked for this system to be piloted in Monaghan, linked to one of the major centres and to Cavan and/or Drogheda. Why did they not agree? - because they had decided to close Monaghan and that had to happen for them to save face and earn their bonuses.
4. Re. Replacement for Prof. Drumm. There is much speculation about who is going to take over from Prof Drumm when his contract comes to an end this year. The Department is in the process of head-hunting a replacement. Prof Keane of 'Cancer Centres of Excellence' fame was reported a few weeks ago as stating that his family were back in Canada and that he had done his job here and was going back to BC. Now it is reported that he has had discussions with 'some people' and that he has a great interest in staying in Ireland as his family is here. Did they all 'flit' over here? When they heard of the huge money to be made in Ireland sure it would be a big attraction?
However as far as we are concerned he is not the man for the job. We are after enduring a top medical person in charge and we know how that has helped us. How many times have we heard experts say that top medical people do not make top administrators and that is what we need to run an organisation as disorganised and unyieldy as the HSE. The person needs to have the ability to manage big business and people but there is an added dimension to the HSE - the person must take people into consideration and keep the patient and people at the centre of the decision making and not just balance the books for the sake of meeting financial targets. Gerry Robinson has shown that this can be done. He is not interested in the job but there are bound to be others like him out there. Prof Keane has succeeded in centralising the Cancer Services and is claiming victory. It could be a shallow victory for some. However when improved figures for better outcomes are shown we must take other changes into consideration other than the centralising of the services. For example, and as we have said many times before, early detection and improved methods of treatment will give us the best results, and diagnosis and treatment closer to home plays a big part in outcomes. This again could be achieved using the same telemedicine methods described above for Stroke. Come on - this is the age of technology - lets use it to benefit mankind. Back to Top | | Trolley Figures issued 13-Nov-2009 | reply to | We came across this article in the Irish Medical Times, which was dealing with the problems in emergency departments, mainly in Dublin. However Mr Fergal Hickey, President of the Irish Association for Emergency Medicine, is quoted by the IMT and the following is printed: 'A pilot project at five sites aims to improve patient flow from EDs to wards. “We intend to ‘board out’ where possible the patients who are finished their treatment,” the HSE plan states. Many hospitals use a variety of methods to downplay the real extent of the ED overcrowding problem and the true position may even be worse that the figures suggest, Mr Hickey believes. “For example, in some hospitals if you come into the ED with palpitations and a decision is made to put you on cardiac telemetry, you are regarded as having left the ED, even though you are physically there,” Mr Hickey said'.
Now that is all very interesting when one considers the difference in figures quoted by the HSE and the INO. Cavan, where many Monaghan patients languish on trolleys, have big numbers on trolleys according to INO but very few according to HSE. The HSE deny that they doctor the figures by putting people into rooms where they are not counted and deny that they omit people waiting on chairs or use any method to decrease the real numbers on trolleys.
Does this make things any clearer? Back to Top | | Crocodile Tears. issued 13-Nov-2009 | reply to | Accroding to the Irish Examiner newspaper of today, Nov 13th John Gormley has sent a very angry letter to Minister for Health, Mary Harney, complaining to her and advising her not to remove acute services from Louth Hospital in Dundalk. One of the main reasons it seems for him to send this letter is that the removal of these services will be detrimental to the town because it is a Gateway town in the National Spatial Strategy plan.
Now Monaghan was designated as a HUB town in the Spatial Strategy Plan. John Gormley put his name, along with Trevior Sergant, on a document promisiing the people of Monaghan that they would resist the removal of acute services from Monaghan General Hospital if they became part of Government. They were taken on board by Fianna Fail but in order to do so they very quickly forgot the promise to the people of Monaghan along with many other promises.
It is rather puzzling now to hear that he is angry about Dundalk while he cared nothing for Monaghan. Monaghan is supposed to be a HUB town and the removal of Hospital services will be detrimental to the future of Monaghan and its environs. That obviously is no concern of his but what is the attraction of Dundalk? Is there hope of a few votes for the Greens? Is it just more empty noises as he did in Monaghan? Are these crocodile tears? He certainly does not fool the people of Monaghan.Back to Top | | Volunteers... issued 12-Nov-2009 | reply to | Dont get the wrong idea here as we are totally in favour of volunteering and we have demonstrated our willingness to volunteer over the years. Volunteering has been a major part of the Irish spirit and way of life throughout the ages and if that were to end it would lower the quality of life for the people of this country.
However we have a major problem with volunteering when it is forced upon us and when it is expected of us. This Government has used 'volunteering' to ensure the provision of services, which should be provided or funded by central Government.
We now have volunteer Gardai, we have volunteer carers, we have volunteer teachers, we have volunteer community workers, and we have volunteer fundraisers.
The later group are really useful to the Government. Again while we support and praise the work being done by the huge number of groups around the country, who raise millions for good causes and who provide the funding for basic services in health, education and social living. We also praise those involved in Community Development Projects as this brings many benefits to the community, beyond the actual project itself.
However when the Government decides to build a new central hospital for children and expects the public to raise almost €400 million to do so - we have a problem. When the Government decides to remove A & E services from hospitals and then expects the public to raise huge sums of money to pay for replacement emergency services - we have a problem. When the Government decides to remove A & E services from hospitals and the public are expected to provide advanced paramedic services voluntarily - we have a problem. When the Government suggests that an air ambulance would be a good replacement for ground ambulances in an emergency but expects the public to supply and maintain this helicopter - we have a problem. When this Government decides, to please vested interests, to centralise cancer services in eight locations, (Not Centres of Excellence as promised), and the public are expected to raise the money to supply transport for patients to get to these locations - we have a problem. When the Government expects the public to become voluntary 'taxi-service' to transport patients to and from hospitals - we have a problem. When all of this is expected then it is no longer a voluntary service and is simply letting the Government off the hook. After all, the 'expenses' claimed and paid to our Government members shows a bad example of 'volunteering'. The Irish Cancer Society are now assisting the Government in that they are going to roll out the volunteer driver system all over the country. We have had it in operation in Monaghan for possibly seven years and it has become an expected system by Government. We just wonder what First-Aid training these drivers will get, what driving test will they complete to qualify, what have the insurance companies got to say about it, who will pay the compensation as a result of an accident, who will pay for the carbon footprints? There are many questions that need answers but we think they will be clouded over and for that - we have a problem.Back to Top | | Double Standards ?? issued 30-Oct-2009 | reply to | Surely it is hypocritical of this Government, and especially the Green section of it, to try to persuade the people of Ireland to cut down on their use of fossil fuels in order to reduce our carbon emissions by 10% . They also intend to persuade us by charging us a Carbon Tax, which they hope will be introduced with the coming Budget in a few weeks time.
Lets just look at all this in a rational manner.
Firstly, what are they going to do with the money they collect from us – this extra tax burden? Petrol, diesel and home heating oil and gas will have the extra charge for us to pay. How will it be used to cut down on global warming or will it just go into the coffers to help pay for salaries and expenses of TDs, Senators and Civil Servants?
Secondly, let’s assume that they succeed in forcing a 10% reduction (and they will have to force it by severe penalties and the like) – Ireland’s population is 0.075% of the world’s total. Now 10% for such a minuscule part of global population will be so insignificant as to register little on a global scale. However we are told that other countries will follow our example (the pebble being thrown into the pond and the tiny ripple etc) – can anyone give us an example where other countries have followed Ireland’s example or where this country has been able to influence the internal decisions of other powers? What chance have we of influencing the policy in China, Japan, USA, Russia or any such major industrial power?
Thirdly, it is fine for John Gormley and his likes to tell us to leave the car at home and cycle or take public transport to work but that is a ridiculous suggestion for rural Ireland, where public transport is non-existent and while he, and his cronies in Government, want to put an end to the rural transport scheme. It is also an insult to the majority of Irish people to be told to only take one foreign holiday or to holiday at home in Ireland. The majority cannot afford to take holidays at all thanks to the incompetence of this Government in allowing our economy disintegrate and sink into the mire. Have they lost all concept of life for the ordinary citizen at this stage?
Fourthly, and most telling of all – John Gormley, along with Trevor Sargent, gave the people of Monaghan an undertaking that they would support our campaign for the retention of services at Monaghan General Hospital. As soon as they went into Government, Monaghan Hospital and most of their other pledges went out the window on the new mercs. Now the double standards come in – the people of Monaghan must now travel to distant hospitals to access treatment – are we to travel on bicycles? Are we to share cars with other patients? Are we to share cars when we are going to visit loved ones? Will he cut down on the number of ambulances travelling our roads? Will each ambulance now take two or more patients? Will new electric ambulances be delivered? What produces the electricity to power these engines? The sad thing is that with the extra charges, the cost of taxis will go up and the cost of everyday items will increase because of extra delivery costs and people will not be able to afford the travel costs to these hospitals. But what about the extra carbon emissions being caused by all the extra travel by patients, their families, the doctors, the nurses and the ambulances? Surely this is increasing the problem and this is being forced on us by the same person who wants us to reduce the emissions. There is a conflict here and it is obvious that the Government, including the Greens, make the rules to suit themselves. It is a clear example of double standards or worse.
Back to Top | | Transparency?? issued 30-Oct-2009 | reply to | Two things happened this week that made us question the transparency of people and the efforts some will go to in order to hide the truth. These are not new to us but somehow the two were highlighted this week and we had to ask questions.
The first is something which has been a cause of confusion for so many people including the national media but no one seems interested enough to try to get to the truth and a proper explanation. We refer to the different Trolley Watch figures given by the HSE and the INO on any particular day. Today, for example, the INO claims that 31 people were lying on trolleys in Cavan General Hospital, waiting for a bed. However the HSE dispute that figure and give 10 as being the true number on trolleys in Cavan. Now we have heard that patients are taken off trolleys when the HSE is doing the count and put back when the count is over. Others have claimed that if a patient is sitting on a chair that he/she is not counted for the trolley figures by the HSE. Yet again we have heard it said that patients on trolleys are pushed into little offices out of sight when the trolley count is being taken and so they are ‘missed’. There was an exchange in the Northern Standard over three weeks recently between a local councillor and a HSE manager but that exchange seems to have been left to the councillor. However, we are still none the wiser as to the reason for the different figures, unless the Councillor is correct.
The difference in numbers is one thing but if the argument concentrates on the actual number then we lose the important aspect of the situation and that is that too many patients are suffering the indignity and trauma of having to lie on trolleys in the first place. We visited the A & E area in Cavan recently and what we saw shocked us. There was a line of trolleys on the corridor with all age groups represented there. One was lying half exposed, another being sick into a dish, another moaning with pain, another sitting frightened, another trying to hide from public view, another coughing deeply – and on it went. The indignity, the trauma, the pain, the humiliation, the mortification and the embarrassment being experienced by these poor humans. If animals were being treated like this, we would say it was disgraceful and the ISPCA would be called in. The poor staff were running about, and we say ‘running’, trying to reach patients, make decisions and making no progress because there were still 18 patients waiting to be seen.
We knew that this would be the outcome but the HSE is content to argue about the numbers rather than do something to rectify the situation. Where is the promise made by Government, HSE and our local Government TDs that we would have a ‘better service’? Those who assisted with implementing this situation must be held responsible and they certainly do not deserve promotion or bonuses. Those who spoke on their behalf, and who criticised the Community Alliance, must take responsibility and eventually pay the price.
Talking about promises brings us to the second circumstances which made us question transparency. All during our campaign we were anxious to get the support of our public representatives. The Government TDs were obviously speaking with one story to the people of Monaghan and had a different approach to their colleagues in Dublin. On the one hand they were not in favour of the removal of services but that is as far as they were willing to go on the matter. The Green party were more obvious with their rejection of our campaign when they were offered power. Sinn Fein was unambiguously on our side. Fine Gael was always on the fence. Every time we tried to get a commitment from them the words they used were very important – they always claimed that they were fighting for the retention of services. We tried to get them to change that to ‘retain and restore’ but they would never use the word ‘restore’. Enda Kenny visited Monaghan last week and, even though he accidently met our Chairman, it was obvious that he did not or did not want to recognise him. He certainly did not want to discuss the Hospital issue but when interviewed by a Northern Standard reporter he, for the first time, was clear – Fine Gael would not be restoring services to Monaghan. When the next election comes around that will have to be an issue and not only in Monaghan but all over the country. So many areas are now earmarked for downgrading and work has already begun in implementing the plans. Only this week we had discussions with people from Kilkenny, where it is now known that services are going to be removed from St. Luke’s to Waterford. This is a hospital, which has been praised by Mary Harney, and held aloft as an example of a hospital which is working well and providing excellent services. Now it is to lose those. They will be told not to put their faith in Fine Gael to save their hospital.
Lastly – we mentioned Mary Harney. All we can say about her is that she should not be in power. We wonder why she can survive while John O’Donaghue was forced to resign. What is the difference? Who is afraid of what? Is there someone afraid of an early General Election? Is there someone afraid that no one wants the job? Is there some one afraid of getting into power?
Back to Top | | Clones leads. issued 22-Oct-2009 | reply to | | Our gratitude goes to the members of Clones Council who are still maintaining the fight against the removal of acute services from Monaghan General Hospital. We thank them for their efforts and say that it is a pity that others are not doing likewise. Some might contend that the services are gone and there is nothing we can do. Well many people are discovering that we have not been given a 'better service' and that things are not 'safer for the patient' now than previously - as we were promised ad nauseum. We are nervously waiting for the 'fatal event' when the needless deaths begin again. It is going to happen and we are again giving the HSE the warning - you will be held responsible and we will be there to make sure that the record will tell the truth and that the finger of blame will pick out the people who ensured that this flawed plan was implemented. In the meantime we urge those members of the Clones Council to continue to highlight the issues and we encourage the other councils and the county council not to let the people down by their silence or we will have to include them in the black list.Back to Top | | DISGUSTING issued 14-Oct-2009 | reply to | If reports are true that the Board of the HSE has voted a €70,000 bonus for Prof. Drumm then it is nothing short of disgusting.
At a time when beds are being closed down, at a time when theatres in hospitals are being closed, at a time when wards in hospitals are being closed, at a time when they cannot sustain acute services in Monaghan General Hospital, at a time when they leave the people of Monaghan exposed to serious risk, at a time when they cannot afford to give a vaccination which will save lives, at a time when they have given a salary increase to Consultants, at a time when they have transferred the cost of providing services to the patient and the family, at a time when they want more and more volunteers to raise money to pay for services they should be providing, at a time when many more services would be axed were it not for the generosity of the general public, at a time when patients would suffer much more were it not for the voluntary committees and individuals who are raising money for patient services, at a time when patients are having to remain in an acute bed because they cannot transfer them to another facility, at a time when the Government is asking us to take cuts in our wages and pay all sorts of levies, at a time when we are hearing the reports of the lavish spending of our Ministers and senior Civil Servants, at a time when people are being paid off to go on the dole, at a time when people are very angry with this Government for their failure to run this country efficiently, at a time when there are too many TDs and Senators claiming too much money from the tax-payer, at a time when nurses and health care workers at the coalface are struggling to keep the system turning over, at a time when fewer and fewer can afford to pay for Health Insurance, at a time when Prof. Drumm's salary in already extravagant and poor value for money, --- it seems that those at the top still have not hit reality - that we are in a depression and recession and that we cannot afford perks like this €70,000.
Despite all that has happened and all that has been said and all that should have been learned from cases like the Ceann Comhairle, the spending still goes on and it is clear that those at the top have learned nothing - the greed is still there and the dis-connect with ordinary people is so apparent. As we said at the beginning - if €70,000 has been decided as a bonus for anyone, including Prof Drumm, it is DISGUSTING.
It also begs the question - what other wastage is still going on? What other perks are being received by those at the top? What other lavish expenditures have been incurred by the HSE? What other bonuses are being paid out? How much has been paid to managers down the line? What bonus was paid to those who closed Monaghan Hospital? Back to Top | | No Hospital issued 22-Sep-2009 | reply to | An article by Elaine Keogh in todays Times has sparked some media attention to what is happening in health in the North East. As someone not living in the North East, as happens regularly, she does not seem to understand the exact situation and the consequences of what she is writing about.
Acording to Teamwork the new Regional Hospital was central to the Transformation/reconfiguration programme for the NE. To place that hospital in Navan was totally obectionable to the people of Monaghan. This has also been agreed by those involved in Cross Border Studies who have researched the provision of hospital services along the Border. The whole objection raised by the people of Monaghan has always been that Emergency care would be too distant if provided in Cavan, Drogheda or Navan. To try to replace what Monaghan General Hospital offered in an emergency with a single paramedic and an ambulance is unworkable, unsafe, and unacceptable.
This time last year we claimed that shortly after services were removed from Monaghan a €100 million capital spend would be announced for Cavan. The writing of Elaine Keogh is the warming up spin that is needed before they can announce that spend. At the moment the HSE are making their plans to remove further services from Monaghan but as one said - 'the climate is not yet right - it is too soon after the removeal of medicine'. The consultants are fed up travelling across from Cavan to carry out minor ops and clinics in Monaghan. It is much easier for them and the HSE to demand that the patient travels to Cavan. There is no concern for the poor the old and the unemployed - how can they afford to pay for the travel and there is no public transport. The ENT service which was lauded by Deputy Margaret Conlon will be transferred to Cavan 'when the climate is right' i.e. when they think that the Community Alliance is dead and gone. We are still here and watching carefully and taking note of all that is happening and who is in the driving seat, including those from the Monaghan area. Wwe are warning mow that a catastrophy is about to happen due to the transformation already carried out and when it does we will be there and we will know who to point the finger at and hold responsible. We will not blame the frontline staff but those who put the process in place and those who supported it right up to Ministerial level. Meanwhile the conning, trickery, deceit, underhand dealings, bonuses, promotions etc etc continue - we are seriously asking ourselves - can we believe them when they tell us that Lisbon is good for us after all the misinformation we have been fed over recent years. Perhaps we need to launch ourselves into a NO campaign.Back to Top | | Canada as an example? issued 28-Aug-2009 | reply to | 'Overhauling health-care system tops agenda at annual meeting of Canada's doctors
By Jennifer Graham (CP) – Aug 15, 2009
SASKATOON — The incoming president of the Canadian Medical Association says this country's health-care system is sick and doctors need to develop a plan to cure it.
Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country - who will gather in Saskatoon on Sunday for their annual meeting - recognize that changes must be made.
"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doing said in an interview with The Canadian Press.
"We know that there must be change," she said. "We're all running flat out, we're all just trying to stay ahead of the immediate day-to-day demands."
The pitch for change at the conference is to start with a presentation from Dr. Robert Ouellet, the current president of the CMA, who has said there's a critical need to make Canada's health-care system patient-centred.'
Got this from irishhealth.comBack to Top | | More from Canada issued 28-Aug-2009 | reply to | 'But Canadians also wait twice as long for non-emergency care and sometimes come to the U.S. for specialized treatment.
Dr. Scott Gottlieb, a resident fellow at the conservative American Enterprise Institute, says the single-payer edifice is starting to crumble.
"What you're starting to see in Canada is that it is falling apart, and you're seeing the growth of a private market for a lot of essential services," he said.
That private market was born after a 2005 Canadian Supreme Court ruling ended the government's monopoly on some health care services.
But since people have to pay out of pocket for them, Canada's public system is still overloaded.
"The average wait time to get an appointment with a new primary care physician is 17 weeks and for specialty care it is even worse," he said.
Canada lacks America's high technology, with about a third of the MRI machines per capita and far fewer specialists.'
This is another article or part of an article from Fox News.Back to Top | | Why scrap 'best services'? issued 16-Aug-2009 | reply to | Why scrap best services asks John Crown in relation to the Breast cancer Services in Sligo, which have been moved to Galway. We ask the same question in relation to the medical services which were available in Monaghan and now moved to Cavan. He argues that there are no 'Centres of Excellence' in Ireland as yet and therefore the efficient and very good services existing in smaller units should not be dismantled.
He also writes about Mary Harney's alleged 'courage' in forcing through much needed reform but John Crown refers to the Minister as the one 'who studiously avoids public debate, who hides behind an army of spin doctors, who recently suggested, under Dail privilege, that doctors in hospitals, whose budgets she had slashed, were deliberately harming their patients by manipulating waiting lists, and who most tellingly will never face an electorate again'. We could add to that by referring to her 'non-party' status and the fact that she has continually refused to meet with members of the Alliance. Never once has she been 'courageous enough' to face the Alliance. Never once has she had thwe courage to come to Monaghan and witness the great work being done there. She would prefer to snipe from a distance. She would prefer to pander to vested interests and ensure that markets are created for the Private investor and the for-profit merchants who deal in peoples' sickness to become rich.
John Crown states that many doctors are afraid to speak out. This is true - we have witnessed it ourselves and their silence is taken as acceptance. Surely they are guilty by associations then. However there is also a big number of doctors who seem to have their own personal interests at heart when they advocate the centralisation of services and the privatisation of our health system. John Crown mentions that some of those who are advising the Minister to close small units are themselves practising and investing in smaller private units. Surely there is a scandal there and will we have to call for a Public Enquiry to ascertain what exactly is going on behind the scenes and who exactly is putting the patients of Ireland at risk either of bankruptcy or worse - needless death. There is supposed to be a law to shield and protect 'whistle-blowers' but when we speak to doctors and nurses they seem to have no confidence in the protection and are even more afraid now than previously.
We think it is important to once again publish items which contradict the spin coming from Government, Minister and HSE offices and this following article from the Annals of Internal Medicine is very clear:
Laine and Sox Ann Intern Med.
While practice surely facilitates progress along the path to better surgical outcomes, its importance relative to other factors is far from clear. Differences in patient and provider factors can make volume appear to have more influence on outcomes than it really does. Because many studies have neglected clustering, failed to focus on condition-specific outcomes, inadequately adjusted for confounders, or assumed that aggregate outcome data predict the outcomes of individuals, the relationships between volume and outcome are neither as straightforward nor as robust as much of the literature suggests. The 2 studies in this issue examine volume/outcome relationships for surgical conditions, but the same arguments apply to volume/outcome studies of medical conditions such as HIV infection. In fact, studies of medical conditions may be more complicated than studies of surgery because episodes of care are difficult to define, multiple providers often care for a single patient, and outcomes develop over a protracted period. 'Does practice make perfect?' is a question that we cannot answer easily. Unfortunately, it appears that perfecting outcomes will require more than simply directing patients to providers with the most cases.
Christine Laine, MD, MPH
Senior Deputy Editor
Harold C. Sox, MD
Editor
Acknowledgments: The authors thank Drs. Paul Epstein, Eliseo Guallar, Russell Localio, and Cynthia Mulrow for their careful review and helpful comments during preparation of this editorial.
Does Practice Really Make Perfect? Editorial
www.annals.org Annals of Internal Medicine Volume Back to Top | | Response to Dr. Rory O'Hanlon. issued 16-Aug-2009 | reply to | An article in last week's Northern Standard headed - 'Dr O'Hanlon raffirms his opposition to resigning on the hospital issue' deserves a response.
First of all we would ask - who elects TDs to office? Surely the constituents who elect the TD have the right to expect the support of that TD in issues which will effect him/her so seriously? However his argument that TDs must take a 'National view' is rather puzzling when one considers the work and effort put in by TDs to get grants for this and that for their areas. Perhaps if less money had been squandered on local projects in the past decade we might have more in reserve to get us out of the current economic difficulties. However if it is OK for TDs to work so dilligently to get this type of support for the 'local issues' then there must be similar effort for other issues locally?
We would also argue that this IS a National Issue, as Monaghan is the template and Dr. O'Hanlon knows that. He voted in this Government Policy and it concerns the entire country. He has stated clearly in the Dail that what has happened is wrong for Monaghan and that Medical Service should have been left in Monaghan but importantly he is not prepared to take action to right the wrong. Where is the principle here - is it right to abandon your local electorate for the National Interest and what is the National interest here - if it is wrong for Monaghan it will be wrong for other areas too or are Monaghan people expected to have an acceptable mortality rate for the National Interest? To us it looks more like a personal interest.
He claims that being a member of a 'bigger party' brings better results for local issues. What is he talking about? He has been a member of the 'bigger party' since his first election and what has been achieved for Monaghan hospital. His colleague, Deputy Conlon, has also stated that she can accomplish more by remianing inside the party - what have they achieved for the health services in Monaghan?
Dr. O'Hanlon refers to the fact that 'experts from universities and various bodies' have made recommendations, which the HSE had decided to accept. Surely he is not lowering himself by claiming that the Government has no power over the HSE especially since he voted for these recommendations himself when they came before the Dail. He cannot misplace the blame. Anyhow - who are these experts? Are they, as Dr. John Crown mentions, some of those who are practising and investing in smaller private hospitals? Are they people who stand to gain financially from the building, resourcing and staffing of the big centralised units? Are they influenced by their own 'vested interests' that Prof Drumm referred to in relation to the Alliance?
There is then a gaping contradiction in Dr. O'Hanlon's argument - He implies that these bodies recommended that surgery be halted in small hospitals but if that is the case why are medical services also halted? However read our other posting here with regard to the research which has been carried out to show how volume is supposed to produce better outcomes and you can see that that argument is also faulty. The 'best information worldwide' is not as Dr. O'Hanlon states, recommending bigger centres for all hospital treatment. That is the 'spin' which this Government has been churning out to support their policy but research does not show that. There are many other aspects to care, which have a greater effect and greater consequences for outcomes - e.g. - proper resourcing by Government and proper accountability demanded by Government from quangos like the HSE. As well it is a proven fact in all countries that outcomes from Cancer will improve by about 25% if there are proper screening programmes in operation to detect the cancers early thereby making treatment less costly and more effective. This Government's reputation for screening programmes leaves much to be desired and the funding which should have been spent on these programmes is instead used up by spin doctors and propaganda.Back to Top | | We warned about this. issued 15-Aug-2009 | reply to | Months ago we warned that Government Policy is one of centralisation leading to privatisation. The markets must be created to entice the big investors to come in to Ireland and provide the services in our health sector. This is being done be reducing the number of public beds available, creating long waiting lists, and be destroying public confidence in our Public Health System. In order to avail of the private facilities people must have health insurance or loads of money. A couple of years ago these were in plentiful supply. There were many very rich people in Ireland who could afford the prices of Private Care and even to invest in these facilities to make more money for themselves. Many were in good jobs and earning good money and coyuld afford health Insurance and so avail of the Private.
Now things have changed as we warned - there is less money about. The big money people are not willing to spend and with increasing unemployment the number who can afford Health Insurance is decreasing as stated by the VHI this week. They claim that 200,000 more people will rely on the public system within the next 18 months. What kind of system will we have by then? We will have the USA system where if you cannot afford you die. The tax-payer might pay for some of the public patients to be treated in private hospitals but for the rest - they are expendable - we cannot afford to keep them alive - that seems to be the thinking.Back to Top | | Free treatment issued 13-Aug-2009 | reply to | The problems caused by removal of services from Monaghan General Hospital are beginning to manifest themselves.
The overcrowding in Cavan, at a time of year generally accepted as the ‘quiet time’, is a frightening portent of things to come during the winter months when many more people will require hospitalisation. Added to that is the threat of Swine Flu, which would put inordinate pressures on hospitals all over the country.
Monaghan is being used as a ‘Step-down Unit’ and at the moment there are about 11 in-patients on average. However there is no doctor on duty in the hospital during the evenings or at night. If one of the patients gets suddenly sick, the staff will have to call an ambulance and the patient will be transferred back to Cavan. We ask – is this a safe practice or is the HSE trying top engineer a situation where they will have an excuse to remove that facility too.
It also appears that all treatment received in the Treatment Room is free of charge. The levy, which was imposed on all who attended without medical card or a GP’s referral, was over €100. However since that charge was for A & E attendance and, since Monaghan does not have an A & E, the charge cannot be imposed on the patient. This is good news for patients. The Alliance also encourages people to make full use of the facility, which still has a doctor in attendance, as low numbers will give the HSE a reason to remove the service totally.
Other incidences of unsafe practice and poorer quality service have been brought to the attention of the Alliance but at the moment we are urging all those who experience problems with the health service to make a written complaint to the HSE or go on Northern Sound, Joe Duffy or write to the Northern Standard. This is important because if allowed go unchecked the problem may turn out more serious for the next patient who suffers a similar situation.
Back to Top | | Problems Cropping Up issued 12-Aug-2009 | reply to | The problems with the reconfiguration are beginning to mount up and we are working to get some of the families to go public with their stories. Indeed most of the stories are concerning senior citizens and we will have more to say on that in the future.
However there are some things we need to point out to the public -
1. You are better at home than in Monaghan as a step down or rehabilitation in-patient. If you get sick while in Monaghan there is no doctor available and they will have to call an ambulance and have you transferred to Cavan. Indeed the rehabilitation you will receive in Monaghan also seems to be less than you might expect. However when I called to see a patient in Monaghan today I have to say that he was in great form to be back in Monaghan after two weeks in Cavan. He did not like Cavan as he knew no one there and was always afraid that someone coming to see him or going home afterwards would have an accident on that bad road. He was not impressed by the attitude of the staff and told him little about his condition.
2. There is no charge for patients who attend the Minor Injuries Unit in Monaghan as they cannot charge since it is not an A & E. So it is now cheaper to go to the Minor Injuries Unit than to your GP. There is a doctor in the Minor Injuries Unit(at the moment) and you will be seen very quickly. We encourage as many as possible to use the unit with whatever problem and you can at least get a diagnosis very quickly. However do not be surprised if a person in a suit tells you to go elsewhere as we are told that managers are keeping a close eye to ensure that the staff stick strictly to the protocols - but then who cares about their protocols!Back to Top | | Another good read issued 11-Aug-2009 | reply to | | In the Daily Mail of Tuesday, August 11th 2009, Dr. Ruairi Hanley has published a very good article on our health services and Monaghan Hospital and it is well worth reading.Back to Top | | A Must Read issued 10-Aug-2009 | reply to | | Banana republic goes bust for Boston is the title of and article written by Dr. Garret Fitzgerald in the Irish Medical Times on the 6th August. It is a must read as it tells it as it is in our health services. Here is a link if you want to read it on-line - http://www.imt.ie/opinion/garret_fitzgerald/Back to Top | | Resignations issued 05-Aug-2009 | reply to | The news is coming through that Jimmy Devins, the FF TD in Sligo Leitrim, has resigned the Party Whip because of the removal of the Cancer Services from Sligo. It is also reported that his stable mate, Deputy Scanlon, is going to follow suit.
Now in itself this is hardly worth reporting as 'resigning the party whip' when the Government is not sitting is a scam, which might fool the people, but will have little impact on anything or anybody. However it does show that he/they are willing to put their nose(s) above the parapet. More than can be said of our Fianna Fail representatives. But it is still not too late for Margaret and Rory to show the electorate in this constituency that they are willing to go out on a limb for their constituents.
Deputy Devins says he is doing it because the excellent breast cancer service in Sligo should be retained there, though networked with Galway. It has been agreed by all that Monaghan had a top class and excellent cardiac unit with top class, skilled and professional staff and we claim that it should have been retained in Monaghan, and it could be networked with St. James or Mater in Dublin. As a matter of fact we claim that our A & E services could also be retained and should have been retained because of the geographical isolation of the area, and this could also have been organised in a safe, efficient and cost effective manner by networking the A & E room in Monaghan with a large Centre in Dublin. However the benefits to patient and the risk to patient were very far down the agenda when the decision to remove services was made and implemented. For that reason our TDs should have had the courage and should have been urged by their supporters on the ground to do what was necessary - stand with the people in the campaign. It is not too late Rory and Margaret - call it now.Back to Top | | Sligo Press Release issued 05-Aug-2009 | reply to | "The campaign members are profoundly shocked and saddened with the news, yet unconfirmed, that the government has decided to go ahead with the closure of cancer services at Sligo General Hospital, despite the overwhelming evidence that the unit there provides unparalleled treatment for patients and has outcomes that rank amongst the best in the world. Closing it is nothing other than an act of vandalism.
The news will bring great distress and disbelief to the people of the North West region and it appears now that the current government has simply abandoned the people of the region.
Local TD’s Jimmy Devins and Eamon Scanlon have indicated that they intend to resign the whip in response to the decision, however this may well be too little too late. Indeed given their intention to continue to support the government on other matters, many take the view that it is nothing other than a choreographed charade to mislead the public into thinking that they are taking an action that is in the interests of the hospital and the people of the region when in fact it is merely about their own political survival. The campaign and the people will not be fooled by such a sham and have seen this all before.
The campaign, in correspondence with both TDs, indicated that if Cowen refused to acknowledge the case for the retention of the services at SGH, then the only thing that would save the services is a complete withdrawal of support for the government on all issues. Both TDs can save the services by making it clear that they will vote against the government ON ALL issues that come before the Dail henceforth. Anything less is highly unlikely to achieve anything.
The campaign will now arrange a series of meetings to organise future actions, part of which will be a canvass in any upcoming election to encourage the electorate not to give a vote of any description to a Fianna Fail candidate, or any candidate with a record of voting for the current government on any issue, should the closure of the cancer unit at SGH go ahead.
We call on all members of the Fianna Fail party in the region to now resign from that party in protest and stand with their friends and neighbours in defending SGH. Crocodile tears and weasel words are useless and insulting and will only lead to anger".
It could be used for Monaghan too by just substituting Monaghan for Sligo and replacing Devins and Scanlon with O'Hanlon and Conlon. Back to Top | | Experts can differ and contradict each other. issued 05-Aug-2009 | reply to | We reprint here an axtract from an article in the most recent 'New England Journal of Medicine' written by Pamela Hartzband, M.D., and Jerome Groopman, M.D entitled - 'Keeping the Patient in the Equation — Humanism and Health Care Reform ' --- We believe it is essential to respect the ethical principle that any choice of treatment must ultimately be made by the patient who will benefit or suffer from it. Many patients have become aware of the scientific limitations of guidelines through reports in the media about recent reversals of expert advice on hormone-replacement therapy for postmenopausal women, low-fat diets for obesity, the use of erythropoietin for cancer-associated anemia, and tight regulation of glucose levels in various settings. Because guidelines are derived from clinical studies carried out in selected groups of patients and their statistical conclusions are based on study populations, they may not apply to an individual patient, especially if he or she has coexisting conditions. In many instances, the results of larger and better-designed clinical trials have contradicted what appeared to be firm conclusions from earlier research. Furthermore, there are frequently experts who dissent from the majority opinion on which guidelines are based, and their views are not routinely represented in the guidelines.
Mandated rather than recommended treatment guidelines are being considered as part of Medicare reform, within the context of “value-based purchasing” and “pay for performance,” but these guidelines will have the unintended consequence of misaligning the goals of doctors and patients. Physicians will face a new conflict of interest: they will be financially motivated to pressure patients into accepting a mandated treatment, regardless of whether it is compatible with their values or preferences, or to avoid caring for patients who refuse the mandated treatment. Such behavior is already reportedly occurring in pilot pay-for-performance programs.3 Moreover, given the scant evidence of meaningful cost savings from pay-for-performance or disease-management programs,2 such reforms may end up pushing physicians and patients to adhere to rules that don’t even achieve their purported financial aims.
What is the remedy? We suggest that shared decision making be central to any changes resulting from current health care reform initiatives. All national guidelines should acknowledge the dissenting opinions of experts. Furthermore, these guidelines should indicate which specific populations were studied and which important coexisting conditions constituted criteria for exclusion from the trials, so that physicians can judge whether and how the guidelines apply to an individual patient. Currently, some guideline committees receive financial support from pharmaceutical and device companies, and there are indications that such support has influenced the recommendations.4,5 In order to assure the public that there is no potential for a conflict of interest that would taint the guidelines, an independent government body should be established to develop guidelines without industry support — analogous to the role of the Food and Drug Administration as an unbiased party for the approval of treatments. Funding could come instead from the federal monies already designated for comparative-effectiveness research.
In the debate over health care reform, much has been made of the WHO’s ranking of the United States as 37th in health care overall.1 What is not emphasized is that we are rated first in responsiveness — that is, in providing patients with choices that are meaningful to them. We scored poorly on the variables related to economics and fairness in distribution of services, and these factors will be addressed through the reform measures that are now in the works. Retaining our hard-won advances in shared decision making will allow us to ethically combine the contributions of medical humanism and evidence-based guidelines while addressing the imperatives of cost containment and universal coverage'.
This is referring to medicine in the USA but the same principles apply to medicine in ireland - or at least should apply and they have certainly not been applied in the reform programme for Monaghan and the North East.Back to Top | | “BIG BRA`PROTEST EVENT” issued 24-Jul-2009 | reply to | On Tuesday July 28th, there will be a protest march in Dublin to
demand the retention, in SLIGO GENERAL HOSPITAL, cancer services for
the North West region.
THE TIME HAS COME TO STAND UP AND PROTEST. IF WE DO NOTHING, CANCER
SERVICES FOR THE NORTHWEST REGION WILL BE LOST COMPLETELY ON AUGUST
6TH. SHOULD THAT BE ALLOWED TO HAPPEN, ALL PATIENTS FROM THE NORTHWEST
REGION WILL BE FORCED TO TRAVEL TO GALWAY FOR TREATMENT.
GALWAY UNIVERSITY HOSPITAL IS NOT READY FOR THE ADDITIONAL PATIENTS
AND PEOPLE IN DONEGAL, LEITRIM AND SLIGO SHOULD NOT HAVE TO MAKE THIS
LONG AND DIFFICULT JOURNEY FOR CANCER TREATMENT AND PARTICULARLY AS
THE REGION ALREADY HAS A FIRST RATE SERVICE LOCATED AT SLIGO GENERAL
HOSPITAL WITH EXCELLENT TREATMENT AND OUTCOMES.
WE WANT THE GOVERNMENT TO STOP THIS MOVE ON AUGUST 6TH 2009. IT MAKES
NO FINANCIAL SENSE AND DOCTORS AND CONSULTANTS SAY IT MAKES NO MEDICAL
SENSE EITHER. TUESDAY'S PROTEST WILL INCLUDE THE HANDING IN OF A
LETTER TO THE PRESIDENT, A PROTEST AT MINISTER HARNEY'S OFFICE AND
THEN ON TO THE OFFICE OF AN TAOISEACH TO HAND IN A LETTER OF PROTEST
AND CAMPAIGNERS WILL TIE THEIR BRAS TO THE RAILINGS OUTSIDE MR.
COWEN'S OFFICE.
ALL ARE WELCOME TO ATTEND THIS PROTEST.
COME JOIN US AND TIE YOUR BRA TO BRIAN COWEN'S DOOR NEXT TUESDAY!
PROTEST SCHEDULE
12noon - Protestors arrive at Aras an Uachtarain to hand in a letter
to President McAleese
2pm - Protestors arrive at the Department of Health to hand in a
letter to Minister Mary Harney
3.30 - Protestors arrive at Department of Taoiseach to hand in a
letter to Taoiseach Brian Cowen and to tie bras to the railings.Back to Top | | A bell that tolls for us all issued 23-Jul-2009 | reply to | HSE’s Decimation Programme is a vast experiment with people’s lives. 18 months ago there were just 1,000 emergency medical technicians (EMTs) and 90 ‘advanced paramedics’ (APs) in the entire country. How many are there today, now that around 40 public hospitals, including Monaghan General, are to close? And how are these staff being utilised?
In the North-East, for example, if a 999 call were classified as serious according to the computer programme that decides these things), the paramedics––if available––would be sent out to that call with the usual crew. So two ambulances were being dispatched to one call. This lunacy was addressed by dispatching four paramedics to do solo runs in single responder vehicles. But APs are concerned about this, because they know how hard it is to rescuscitate patients single-handed.
There are four so-called ‘models’ of paramedic deployment in existence, nationally. But no good evidence exists to suggest that any of the four will actually work in Ireland. Nor is there any good quality research to show that one model is better or worse than another. It’s all a shot in the dark. Touted as ‘advanced paramedic’, Ireland’s emergency services are so underdeveloped that emergency work is intertwined with non-emergency duties, such as transporting patients from A to B. Advanced paramedics, as well as EMTs, are required to do non-emergency patient transport. Paramedics of all grades, stuck for hours outside overcrowded hospital A&E departments, are then unavailable for emergencies. Paramedics say their skills are not being used where they are needed, that they are sitting around waiting for patients to be discharged so they can bring them home.
Ireland is now running before it can walk, closing hospitals on foot of an underdeveloped paramedic service that only began four years ago. Training is minimal, compared to other countries. The advanced paramedic programme here lasts for just 11 months: in most other countries, such training routinely takes two years. In some EU member states, such as Poland, paramedic training lasts for four years.
Advanced paramedic training in Ireland includes what is called an ‘internship’ (a term more often associated with student doctors) where paramedics learn to put theory into practice on living patients. Unlike medical or nursing undergraduates, however, this shoestring internship involves just six weeks. The car, a ‘rapid response vehicle’, is crewed by two trainees, who have no other ambulance staff on board to turn to for advice. For the first two or three weeks, students are monitored by a hospital A&E consultant or an instructor or even a general practitioner. (This is surprising, as GPs would not normally see themselves as being skilled in emergency work.) For the final three or four weeks, trainees are on their own, under telephone ‘supervision’. How scary is that for 999 callers?
Little or no evidence is available on the impact of paramedic training in Ireland. The first cohort of students (30) to do the internship cared for 1 237 patients. This averaged out at just 19 patients over six weeks. As a preparation for giving dangerous drugs to patients and engaging in potentially lethal procedures, this level of hands on training seems inadequate.
Just half of those paramedic trainees got an opportunity to perform a heavy duty medical intervention. Putting in a line (as the Americans call it) was the most common advanced procedure, with each student putting up an average of eight drips. Oppotunities to perform other serious medical interventions over the six weeks were even more limited. A total of 55 patients had suffered a cardiac arrest, so each student got to deal with two heart attacks. And only 22 trainees out of the class of 30 got a chance to insert an endotracheal tube or laryngeal mask.
Inserting an endotracheal tube is one of the most invasive and dangerous interventions in the paramedic scope of practice. These tubes are placed deep in the chest: they are used to intubate a patient who is about to be attached to a ventilator that will breathe for that patient. If something goes wrong during that intervention, however, that patient will die as, as the intubated patient is no longer able to breathe on his own.
Emergency consultant at the Lourdes Hospital, Dr Conor Egleston, has drawn attention to the death rates associated with 'advanced life support'. The medical literature is studded with studies testifying to the high mortality rates among patients subjected to such procedures. Scientific research shows that severe trauma victims looked after by advanced paramedics are three times more likely to die than those cared for by ordinary paramedics or EMTs. Basic life support, not advanced paramedic intervention, was the hallmark of a good emergency service, Dr Egleston concluded.
But if getting the patient to hospital as fast as possible instead of performing invasive, high-risk and time-consuming interventions in the back of a parked ambulance is the key to patient survival, then Ireland is going down the wrong road.
To require paramedics to take the place of hospital A&E doctors and nurses is unjust to patients and unfair to staff. The truth is that you cannot even put up a drip in a moving ambulance, because you cannot find a vein in a patient being bounced about in the back of a van that has no suspension. The alternative is to ‘stay and play’, but the greater the delay in bringing a patient to definitive care in hospital, the higher the risk that a life will be lost.
This Government has shamefully betrayed the people of Monaghan and the nation, since Monaghan is the pilot, nationally, for HSE’s Decimation Programme. Emergency ambulance services should be an addition to public hospital A&E services, not a replacement for them.
The closure of Monaghan General Hospital is the beginning of the end. The bell that tolls for Monaghan tolls for us all.
Contributed by Marie O'Connor and as published in the Northern Standard.Back to Top | | Final Day. issued 22-Jul-2009 | reply to | Today was the final day for Monaghan General Hospital. It was a very emotional day for many. Those who had received excellent care over the years were recalling and expressing their thanks. Those whose lives had been saved in Monaghan were very emotional. Many expressed their fears and anxiety at having to depend on an ambulance to get them to Cavan, Drogheda, Dundalk OR Navan alive, where prior to this they were able to rush into Monaghan and get immediate care and attention - these are people who have had heart attacks and a threat of another. They live in fear. Of course the staff members were totally devasted and tears were plentiful. How they have been treated is unbelievable. Then we were hearing the horror stories from Cavan and from Monaghan - patient safety is a joke with the HSE.
The turn out from the pbulic was great. A quick count of the signatures would place the number a little over 8,000. What a mandate for the Alliance. Our thanks to everyone who helped with the day.
Back to Top | | Change of Plan issued 20-Jul-2009 | reply to | Due to circumstances beyond our control and restrictions being placed on us by authorities we have had to change our plans for the Vigil. The following are the new arrangements:
From 9am on Wednesday until 6pm members of the Alliance will be at the Hospital gates. Members of the public can come and sign the Book of Condolences and Support. At 6pm the final speeches will be made with some ceremony.
Since we began our campaign we have always ensured that it was done in a dignified manner. We are disappointed that our final act prior to the removal of services had to be curtailed but we can live with that.Back to Top | | Paramedics cannot replace doctors issued 20-Jul-2009 | reply to | The Government’s plan to close public hospitals, such as Monaghan General, should lead to a boom in ambulance activity. As ambulances strive to replace hospitals, let’s take a closer look at our emergency services. Although HSE is rushing to close hospitals, it is clear that our emergency services are in their infancy. Ireland’s first ‘advanced paramedic’ programme only began in 2007. As of yet, there appears to be no good evidence attesting to the safety of such services in Ireland.
Job titles have been changed: they did not, apparently, enjoy legal protection. But that legal protection exists to protect the public as well as the job holder. In the case of the emergency services, however, such protection seems to be in short supply. So emergency medical technicians (EMTs) were renamed ‘paramedics’, while paramedics became ‘advanced paramedics’. (No such corresponding advance in training was discernable, however.)
This change of title has caused a huge amount of confusion, even within the services themselves, among aspiring students and new recruits.
Was this done cynically, just to pull the wool over our eyes? To get the public to think that some grades represent higher levels of expertise than they do? To fox communities whose hospitals are being closed, like Monaghan’s into thinking that their emergency services are a lot more developed than they actually are?
The new titles raise the problem of comparability, of equivalence. This makes it difficult, if not impossible, to compare Ireland’s emergency services with those of other countries. Our ‘advanced paramedics’ are understood to be the equivalent of paramedics in the London ambulance service, for example. This raises questions over the grade of ‘advanced paramedic’ in Ireland: how well does the training bear comparison with comparable grades in other countries?
Our emergency services are riddled with problems. Nationally, some are believed to be working in these services as ‘EMTs’, with just one week’s training. Furthermore, a minority, it has also been reported, are working without being registered at all with the Pre-Hospital Emergency Care Council (PHECC). You don’t have to be on the register, it seems, to work in the services, even in the public sector, as it is not an offence to practice as an EMT or a paramedic without being registered.
In March 2008, around 10 per cent of HSE staff who were working as paramedics were reportedly not registered as paramedics; while a small number of staff working as EMTs were not so registered. Whether or not all private ambulance staff are registered appropriately is not known, In fact, it seems to be routine enough for staff not registered with the PHECC to work in the services.
Whatever about patient safety, our emergency services are now offering good employment opportunities. In the public sector, people in their late teens, with or without the Leaving Cert, may apply to become emergency medical technicians. While a good standard of general education is required, no formal entry requirements are laid down for these courses. This seems to be somewhat out of step with trends in the economy. Even Tesco requires check-out operators to have Leaving Certs.
EMT training lasts for just 9 months; with a 7-week course in school followed by 26 weeks of practical placements, topped off by a one-week trauma life support course. After the final exam, trainees get their EMT or ‘paramedic’ cert. Paramedics are not, however, licensed to put up drips, to give advanced life support drugs or to administer strong painkillers.
To become an ‘advanced paramedic’ requires just three years’ experience as an EMT. You can apply to become an ‘advanced paramedic’ at the age of 21. This restriction is believed to stem from the fact that the job requires a full D and C license, and this license is restricted to over-21s. But 22 seems a trifle young to be doing the very demanding, invasive and high-risk procedures that ‘advanced paramedics’ are expected to do, not to mention the life-and-death responsibilities the job carries. Moreover, ‘interns’ or trainee paramedics are treated as core team members, crewing ambulances and administering medication just like their qualified colleagues.
Initial training leading to a diploma in emergency medical technology is provided in Dublin or Ballinasloe. Diploma holders are then assigned to an ambulance station to begin work. A higher diploma leads to an advanced paramedic’ qualification. The training programme is just 11 months long: completion of the programme allows the diploma holder to put up an intravenuous drip, administer extremely powerful drugs, such as clotbusters, and perform other highly advanced medical procedures, such as intubation.
Formerly confined to hospital anaesthetists, intubation is a difficult and dangerous skill. A heavy duty procedure, it involves inserting a tube connected to a ventilator deep into the patient’s lungs: the machine breathes for the patient who has had the power to breathe taken away by the paramedic.
Currently, neither EMTs nor paramedics are permitted to discharge patients at the scene: all patients must be transported to hospital, but this rule will undoubtedly change. As more and more acute public hospitals close, paramedics will assume more and more of the doctor’s role, after less than two year’s formal training. But it takes up to 10 years to become a doctor. So who says paramedics can safely replace doctors?
Written By Marie O'Connor, author of 'Emergency - Irish Hospitals in Chaos', and published in the Northern Standard newspaper.Back to Top | | Do Not Let the Hospital Die Alone. issued 15-Jul-2009 | reply to | The Community Alliance has organised a 24-Hour Vigil to mark the death of our hospital – a hospital which has been there for the people of this area since the mid-30s. It is also an opportunity to remember the faithful and dedicated members of staff who have worked in that hospital during its lifetime and to say thanks to them for their expertise and care. It will also be a time to highlight those, who are responsible for the death of our Hospital and to ensure that it will be remembered by future generations.
Programme for Vigil:
6pm on Tuesday, 22nd to 6pm on Wednesday, 23rd. – the Vigil at the gates of the hospital.
11.30 to midnight Tuesday – Candlelight Silent Vigil for the time of death.
5.30pm to 6pm Wednesday – The Last Post.
6pm – 6.30pm Wednesday – Addresses by five speakers and disperse.
The Community Alliance requests that clubs, organisations, businesses and groups (or individual) will offer to ensure a presence at the Gates for one hour during the Vigil. This can be done by ringing 0860443300 to book your slot. It is hoped that Clubs, Organisations and Businesses will make the effort to participate. However the general public are asked to call at the Gates and stay for sometime to show their respect for the hospital and their revulsion at its demise. There will be a Book of Condolence to be signed by all who attend and this will be a record for future generations. It would be fitting if there could be a good crowd at 11.30pm to Midnight on Tuesday and again from 5.30pm to 6.30pm on Wednesday evening but it is important that there is a presence at the Gates at all times during the 24 hours. If you are coming to the Candlelight Time please bring a candle or torch with you.
This is not something that should be left to others. Each of us has an obligation to be there to mark this sad and demoralising day for County Monaghan and its people.
Back to Top | | We Are At Risk From Today. issued 15-Jul-2009 | reply to | As and from Wednesday, July 15th (today) no patients will be admitted to Monaghan General Hospital. This in effect means that it is no longer a hospital from that date. The existing patients will be either discharged or transferred before Tuesday, July 22nd, which means the process will be complete by that date.
The people of Monaghan are at risk from July 15th as no emergencies will be taken to Monaghan General Hospital unless it is clear that they will not need admission. It is now important that every family questions and makes complaint when things go wrong and that we hold to account those responsible for the situation.
Even though the Hospital is virtually closed from today, Wednesday, July 15th we still go ahead with our Vigil on Tuesday next to mark the occasion for history and leave a proper record behind so that future generations will know what happened.
Back to Top | | Dr. Elmo de Hoedt issued 15-Jul-2009 | reply to | This week Monaghan mourned the death of a man, who spent his life working for the people of Monaghan. He was Dr. Elmo de Hoedt, former Consultant Anaesthetist in Monaghan General Hospital. For decades this man attended the patients and carefully and professionally used his expertise to assist in their recovery. So many people owed their lives to his skills, knowledge and competence. He was a quiet man, who never counted the hours and never refused to work if a patient needed him. He was one of those doctors, where the patient came first above all other considerations and the need for Monaghan General Hospital was paramount.
It was ironic then that on the very day of his Requiem and burial (Wednesday July 15th 2009), we should witness the final step in the death of the hospital he loved so much and where he spent so many years of his life. On this same day the HSE instructed staff not to admit any new patients to the Hospital in preparation for the removal of all acute services from Monaghan to Cavan on Tuesday, July 22nd. next. No doubt he looked down in disgust and disapproval at what was happening.
We are confident that he rests at peace and knows that the Lord will appease the wrongs being imposed on the people of Monaghan.
To his family and wide circle of friends we offer our deepest sympathies and we thank God for bringing him to us.Back to Top | | Death of a Hospital issued 11-Jul-2009 | reply to | The HSE seem intent on going ahead with the pplans to remove all acute and emergency services from Monaghan on Wednesday, July 22. It has not been made clear yet if that means midnight on Tuesday, July 21 or midnight Wednesday July 22. However the Alliance has decided that the Hospital will not die a lonely death - there will be a 24 hour vigil at the gates of the hospital from 6pm on Tuesday until 6pm on Wednesday. We are asking clubs, organisations, groups of individuals, residents associations, businesses and townlands to volunteer to cover One Hour at the gates. All this means is that someone from that group will ensure that at least three people are at the gates during that hour. We will also invite members of the public to pay a visit to the gates when they can and show support. We intend having a caravan, where those 'on duty' can make a cup of tea and/or stand in if it is raining. We will also have a Book of Condolences, which we want people to sign when they call to the gates. It will also contain a message for Mary Harney and this Government of Fianna Fail and the Greens.
Anyone agreeing to sign up for an hour can ring 086 0443300.
Then at 6pm there will be a short public address at the gates and we would like as many as possible to come to that. It will last for 20 minutes.Back to Top | | New Low for some.. issued 10-Jul-2009 | reply to | WE have heard it all now. Over the years since our election to the Alliance and throughout our campaign many people have been blamed for the downgrading of Monaghan Hospital. The politicians in Government blamed the Medical Consultants, the Royal Colleges, the Nurses, the Health Boards and then the HSE, the economy, local politicians and some even blamed the patients, for not making use of their own hospital and using their feet to show that they had no confidence in their own local hospital. Dr. Rory O'Hanlon brought it all to a new low yesterday, July 9th, when he is reported as having blamed the 'protestors' for the demise of Monaghan General Hospital. The actions of the protestors, it seems, forced the HSE to implement the downgrading of the hospital against their will!!! He also used the occasion, we are told, to mention the fact that he had a bad personal experience of a protest.
It is a well known tactic in any debate that when you are in a tight corner you go for the person - 'Argumentum ad hominum' or something. Whatever it is, Dr. Rory is using it - to try to the blame our campaign and to make an effort to blacken our name is below contempt.
Let us be quite clear on things.
1. Politicians are elected to represent the people of an area and to formulate the legislation and make the decisions for the smooth and successful running of the country, ensuring that every citizen is treated equally and is guaranteed his/her basic human rights.
2. The Government of politicians decide on 'Policy'. Normally the Department of Health would implement the policy but this Government prefers to set up a separate quango to do this, as it shields them from criticism. In the case of health, the policy is one of centralisation and privatisation and the quango is the HSE.
3. This quango draws up plans on how to achieve this policy and they present these to Government for approval. The Government makes a few 'twitches' and hands over a huge sum of money to the quango and tells them to proceed.
4. When things go well the Government takes a bow and claims the praise. When things go pear-shaped they blame some other body.
And that is where we are at with our health services. The Government has allowed the HSE to get out of control and the Government spends its time looking for a scape-goat. It appears that they have now exhausted the list and the only ones left are - the patients for getting sick in the first place. However they are working on that because a huge number of the population are now afraid to get sick.
Shame on this Government and its supporters for leading us all to such a situation and then try to blame us.
We will have more to say on our visit to Leinster House last night (July 9th) when we had to listen to and watch Dr. Rory and Margaret trying to justify themselves. We hold them responsible.Back to Top | | The Night in the Dail. issued 10-Jul-2009 | reply to | The Adjournment Debate in the Dail on Thursday night, July 9th was on the removal of acute services from Monaghan General Hospital. Four of the Cavan/Monaghan TDs would address the house. We decided to attend and bring a few friends. We got a great reception for Deputies O’Caolain and Crawford and we thank them for that. We also thank them for their efforts in getting the debate and the points they raised during it. However they have been consistent in their efforts since we began our campaign.
Prior to the debate, Peadar and Brendan McCleary met with Jan O’Sullivan, Health Spokesperson for Labour; Enda Kenny, Leader Fine Gael and Sinn Fein Health spokesperson, Caoimhghin. We discussed the removal of services with them and explored actions, which we and they might take prior to the date. These will be announced in due course.
Back to the Public Gallery and the Debate. First to speak was Margaret Conlon TD. Her opinions expressed contained confusing statements. On the one hand she wanted the Medical Unit in Monaghan, which she referred to as ‘second to none’, to continue but later she advocated that services be retained until such time as better was available elsewhere. She called on the HSE not to proceed on July 22nd as ‘it is too soon’. She complained that the HSE did not manage the change properly and did not consult with her. We would ask – was the HSE not set up by this Government and is it not accountable to this Government? On the one hand the Government wants the HSE to shield them from criticism and yet they want control of the HSE – they need to decide which they want as they cannot have both. She went on then to state that she will hold Prof Drumm and the managers of the change responsible if something goes wrong. We reiterate our stance – we will hold her and her Government colleagues responsible – they cannot shift the guilt to the HSE as they have supported and agreed with everything the HSE has done. Mary Harney claimed that on numerous occasions.
Deputy Crawford pointed out that the Minister is in charge and he asked some pertinent questions in relation to the cooperation of GPs and asked for the evidence that we will have a better service. He also pointed the finger at the Government and the support given by the three Fianna Fail deputies from the Cavan/Monaghan constituency. He ended by calling on the Minister to take control of the HSE, to stop the lunacy being applied to Monaghan General Hospital and to make the HSE accountable to the Dail.
Dr. Rory O’Hanlon was next to speak and we were somewhat miffed before he began when we heard that earlier in the evening he had made a derogatory statement concerning the Alliance on National Radio. He claimed, we were told, that it was the actions of the protestors that speeded up the process of removal of services before the alternatives were ready. We were to blame, in other words, and he used the occasion to insert an emotional call for sympathy when he recalled his own bad experience of the protest, obviously referring to the Opening of the By-Pass. In his contribution to the debate he too was rather confusing – one the one hand he advocated the retention of the medical services in Monaghan but also suggested that Cavan and Drogheda should be upgraded to take the Monaghan patients. He also called for the provision of CT Scanner in Monaghan. We would loved to have asked him why, since no emergencies are going to be arriving there. He went on to ask the Minister to ask the HSE to sit down with ‘elected representatives, representatives of Hospital staff, GPs and Patient Representatives to work out a system that can be put in place in Monaghan. He placed the responsibility on Prof drum and the HSE but Deputy Crawford objected and pointed the finger again at the Minister, reminding the House of what happened in Roscommon. We would have added Kerry and Bantry.
The last speaker was Deputy O’Caolain who reminded all that this was a national issue, since the same plan will be rolled out for all ‘small hospitals’ and stated that this was a political decision. He also announced that the Taoiseach and Minister Harney were closely involved in the decision to axe the services in Monaghan and the date for doing so was strategically selected by them. He stated that the people of Monaghan and Cavan had been betrayed by Deputies Conlon, O’Hanlon and Smith and said that they should hang their heads in shame. He then spoke of the scurrilous attack, which he heard on Drivetime on RTE earlier that evening, when Deputy O’Hanlon blamed the campaigners.
The reply came from Deputy Áine Brady, when, on behalf of the Minister, she read a prepared statement, which was nauseating as we have heard it repeated over and over again during the past seven years. The only difference is that there is a date for the removal of the services.
She stated that the programme being implemented in the North East is in line with the international model being developed. Unfortunately that is where we have the difficulty – some countries are developing it while others have abandoned it because it did not work. Still others have used aspects but adjusted to take the needs of rural communities into consideration and to provide them with the basic life-saving services in their local hospital and not in the back of an ambulance. Adjustments had to be made as much of the system is developed for densely populated areas like Greater London and Greater Manchester but in the Irish context this plan is totally unsuitable.
Again the Minister trotted out the old ‘Good Outcomes need big volume’ argument, which has been refuted by medical experts at home and abroad. She tried to assure us that the changes would bring ‘significant improvements in services’. We claim that it might bring improvements in some services but will leave patients exposed to serious risks in emergencies and the young, the old and the poor will suffer greatest. The Minister then outlined the changes, which we are very much aware of. One of the claims is that the Medical Assessment Unit in Cavan provides better, safer and significantly easier access to acute hospital services in the Cavan./Monaghan area. Who are they trying to fool – the acute services in Monaghan at the moment are second to none, and certainly more accessible than having to travel to Cavan to access a poorer service. It will, of course, save money for the HSE and reduce the numbers given for those on trolleys. In future, when the GP refers the Monaghan patient to the MAU in Cavan the patient must absorb the cost of the travel to Cavan, thereby savings for HSE and since patients lying on a trolleys in the MAU, or the Observation Ward or the Admissions Ward in Cavan are not counted, then the trolley numbers for Cavan will appear to be reduced but in actual fact there is no reduction – so when is a trolley a bed? There was then a discussion on the Pathways Unit in Cavan, which was total and absolute rubbish.
The Minister then returned to Monaghan situation and gave a description of the New Minor Injuries Unit and the Day Services and went on to say that the HSE has committed to installing a new CT Scanner in Monaghan. We say – big deal – especially when it will only be available when staff come across from Cavan to work it. She continued then to extol the virtues of the ambulance and paramedic service and the added Community Care packages.
The cooperation of GPs will be essential and the HSE will continue to seek engagement with them. Two meetings with GP in the previous week were mentioned but we would like to know the numbers of GPs attending each of these two meetings.
She ended by going back again to their mantra that volume will ensure better outcomes and so centralisation is necessary. Again we state – international evidence does not totally support that argument nor do eminent medical consultants, but when Government Policy is centralisation leading to privatisation they have to justify it somehow and they obviously hope that if they say it often enough people will begin to believe them.
In general then we learned nothing new in the Dail but we came away with some sad reflections. For example – this is a national issue and will effect every patient and family in this country and yet the people of this country were not represented at that debate in the Dail. Surely other TDs should have been there to show support and represent their own constituencies. This constituency is represented by five TDs but only four attended. Perhaps Deputy Smith is content that Cavan is getting the work but when beds are full, waiting lists extended and mistakes made the Cavan people are going to suffer too and the quality of their services will fall dramatically. Surely he should be concerned for own his people, even when he has no concern for the Monaghan people. Lastly – what a waste of time for four sensible people to stand up in the Dail asking the Minister to do something, while he deputy sits patiently waiting her opportunity to read out a prepared statement which ignores the requests of the speakers. Sure anyone could have read the response.Back to Top | | Date Has Been fixed. issued 08-Jul-2009 | reply to | We now know that the HSE intends to end all acute and emergency care in Monaghan General Hospital on July 22nd 2009. History will record this date as the day that the mortal wound was inflicted on the people of Monaghan and beyond, because we are not here talking about just Monaghan, but the entire country. This is the plan for all small hospitals, except of course for 'small private hospitals'.
History will also record those who assisted the process, including local people who supported the plan both inside and outside the HSE.
Local Radio ran an excellent programme of reaction and this exposed other failings too.
It was confusing to hear Deputy Margaret Conlon trying to justify her stance but it all became clear when she clarified that it was only the management of the plan and not the plan itself that she was against. She seems happy enough that services be removed to Cavan when they have enough trolleys for the Monaghan people to lie on. She is hoping to have a meeting with Prof. Drumm to discuss the issue - not that we can see any benefit coming from that. After all it is Government policy - her Government Policy and she would need to ensure that her Government changes the policy before she goes to Prof. Drumm. The Government wants to centralise and privatise and is listening to vested interests. They are also cherry-picking the parts of the Teamwork and Hanly Reports, which assist them to achieve their plans and then using plenty of our money to pay the PR Consultants to produce the spin to trick the populace into believing that they have the patients' interests at heart.
The date chosen is also interesting. It comes after the Dail has closed down for the Summer and with only a couple of days left there can be little discussion or debate on the issue. The Monaghan issue can be sidelined for a few months, just as the economic problems facing the country.
Finally for now - we meet tonight to decide on a suitable course of action for the remaining two weeks of Monaghan Hospital life. However you can be sure that we will have the main protagonists in our sights. The Government, which includes the Greens, might try to off-load the responsibility onto the HSE or Teamwork but we will keep the focus on the Government as it is 'Government Policy'. They might also poinr the finger at Mary Harney - so will we but she is there because this Government wanted someone to hide behind - to take the flak and absorb the missiles fired in their direction - so there is no getting out for this Government.Back to Top | | Public Notice. issued 19-Jun-2009 | reply to | This notice appeared in the Northern Standard:
The People of Monaghan call on Rory O'Hanlon, Fianna Fail TD and Margaret Conlon, Fianna Fail TD,
to 'SAVE OUR HOSPITAL OR RESIGN'.
Dear TD’s,
Only your intervention can now stop the political decision to remove services from Monaghan General Hospital.
This is your last chance to save the lives of Monaghan People.
Jackie Healy Rae TD saved Tralee General Hospital.
Michael Finneran TD saved Roscommon General Hospital.
Will you Save Monaghan General Hospital?
This is a resignation issue:
'OUR LIVES OR YOUR JOBS' - IT'S YOUR DECISION.
Issued by County Monaghan Community Alliance.
This is the first step in a campaign to halt the erosion of basic acute in-patient services at the hospital. Treating all people of this country equally and fairly is central and political power or pay-back should not determine location of services or the amount of risk to be accepted by people. Back to Top | | Here we go too. issued 16-Jun-2009 | reply to | The mix of profits and hospitals is deadly and costly, as revealed by McMaster University studies published in the Canadian Medical Association Journal. "Canadian governments would pay an extra $7.2 billion in annual health care costs if Canada switched to investor-owned private for-profit hospitals," reported the study. According to Dr. P.J. Devereaux, the lead author of the study, "With for-profit care, you end up paying with your money, and your life." He based his statement on a previous study by the group that showed the switch to for-profit hospitals would result in an additional 2,200 unnecessary deaths every year.
It could also result in massive fraud, as it has in the US. In the mid-1990s, health-care fraud by U.S. corporate giants was estimated as high as $100 billion annually. Washington actually started catching up with some of these crooks by 1994 -- the year that National Medical Enterprises paid a then-record $379 million in fines and restitution for fraud in psychiatric services. In 1997, the mega-giant Tenet Healthcare Corp. agreed to pay $100 million to settle claims that patients were kept in psychiatric hospitals simply to maximize insurance payments. Columbia/HCA Health Corp., America's largest hospital company, agreed to pay $745 million to settle civil fraud charges for systematically ripping off Medicare.
Just thought this is interesting - coming as it does from Canada.Back to Top | | Gateway to close. issued 12-Jun-2009 | reply to | The end is certainly in sight now for Monaghan General Hospital.
Contracts are not being renewed.
New staffing arrangements have been agreed with INO.
Huge gates have now been built for the main entrance to the hospital
and will be erected next week. The gates will be closed at night to
prevent patients presenting.
The date for the removal of all acute care to Cavan will most likely
be announced next week.
This will likely be done over a period of one month. 32 of the 58 beds
in Monaghan will close during these 4 weeks. The remaining 26 beds
will be used to care for those patients they have been unable to ship
out to nursing homes or which they intend to retain in Monaghan––using
it as a step down unit.
These patients will require nothing more than nursing care. There will
be no doctors in the hospital except during office hours, Monday to
Friday.
Monaghan General Hospital will retain a doctor (registrar) in the
Treatment Room during its opening hours of (maximum) 12 hours per day
for the month. Until they have completed a public awareness campaign
to tell patients not to present privately at MGH.
LESSONS:
1 If you are not served by one of the 12 designated 'centres of
excellence' for acute and emergency care acrosss the country, then
prepare yourself and your family for a similar fate to Monaghan. Do
not be fooled that it will not happen - it will. And all the Jackie
Healy Reas and Michael Lowrys will not be able to prevent it.
2 Medical cards do not pay for transport for patients to a distant
hospital or for family members to visit them.
3 Private insurance will not help you to reach a distant hospital
faster in times of emergency.
4 If you are served by a Major Centre, then prepare for longer queues,
waiting lists and more expensive health insurance.
5 Prepare for more of your income going to pay for private treatment
for those with no insurance through the NTPF and also through private
facilities.
6 Prepare for more medical mistakes and adverse events, as staff in
the major centres are over-worked and unable to cope.
7 Prepare for an increase in traffic on your local roads, as patients
from the rural areas try to get to that hospital near you.
8 Prepare to wait longer for the arrival of an ambulance, as it will
take much longer for each one to deal with an emergency.
9 Prepare to have to take time off work or to give of your time freely
to care for an ill relative at home. There will be no bed for ill
patients in hospital: they will be discharged as quickly as possible
into the care of relatives.
The times they are a-changing, but not for the better. But then, it
seems the people of this country want the present Government to
continue implementing this disastrous plan for our health services.
Otherwise, in any constituency, they would not have voted them back
into power.
Back to Top | | Stay of Execution. issued 02-Jun-2009 | reply to | May 31st was the deadline but they have deferred the date for an unknown duration. People wonder what the elections have to do with this decision. The excuse given was that everything was not in place to facilitate the removal of services from Monaghan. We say that everything will never be in place but they still intend to go ahead in the near future. Our information is that things are not going to plan in Cavan and are not as 'rosy' as the HSE would claim. They still have too many people being admitted, not enough people being discharged early, and families are being difficult in not taking their loved ones out of hospital and looking after them at home. The MAU is being lauded as a great success but again the word on the ground is that it is under strain and would not be able to cope if Monaghan was taken off call now.
They say they will tell the public when it is going to happen but we wonder how much notice that will give. Of course they must also launch a huge communications campaign prior to that date as they cannot have patients presenting at Monaghan when the services have been removed.
The HSE then just keeps rumbling on to achieve its target of removing the services from Monaghan and making sure that certain HSE personnel will be due a 'performance bonus' at the end of the year. That is another issue but we cannot expect our Government to make changes there when they are unwilling to change their own methods of payments.
The Taoiseach paid a visit to the county on Monday last. It was a closely guarded secret - so secret that some members of his own party did not know where he was going to visit !!! However he did visit, above all places, St. Mary's Nursing Home in Blayney. He was invited to visit Monaghan General Hospital and to meet with the TDs, Medical personnel and with members of the Alliance. He refused this invitation. Was Monaghan a little too far north?
The Councillors and the Alliance decided to form a 'greeting Party' for him nonetheless. It was noticeable that a motion passed by the Council to hold such a 'protest' was ignored by certain members of the council and we noted their absence. However due to the short notice and lack of information we were unable to mobilise in huge numbers, not that we wanted to, as we just wanted to ignore him, who ignored us and has continually ignored us since he became Taoiseach. Of course he is happy to support the privatisation agenda being pursued by his Minister - the partyless Mary Harney, who has also refused to meet with us since she was appointed to the post. Are they afraid that we might make them feel guilty by showing them, and giving them the International Evidence, that the policy they are implementing is wrong and that it will not improve patient safety, will not cost less (it will double the health bill at least), will be even more inefficient, and will cause many more needless deaths. They are pandering to the vested interests, who are going to make huge profits from the illnesses of the people who have the money to pay either for treatment or for insurance and from the tax-payer who will pay for some of those who cannot afford the treatment themselves. Oh, it is so wrong but so many have bought into the spin and are convinced by the spin doctors. Government Party candidates, including Fianna Fail and the Greens, are going about peddling that same spin to anyone, who might challenge them on health issues. We are a gullible race but we will pay the price eventually.
The Taoiseach refused to sit down and talk with us and so we decided to stand and refuse to talk to him. We stood as he, and some of his faithful followers (others went in through a rear entrance, we are told), entered the grounds of St. Mary's on Monday last and there was not a sound from the protestors. We shook the banners but said nothing. We blame him and it was shame on him for coming to our county and refusing to speak to people who have serious concerns. It was a silent protest and people were urged to continue that silence for him and his candidates when they find themselves in the voting booth on Friday. We in the Alliance will wait and see what the people of Monaghan have to say but we have no intention of accepting the implementation of this plan in silence.Back to Top | | Big Mistake. issued 31-May-2009 | reply to | History repeats itself, they say, and we should learn from history but this Government obviously does not. Our State over decades bowed to the wishes of the Church and were swayed by the arguments put forward by that institution. Then they lost favour and the Construction Industry and the Banks took over. This was the Celtic Tiger age and money was God. Money dictated policy and those who had money, no matter that it was purely out on loan, were able to shout loudest and buy their way into the pockets of the powerful and they were able to sway things their way. Now the backlashes are happening. The Ryan Report exposes the cosy cartels and the cover-ups, the turning of blind eyes, the ignoring of pleas from the oppressed. And we all must pay a huge price in consequences.
However a similar situation still exists. The Church and the Builders and the Bankers have been replaced by those who want to make fotunes from the sickness and illness of the people of this country. Driven by a quest for profit, but cloaked in a claim for patient safety and better services, vested interests have gained control and can now manipulate the powers of decision making in their favour. They have convinced the Government that by centralising services, by privatising, by reducing bed numbers, by starving public hospitals of resources they can provide a world class health service. The results so far show just how flawed this argument is but the Government is still blinded by the subterfuge and will not listen to the people, who, through the experience of living this shambles, are trying to get the Government to shout 'stop' and lets listen to the people on the ground instead of these others, who are leading us astray. If they do not do so very soon then it will be too late and in a few years time we will have another scandal to be sorted out and another report to be published, and more huge claims being submitted for compensation and the Government will still not take responsibility.
You think we are wrong - then just look at what has been ahppening over the past decade in health and tell us that common sense has prevailed and that the patient has been at the centre of decision-making. The truth of all this came out when a Fianna Fail candidate called to a certain few houses where he was challenged on the hospital issue. His answer was the stock Government reply - patient safety etc etc and it was the doctors who were at fault. However when challenged on that it was then the Public service who was to blame and they held power because of the stance adopted by the public service unions. That was challenged and it then became the world recession and the HSE, who have squandered the billions given to them. Eventually it came back to these medical people but never could it be the fault of Government or those making policy decisions at the cabinet table. The real culprits will be exposed after a Report is published and the truth is laid bare. In the meantime let us continue to allow these people to make their fortunes from our misfortune of getting sick.Back to Top | | Ambulance Delay Unacceptable. issued 12-May-2009 | reply to | The delay in the arrival of an ambulance to deal with the emergency at Sliabh Beagh Hotel, Knockatallon, on Friday night, May 1st is totally unacceptable to the people of Monaghan and once again shows that patients are being put at risk in order to save money.
Our sympathies are with the family and friends of the late Mr. Boyle, who died as the result of a heart attack, while he attended his sister-in-law’s birthday party in Sliabh Beagh. Nurses at the party carried out CPR successfully but, due to the delay of getting him to a hospital, he suffered a further attack and was pronounced dead at the scene.
When an ambulance was summoned the caller was informed that the Monaghan ambulance was on its way to Cavan and that an ambulance would be dispatched from Dundalk. It turned out that this ambulance was already close to Castleblayney and was directed to proceed to Knockatallon, where it arrived 37 minutes later, according to the HSE (42 minutes according to locals). At one hour and five minutes the Monaghan ambulance also arrived on its way back from Cavan. However both were too late to convey the patient to Monaghan General Hospital, never mind Cavan, and this raises great concerns about the promised ‘better services’ for the people of Monaghan and is further proof that the plan will not work.
The Alliance would question the following:
We were told that there was an extra ambulance for Monaghan and that this would mean two ambulances on duty at night. Where was the second ambulance or is the Dundalk ambulance counted as the second ambulance?
We were told that we would have a ‘First Responder’, who would get to the scene first in a 4 X 4 and have the ability to administer thrombolysis. Where was the ‘First Responder’?
The HSE now claims that: ‘The ambulance service is not a static service. Emergency Ambulance crews are mobile and will respond to assist where required’. What does this mean. Are they saying that the ambulance drives about the roads waiting for a call-out? Are they saying that the ambulance could be based at Castleblayney, Carrickmacross or Clones and respond to an emergency when requested? Whatever way you look at it, it is far from satisfactory and does not work.
The HSE might claim that the extra ambulance and First responder will not be put in place until the hospital is taken ‘Off Call’. Surely they would need to be in place, for a number of months at least, prior to taking the hospital ‘Off Call’ in order to test the system and to attempt to solve the problems arising. Otherwise we are going into an untried and untested situation, which may result in many further deaths. However they likely see it as a cost saving exercise.
Some months back we advised the HSE to get their sympathy cards ready, as they would need them again. Their statement, issued last week, offers their sympathies. Unfortunately we are likely to get more of these in the coming weeks.
The Sliabh Beagh Hotel management has sent a letter of complaint to the HSE and has conveyed its objections to the delay, which gave this man a much poorer chance of survival.Back to Top | | No Response.. issued 12-May-2009 | reply to | We submitted a series of questions to the HSE for answer but to date they have not even acknowledged the correspondence. The questions follow here but we hear on the grapevine that the 5 Advanced paramedics took control of their new vehicles on Monday, May 11th and began work in County Monaghan. We are not sure how many will be on duty at any given time.
The questions we posed to the HSE are:
1. Is it essential that the GPs of Cavan and Monaghan cooperate fully with the MAU prior to the transfer of acute care from Monaghan General Hospital?
2. Will the HSE secure the cooperation of GPs prior to that date?
3. Will the HSE guarantee that the Advanced Paramedic, with the Thrombolysis, or whatever, will arrive with the patient sooner than that patient could have reached Monaghan General Hospital either in private transport or in an ambulance?
4. If it came to pass that lives were being lost and there was an increase in fatalities, after the introduction of advanced paramedics, as happened elsewhere, will the HSE revert to the present system, only managed differently?
5. Who makes the decision to dispatch the Advanced Paramedic and who supplies the information for the making of that decision?
6. What happens if the Advanced Paramedic is en route to hospital in Drogheda in an ambulance with a seriously ill patient and his/her 4 X 4 has been left at the scene, when a second serious call comes in, this time for a heart attack victim in North Monaghan?
7. Let us imagine an emergency in Clara, North Monaghan – there has been a multiple crash or an industrial accident with at least ten injured. We would like the HSE to give us details of their emergency plan to deal with this situation. We know how Monaghan County Council and its services will respond – how will the HSE respond?
8. When is it expected that the extra ambulance will be provided for Monaghan?
9. When is it expected that ‘enhanced ambulances’ will be in service in Monaghan?
10. How will the HSE prevent patients arriving into Monaghan General Hospital looking for treatment after the closure of the Minor Injuries Unit each weekday and all over the weekends?
11. We have been informed that some consultants feel very much under pressure from administration to discharge patients sooner than they (the medical people) would like. What penalties will be imposed to compel the doctors to comply with earlier discharge times?
12. Can we have details of the work necessary to set up the 13 rehabilitation beds in Monaghan General Hospital?
13. How many Physiotherapists will be employed to work in the Rehabilitation Unit?
14. We ask the HSE to give us exact details of the 10 extra Community care packages, which they claim will support the early discharge and ‘hospital at home’ system. We also need to know the total Community Care packages in counties Cavan and Monaghan.
15. If these Community Care packages are set up, can the HSE guarantee the people of Monaghan that they will continue indefinitely with adequate funding.
16. How many Primary Care teams are planned for Monaghan County, what is the location of each, when will these be operational, what will they offer, who pays for the services provided, and why do they not have to be in place prior to the removal of services as recommended by Teamwork.
17. Will the HSE please explain how these Primary Care teams, if set up, will be able to replace acute hospital services?
18. When a ‘Review of Services’ states that certain services are unsafe in a particular hospital, why is the HSE so erratic in its follow-up decision making. If a ‘Review’ is critical of services in places like Monaghan the decision is to ‘remove it’ but if the ‘Review’ is critical of services, like A & E in Cavan, those services will not be closed – ‘it is not going to happen in the current circumstances’ as it depends on the provision of a new Regional Hospital. Teamwork recommended that Monaghan should lose it services following the building of the New Regional Hospital. Surely – what’s good for the goose is good for the gander but not in Monaghan’s case.
19. How will the cost of providing the transformed configuration of health services compare with the costs associated with the present system and please supply us with figures to show the cost of the reformed healthcare system in the Cavan/Monaghan group.
20. Has any consultation with service users taken place in Monaghan and if so please supply details?
Back to Top | | Statement from Community Alliance 12/05/09. issued 12-May-2009 | reply to | At our meeting on Tuesday night it was decided not to enter any candidates in the forthcoming Local Elections. We have discussed the issue at numerous meetings in recent months and came to the conclusion that entering the political field at local councillor level would not serve to further our campaign in any effective way.
Monaghan General Hospital is a national issue and its future will be determined by Government policy. The present Government is intent on removing acute care from small hospitals to further their agenda of privatisation and centralisation and we have witnessed the powerlessness of local councillors in getting the ear of those in Government and especially those in Cabinet.
If the downgrading of Monaghan General Hospital is to be halted then the pressure must be exerted in Dublin, as has been proven by the U-turn achieved by Michael Finneran TD. for Roscommon Hospital, when he took a strong stand against the plans to remove services from there. Our opposition TDs have been constant in their calls for a change of policy but those in power do not listen. Our Government TDs have been weak and lacking in commitment to achieve a change or they agree with the plans – either way they have been unable to secure the future of acute care and emergency facilities at Monaghan. They, therefore, must accept that they will be held responsible, with their Government colleagues, when things go wrong. Indeed there have been many issues of late, which raise serious concerns, but our Government representatives have been noticeably silent. They must also accept that their tactic of discussion, meetings and diplomacy has failed to save Monaghan General Hospital from decimation.
We are conscious that many expected the Alliance to get involved in these local elections and we thank them for the encouragement and support they have given us. However we have made our decision in what we consider to be in the best interest of our Hospital and we hope that the support for the campaign will continue to manifest itself.
Further information:
Peadar McMahon, Chairman, 0860443300
Back to Top | | Declan Ganley Impressive. issued 09-May-2009 | reply to | The Alliance met with Declan Ganley of Libertas on Saturday last, May 9th. Peadar McMahon and Enda Fields were our representatives. They briefed him on the current situation and the possible actions of the coming weeks. They also broadened the issue out to include the other small hospitals in Ireland and discussed the issue as a European problem. He had visited the hospital and had spoken to some staff members prior to the meeting. He was very impressed with the hospital and its potential and was in agreement with our campaign and demands.
He asked the Alliance to attend his public meeting on Saturday night to discuss the matter further. Peadar McMahon attended.
Peadar reports as follows:
It was amazing the number of those out of the 50 or so present, who were anxious to bring up the hospital issue. Some of these were not even from County Monaghan but saw it as a further example of incompetence and unsafe practice by the current Government. They applauded the work of the Alliance and encouraged us not to give up the campaign, even though the end seemed near.
Declan Ganley had great empathy for the people of Monaghan as he himself and his family depend on having the services in Roscommon hospital, which is also under threat. He referred to the dangers of not having the basic emergency services within reach of a victim, whether it be a heart attack or a traffic accident, and stated that hospital services must be based on geographical considerations rather than volume and numbers. This is something, which he has promised to tackle, when elected, and he has promised that he will host a major meeting of experts from all over Europe and this meeting will be in Monaghan. The purpose will be to devise a plan whereby hospitals like Monaghan will be able to provide for the basic requirements of the people living in its catchment area. He is very interested in the cross-border aspect and knows that this has been successfully implemented in other countries. He is also very interested in telemedicine and knows that this can be central to a solution.
The economy was a big talking point, as would be expected, and Mr. Ganley had lots to say on the way forward and how places like Monaghan can survive the recession. He once again brought the hospital into the equation as he sees the existence of an acute hospital as essential to economic development of an area, especially in rural Ireland. Ireland is being urbanised and centralised and both are detrimental to the future of this country. Rural Ireland must be maintained, sustained and revitalised to encourage the entrepreneurial spirit for which this county is well-known. Otherwise young people will have to head off to foreign shores to seek a living and rural Ireland will be deserted. Education and health are the two most important aspects that must be enhanced rather than cut-back.
It has to be said that Mr. Ganley was very impressive and gained much support from his presentation. He has a plan and revealed the plan to us and that is a very welcome step forward.Back to Top | | How long until .. issued 25-Apr-2009 | reply to | How long will it be till we have another Susie Long type disaster in our health services? Not too long we would hazard a guess judging by the latest scandals. The HIQA report on Waterford Hospital was carried out last Autumn. Where has it been since then? Has it been locked away in a store-room? Has it been sitting on the Minister’s desk? One thing is sure – it was not released to the public until now. Why? They did not hide the Ennis Report for six months – oh no – it was out there like a shot and the Minister wanted to use it for her purpose – to remove the services from Ennis. There have been other reports, which have found large hospitals deficient, but they too have been overlooked and dismissed with a promise that the recommendations made in the report would be implemented. We are told that the Waterford report is now irrelevant – the person who said that also needs to be removed from office as it shows a total disregard for the patient or patients who used or require those services in Waterford. All this has done is further undermine the confidence of the public in the HSE and the Minister and when they tell us that ‘significant progress’ has been made to rectify the situation we are not quick to accept it.
Then we have the storm over the numbers waiting for a colonoscopy and the Minister tells us that ‘urgent cases’ will be given priority. Who can decide if it is an ‘urgent case’ without the test – the patient needs the test to ascertain the problem and then it can be classed as ‘urgent or not’. However if Mary Hareny was told that she needed a colonoscopy to rule out anything sinister I think she would immediately regard herself as ‘Very Urgent’ - so what is the difference then between her and ordinary Joe Soap?
She is also reported as saying that the two tier system has been done away with since the consultants signed the new contract – she’s wrong again. It is still there and money still gets you in faster. Not only is there a two tier – there is also a three tier when one includes the diabolical National Treatment Purchase Fund. This is another scandal which has been allowed to continue and increases the cost of health care to the tax-payer.
All in all it is time Brian Cowen smelled the coffee and removed the curtains and had a look at the real happenings in Health and where we are heading. He should then clear out the health nest of minister, advisors, Prof. Drumm and his advisors and get some common sense into the running of the this country. The advisors who led him into removing medical cards from over 70’s, the removal of pensions and long service payments to TD’s, the bailing out of the banks, and all the other catastrophic decisions are leading us down the slippery slope to disaster and needless deaths. Wake up Brian and listen to party members like John McGuinness.
Back to Top | | Removal before May 31st ? issued 22-Apr-2009 | reply to | Sunday May 31st 2009 is ‘D’ for ‘Disaster Day’ for the people of County Monaghan, as information has come to hand, which would indicate that all acute care will be removed from Monaghan by May 31st and that the hospital will go ‘Off Call’ from that date. This will fit in with the staffing levels for the hospital from June onwards, when it appears to be the plan that, in total, two nurses and two carers will be on duty in the hospital during the night hours.
The decision to transfer acute care from Monaghan was supposed to happen when an evaluation of the Cavan Medical Assessment Unit took place after two months in existence and then in a structured and planned manner over the summer months. However financial reasons are being cited as the reason to fast-track the plan and it seems that patient safety can be compromised for the sake of keeping within budget. Any concerns in relation to lack of capacity in Cavan will be solved, according to the source, by reducing access and cutting down on the number of patients being admitted to hospital in the first place.
So despite the opposition expressed by the GPs and medical personnel in Cavan and Monaghan, despite the long campaign by the people of Monaghan, despite the promises of Government party representatives, despite the needless deaths last time Monaghan was ‘Off Call’, despite the contra-indications from the experiences of other places, despite the warnings from expert medical opinion, and despite the number of alternative methods, which could be used, this Government has decided that they will remove all acute inpatient care and emergency treatment from Monaghan General Hospital. Warnings were issued that lives would be put at risk last time Monaghan was ‘Off Call’ and lives were lost needlessly. This time we are told that advanced paramedics and enhanced ambulances will adequately replace hospital treatment. The death of Dan McDonnell in Clare this week does not inspire us with confidence – rather it adds to our fear that we are once again to face the needless deaths and hear the ‘regrets’ expressed by the HSE and Government. Indeed the international experience of pre-hospital care, provided by paramedics in a speeding ambulance, has been shown to be problematic to say the least. The HSE and Government, however, using millions of tax-payers money to pay ‘spin doctors’, continually try to convince the public that they are putting the patient at the centre of decision making and that their reforms are to improve patient safety and patient care. However their claims do not stand up to scrutiny.
The HIQA report into services at Ennis General Hospital uses the same arguments as the Teamwork Report for the North East and appears to manipulate the research material for its own ends. The platform, on which it relies, is the Volume/Outcome principle, which claims that the bigger hospital with greater volume of patients will have better outcomes for the patient. However the three key references from international research, which HIQA draws on, can be refuted by that same research. The report fails to use the entire conclusions of these research papers and thereby misleads the public. As an example the HIQA report does not mention an Editor’s note, where it concludes that ‘’high volume does not necessarily lead to better process of care or better outcomes in all clinical conditions’’, and again quoting from research – “a shift of care to higher-volume hospitals is justified only if it does not delay the diagnosis and treatment”.
Indeed another of their references contains the following statement, not used by HIQA – “using volume criteria alone to choose a provider may in some instances increase the risk of mortality’’, and for the record - since most of the research relating to Volumes and Outcomes comes from the USA, it is worth noting that in a league-type assessment of [6,000] American hospitals in 2002, 40 of the top 100 US hospitals were small to medium in size, i.e. with bed numbers ranging from 25 to 250.
Some will accuse us of ‘scaremongering’ once again but if that’s what it takes to make people aware of the seriousness of the situation we are facing - then so be it. However our claims in the past will verify that we have never been far from accurate other than in timescale and, unfortunately, unless this Government changes policy immediately, our predictions will materialise again. If you think that our predictions are correct then you have a duty to yourself and your families to do something about it. People will be calling to your doors over the coming weeks and you must make your feelings known to them. Monaghan is being stripped of its assets one by one and the people of Monaghan are being abandoned, with pitiful sops being offered from time to time. Post Offices, Army barracks, Garda barracks, headquarters for various bodies, and jobs are being taken from us and our communities are being threatened with extinction. Major funding was spent over the past decade to promote community and volunteerism and at the same time the central supports for community were being taken away. We are losing our identity and our pride of place and they want to gather us all together in major urban sites, thus creating ghettoes with the ensuing social problems. Now they are also putting our very lives at risk. It is not acceptable and all sections of community, from sporting organisations to the Church, must stand up and reject, in the strongest manner possible, this erosion of rural life.Back to Top | | Sad news ... issued 20-Apr-2009 | reply to | The news that a man, Dan McDonnell, died a short distance from Limerick Hospital after having been taken past Ennis, is ringing familiar bells with members of the Alliance and the people of Monaghan. It was forecast that this would happen and that there would be needless deaths. Is this the start of it? We do need a full enquiry to ascertain exactly what happened and the sequence of events leading to his death. However we would not have much confidence in an enquiry carried out by the HSE themselves. We know what that will end up saying.
In the meantime we pass our deepest sympathies to the wife, children and relatives of the late Dan McDonnell and we would hope, if there is any suspicion or inkling that his life could have been saved had he been taken to Ennis and the services had been in place, that decisions can be reversed and that his death will not have been in vain. We also encourage the committee and the people of Clare to continue the campaign to have these basic services placed in Ennis on a 24/7 basis and to point the finger of blame where it needs to go.
We also wonder why this has nopt made the news headlines in this area of Monaghan as it is surely a news item that has big links with people from this area - but then it would not be proper to highlight things like that.Back to Top | | Money talks.. issued 15-Apr-2009 | reply to | It just proves how disadvantaged a group like ours is when it comes to campaigning against a power like the HSE when you see the full page articles in last week’s Northern Standard. WE have no problem with the Northern Standard, as they have always been very open to any of our statements. However many other media outlets are not as balanced and swallow ‘spin’ without having to have a drink of water to go with it. If the HSE, or other Government backed organisation, utters any statement it seems to be accepted as gospel and any slant or hidden twist to facts, that might be used, are unseen by the reporters. We cannot afford the millions necessary to purchase the services of top class ‘spin merchants’ to phrase our statements or do our press work for us but that does not change the facts nor does it make what is happening to us in Cavan/Monaghan any more safe. We did blink when we realised the number of Public representatives who attended the big launch and the number of journalists who were present. Does that mean that HSE managers outnumbered the guests? We were, however, disappointed by some of the comments reported as having been made by some of the Public representatives and we would wonder if their party colleagues in Monaghan would agree with the sentiments they expressed – but more of that anon.
The Medical Assessment Unit is open in Cavan and we have no problem with that. The fact remains that if a Monaghan patient wishes to avail of the services there they will have to travel and that is where the problem lies. How will everyone be able to do that? It will not provide equal access and are we going to have more and more people discharged at all hours of day and night and left to fend for themselves? We know of those who have had to pay huge sums to taxi firms to get home from Drogheda and Cavan prior to this – will the numbers now increase and will people be able to pay the fees? This moving of services is supposed to save money for the HSE but all it is doing is transferring the cost directly to the patient.
It is also meant to cut down on the number of beds needed in Cavan – but again all it is doing is putting the patients into a side room while awaiting a bed. It cannot be argued surely that they are not ‘in the hospital’? They have put fancy names on these side rooms – Admission Lounge, Observation Ward and Transit Lounge. The word lounge conjures up nice thoughts but this is what has been happening to reduce ‘patient on trolley’ numbers – shove them into a side room and, even if they are sitting on chairs, they are not counted as patients on trolleys.
They keep telling us that this MAU is similar to that in St. Luke’s in Kilkenny. Our information is that it is different in many ways and especially in relation to the co-operation of local GPs. However it is once again just part of the ‘spin’ just as we got from the Minister re. health services in other countries.
Our main concern still exists and that is - what will happen in times of emergency. We are constantly told that the services will not move unless all parts of the jig-saw are in place and working. That cannot be true. If they take Monaghan ‘Off Call’ then immediately we will rely on the ‘enhanced ambulance’ and the advanced paramedics. So what happens if they are not capable of providing a safe service – will Monaghan then go back ‘On Call’? no chance – we will have no staff in place to do so. The managers seem to be very positive that this will all work perfectly from day one. We will hold them to that but we are far from confident. It is one thing to have a licence to administer 100 different drugs – it is another thing to administer the proper drug at the appropriate time and that, for an advanced paramedic working in difficult situations and conditions, could happen sooner rather than later. The experience in some places, where advanced paramedics are first responders, is not all positive and intubation by paramedics has increased fatality numbers and has caused great ‘concern’. Other countries, where this system has been tried, are different to rural Monaghan and rural Cavan. Other countries use ‘distance to hospital’ as the criteria whereas the Irish Government uses population numbers as its criteria – a system developed in the UK for the Greater London and Greater Manchester areas, which are so different to Ireland.
There is also the problem with distance to Cavan or Drogheda and we have no confidence that paramedics in a speeding ambulance will be able to keep us alive until we get there or that we will not have suffered more pain and deterioration during that time, deterioration that cannot be reversed. International research supports our view and it is amazing how the HSE can quote ‘International best practice’ to us when it suits but they ignore and dismiss that best practice when it does not support their plans.
They can keep telling us of the increased number of services and the busy schedule of work that will happen in Monaghan but that, too, does not take away from the worries and fears we have about reaching that other hospital alive but their ‘spin’ keeps trying to divert our attention away from silly things like dying in an ambulance on the way to Cavan. We will be advising the people of Monaghan to be prepared to question every death of a loved one and to get satisfactory medical answers to deaths in ambulances and after arrival in a distant hospital. A manager is reported as saying that the move of services from Monaghan would not take place until it was seen that the new system was ‘working effectively enough to make the move feasible’. To us ‘effectively enough’ is not acceptable but it does tell us that less would satisfy them. Is that because they do not have to live with it?
We will come back to this issue later but right now we have to read an article in the Village magazine in relation to Mary Harney and her husband, Brian.Back to Top | | Explanation please.. issued 15-Apr-2009 | reply to | The question keeps coming up, as it did again at our meeting tonight, Wednesday, that we cannot get an answer to and we have never heard the HSE explain it to us but it is confusing.
They tell us that the reason why the Treatment Room services have to be downgraded and why acute care has to be taken away is that these are not sustainable because of the small numbers of patients. Small numbers, they say, means that staff lose their skills and the service becomes unsafe. They also say that economically it is not sustainable either because of the small numbers of patients.
The question - how will the replacements - the paramedics - remained skilled as they will have similar numbers to deal with. As a matter of fact there will be an increase in numbers to attend the same number of patients and therefore they should lose their skills faster. If they are to be upskilled and retain their skills - how will this be achieved? Surely the existing staff could have been upskilled in a similar manner. What is the difference?
Regarding the economies - has the new system been costed? Do they know how much it is going to cost? We have never seen and we doubt if there are any figures available but, from the experience of other places, the cost will be much greater for the new system. Isn't it a wonderful country that proper costings did not have to be produced before the work began but then that is no surprise either.
Conclusion - their arguments do not add up and are flawed. Back to Top | | Response to Ennis Report. issued 10-Apr-2009 | reply to | We cannot but welcome any report that recommends an improvement in patient services and patient safety. However this report is incomplete and is lacking in accountability. It highlights certain deficiencies but fails to lay the blame at a door or to point the finger at the office holder(s) responsible. It then suggests a manner in which the concerns should be addressed and we have a major problem with those proposals.
Ennis Hospital, like many other similar sized hospitals including Monaghan, was likely starved of resources for years. Necessary structural work was neglected, locum and temporary staffing was the norm and acceptable to the authorities, vacancies were left unfilled, empty promises were made and reneged on, staff concerns were ignored, managerial structures were absent or failing, all leading to demoralisation of staff, a loss of confidence for patients and the increasing likelihood of mistakes in many hospitals. Now they are going to use the problems in these hospitals to justify the removal of services and this is where we really object to this report – closing down the services and moving them to a distant hospital does not solve the problems – it just creates new ones and is unsafe for patients. Yes, medicine has changed and the methods of delivery have to change but placing the basic requirements of people at a distant location is not the way to go if the patient is at the centre of decision making.
Once again we hear the mantra trotted out that volume equals better outcomes. Dr. Jim Jamison, Health Research Consultant, Belfast and Dr. Michelle Butler, Senior Lecturer, UCD School of Nursing, Midwifery and Health Systems, Dublin, are quoted as follows: The presumption that there is a strong relationship between volumes and outcomes has been a major driver of centralisation. Yet there is no compelling evidence for such a relationship, except in a relatively small number of specialties. However, and perhaps more importantly, there is evidence that multidisciplinary approaches produce better results, and such coordinated efforts also require larger teams – though in some cases they need not require centralisation and can be achieved through clinical networks instead.
Again a comprehensive report on the National Health Service in Scotland in 2005 (the Kerr report) has the following recommendations: Empower multi-disciplinary teams in community casualty departments to provide the vast majority of hospital-based unscheduled care – networked by telemedicine to consultant led emergency units.
Research has shown that services can be delivered safely, economically and efficiently in small rural hospitals using modern technology – so why is this not an option in Ireland? What we are expected to accept is that, as a number of complex surgical and medical interventions benefit from volume, we must move all acute care to these high-tech super hospitals. That is a waste of resources and puts lives at risk due to ‘distance decay’. The alternatives of advanced paramedics and enhanced ambulances, which we are offered, have not been tested in Ireland yet we are to become the ‘guinea-pigs’. Indeed in countries where this has been introduced, like Auckland, there have been many problems reported and an increase of fatalities. Is there an accepted mortality level for the rural people of Ireland?
The question we ask then is why has HIQA gone down this road? Is it because they must keep their recommendation in line with Government policy of centralisation? Is it because they do not understand the needs of rural populations and will not have to live there themselves? Is it that they too are promoting the Private Agenda – helping to create the markets to attract the private investor to provide the services? Is it that they are being used by Government to achieve the closure of small hospitals?
It must be something other than patient safety as we cannot find any other country, where the rural populations are being abandoned so blatantly as here in Ireland.
We are also puzzled by the fact that there have been mistakes and problems in bigger hospitals and major hospitals and they have been investigated but in none of those cases was it recommended that services be removed – rather the reports were quietly shelved and the problems brushed under the carpet. There is something not right about all this. Back to Top | | Making a mockery of Monaghan? issued 03-Apr-2009 | reply to | On 31st March 2009 Deputy Caoimhghín Ó Caoláin put an Oral question to Mary Harney re. the difference between Roscommon Hospital and Monaghan Hospital, where Roscommon has been allowed to maintain services that have been removed from Monaghan - services that were planed to be removed from Roscommon but, after lobbying by Michael Finneran, this plan was scrapped and the services remain there. However in Monaghan the services continue to be drained away till we are almost at the point of turning the key in the door. The pathetic attempts at a reply are nauseating and repulsive. The effort to make a differential between Roscommon/Portiuncla and Monaghan/Cavan fell flat and Mary Harney then fell back on that elusive claim - services 'were removed for patient safety reasons' !! Convince us Minister, remind us of all the mistakes made in Monaghan General Hospital, remind us of all the needless deaths due to the poor and unsafe services in Monaghan General Hospital, give us the number of patients who died because they first went to Monaghan General Hospital, tell us why the staff in Monaghan were treated so abominably? - tell us why management was removed from Monaghan General Hospital? - tell us the real reason why maternity was taken from Monaghan? - tell us the real reason why surgery was taken from Monaghan? - tell us why Monaghan was taken 'off call' in July 2002? - tell us why there were questions over the deaths of 17 people before emergency medicine was restored to Monaghan? - tell us why the medical establishment in Monaghan does not agree with your evaluation of patient safety requirements? - give us your guarantee that we will be safer in an emergency when these 'new plans' are implemented, - give us your guarantee that lives will not be lost needlessly, - guarantee us that you, even though you may not then be Minister or even in politics, will take personal responsibility for the problems, which might arise as a result of this removal of services from Monaghan, and just tell us why you have refused to meet with us since you became Minister.
Then the Chairman called a conclusion to your reply to Caoimhghin O'Caolain and you were off the hook. Deputy O'Caolain's response is reported as 'That is absolute nonsense' - we might have stated that in a different way.Back to Top | | Stuck in a groove. issued 03-Apr-2009 | reply to | The responses we get for any of our questions in relation to the removal of services from Monaghan General Hospital seem to all say the same thing but it does not seem to be getting the message through to us, and not because we are 'thick' but because we are living with the scenario and have experience. The record seems to be stuck in a groove.
Deputy O'Caolain asked a question, for written reply, from Minister Harney on March 31st last and we get the same fudge churned back to us, which includes: 'Finally, I must emphasise that the changes proposed by the HSE and fully supported by the Government are for reasons of patient safety. The HSE will work with all stakeholders to bring about the improvements in a carefully planned way that puts patients first'.
The only part of that statement we can agree with is where it states that these changes have the 'full support of Government'. Yes we have always maintained that Government must bear the responsibility and that includes the Greens, who made a deal with the people of Monaghan prior to the election - but we will have more to say on that prior to local elections in a few weeks.
Secondly we are not convinced about the 'patient safety' argument, as research does not back it up and, since certain procedures, never tried and tested in Ireland before, are now being introduced to make guniea pigs of the people of Monaghan, it is difficult to be accepting of these plans.
Lastly the HSE is not working WITH stakeholders - it is DICTATING TO stakeholders - medics and patients alike - and this is not a great way of achieveing anything. All our attempts to begin meaningful discussion and debate have always met with resistance and the meeting soon turned to - 'yes we can discuss that but we will still do what we have planned and you can go take a jump' type of attitude from the authorities. So that is putting patients first? As for implementing in a 'carefully planned way' - well all we have to do is look back at the record and once again our confidence is knocked to base level and fear replaces all other emotions.Back to Top | | Health Stats?? issued 23-Mar-2009 | reply to | The HSE today has launched the new Health Stats on its website and this is going to really change how services are provided in Ireland - not likely.
We have three problems with this process:
1. Why are these results being published? Is it a case that they want to direct patients away from certain hospitals or do they want to embarrass other hospitals to do things differently, but in a way that may not be in the interest of the patient - e.g. early discharge and in some cases - discharge too early. HealthStat chair, Maureen Lynott, states that: '“HealthStat is a powerful tool but it is complex – like the services it represents. It is designed for use by professionals working in the health system and also by other professional groups with an interest in the health system.” but why put them on a public site? Surely the public will visit the results and, not being able to interpret them correctly because of the complexity, will come to the wrong conclusions.
2. We must ask about the missing pieces of the jig-saw. One aspect of the provision of hospital services, which seems to be absent from the stats is the role of the HSE management and administrators. They have a major impact on the efficiencies and the manner in which services are delivered but there does not seem to be figures included in these Stats to represent this. Prof Drumm states: 'The information includes measures such as outpatient department wait times, the average length of time patients stay in hospital, GP access to diagnostics and if patients and their families are being informed of their treatment and included in discharge planning. It also records how well each hospital is using its resources measured by example, absenteeism levels, number of patients seen in out patient clinics and therapy'. So what about mismanagement? What about weak management? What about inefficiencies in management?
3. Who is collecting the figures and putting them together? Who is drawing the conclusions from those figures? Who will be able to influence the outcomes? Will the figures be accurate? Who will check the accuracy of the figures? Who will check the person who checks the accuracy? How many people, some of whom should be spending their time treating patients, will be involved in a hospital in getting the facts and figures available each month?
These are worrying questions for us and we have other concerns too but more of that anon. We were not surprised, however, that Monaghan General Hospital was left out of the equation. The HSE uses every opportunity to get the message out there that Monaghan does not exist.Back to Top | | Prof. O'Keeffe V HSE issued 23-Mar-2009 | reply to | | Professor Michael O'Keeffe was interviewed by Pat Kenny on his morning programme this am. What a performance? That man should be Taoiseach. He is so full of common sense and good ideas. He is of course working at the coal-face and knows what he is talking about - not like some of those who are making profound statements on our health services. The HSE have really no reasonable reply to his points. He is another Gerry Robinson and would get the same results as Gerry did, if he were given the freedom and resources to do what he wants to do and what he can do with great expertise and skill and professionalism. He is not alone - there are many similar consultants round the country who have their hands tied by the bureaucracy of the HSE and the system in which they have to work. We too had consultants like that in Monaghan but they were frightened away and forced into a position, where they could not perform their duties efficiently or properly. He was so right when he referred to all the platitudes and cliches used by HSE personnel on a daily basis - we are sick and tired listening to them. The HSE person on radio at the same time claimed that she talks to frontline staff all the time - there is the crunch - she does not listen nor does anyone in the HSE - they have their minds made up by others and they pretend to listen but it will never change anything as the decisions have already been made further up the line of command. Prof. O'Keeffe wants the HSE to sit down and really listen to him and his solutions and ideas. We are extending the same invitation to the HSE - sit down with us and listen to what we have to say. Afterall - we are the people who live here and will have to put up with the consequences of the decisions.Back to Top | | Cross-Border Cooperation. issued 23-Mar-2009 | reply to | Here we reproduce parts of studies carried out by the Cross Border Studies group in Armagh in relation to Cross Border Hospital provision:
1. A report, commissioned by the Centre for Cross Border Studies:
As far as the economics of cross border co-operation are concerned, such initiatives provide an opportunity to enhance the services provided to populations either in the vicinity of the border, or more widely, by increasing ‘critical mass’ to justify concentration. Evidence that this will produce benefits attendant on exploitation of economies of scale in the acute sector is not strong, and is counterbalanced by good evidence of decay in utilisation of a service as the distance from it increases. Evidence of a relationship between volume and outcome is mixed. The argument that services must be centralised in the interests of quality - given opportunities for more imaginative patterns of service delivery and the observed distance-decay problem - is not supported.
2. Removing the Barriers to Cross Border Cooperation in Health:
The Cerdagne region
The situation in Ireland contrasts markedly with that in some other parts of Europe, for example in the isolated Cerdagne border region in the eastern Pyrenees between France and Spain, 100km from Perpignan and 140km from Barcelona. The closest surgical or obstetric facilities in France are more than an hour’s drive away. For over a decade a well equipped hospital in Puigcerda on the Spanish side of the border has acted as a de facto emergency clinic for French patients. Agreements were signed in 2002 with the regional French hospital authority and in 2003 with the Languedoc Roussillon health insurers to ensure that the hospital would be reimbursed for emergency and obstetric care delivered to French patients.
More importantly, a project is now under way to build a crossborder hospital in Puigcerda which will serve the population of the entire border region and be jointly planned, funded and managed by the French and Catalan health authorities.
Conclusions
There is clearly scope for such hospital planning and rationalization exercises in the border region of Ireland. In particular there is a need to revisit the Teamwork Report to investigate what difference might be made by allowing for a greater flow of patients into the North Eastern region from Northern Ireland and vice versa. The recommendation in the report was for a new regional hospital in the southern part of the region. As the report itself acknowledged, there would then be appreciable overlap between the new hospital’s catchment population and those of the hospitals in north Dublin, and there must be considerable uncertainty about whether the net flow would be in a northerly or southerly direction. An alternative would be to locate the new hospital in the northern part of the region where it would cater for a portion of the residents of South Down and South Armagh. We recommend further detailed study of this option.
This would involve a careful examination of whether the catchment population criterion in the Teamwork Report, which was developed in a society (England) with a very different settlement pattern to that in Ireland, is really appropriate for a sparsely populated rural region; also whether a different balance between benefit and risk should be struck.Back to Top | | Respect or profit? issued 23-Mar-2009 | reply to | Christopher Balchin lives in Yankee Lake, teaches social studies and is a co-author of Aesthetic Realism and the Answer to Racism. The following is an extract from a piece of his work:
American philosopher Eli Siegel, founder of Aesthetic Realism, said that contempt, thinking we'll be more by making other people less, is the greatest interference in people's lives, including in economics.
One of the most foul instances of contempt today is the exploitation by a few people of the sickness, pain and worry of millions of others, including the elderly. Ellen Reiss, the class chairman of Aesthetic Realism, explained why for-profit companies and decent health care are like oil and water when she wrote: "Once you are after profit, you can't be too interested in what people deserve. ... It will cramp your ability to make money from them." The most pressing needs of Americans today are seen as an opportunity for profit. It doesn't have to be that way.
In order for every American to get the health care they deserve, this question, which Eli Siegel asked, must be addressed: "What does a person deserve by being a person?" Back to Top | | Reality - or spin No. 2 issued 22-Mar-2009 | reply to | This Government is allowing and supporting the Minister for Health to privatise our health services on a massive scale. We are also told of the great Health service in Canada and it is often quoted to us as the prime example of good practice and international best practice. Here we quote from an article in the Canadian Healthcoalition website which should be of interest to every person living in Ireland and depending on health services here:
Reality Check
For-profit health care facilities ...
a) have higher death rates than not-for-profit facilities (1,2,3);
b) cost more (4);
c) provide lower quality services(5);
d) engage in schemes to cheat taxpayers (6,7,8);
e) compromise access to public services (9); and
f) provide less nursing care than not-for-profit nursing homes (10).
References:
(1) Devereaux, P.J., et al, "A systematic review and meta-analysis of studies comparing mortality rates
of private for-profit and private not-for-profit hospitals", Canadian Medical Association Journal,
May 28, 2002; Vol. 166, No. 11
(2) Thomas, E., et al, "Hospital Ownership and Preventable Adverse Events", Journal of General
Internal Medicine, April, 2000
(3) Devereaux, P.J., et al, "Comparison of Mortality Between Private For-Profit and
Private Not-For-Profit Hemodialysis Centrers,"
Journal of the American Medical Association (JAMA), November 20, 2002; Vol. 288, No. 19
(4) Devereaux, P.J. et al, "Payments for care at private for-profit and private not-for-profit hospitals:
a systematic review and meta-analysis", Canadian Medical Association Journal, June 8, 2004;
170 (12): 1817-24 / Woolhandler, S. et al, "When Money is the Mission - The High Cost
of Investor-Owned Care", New England Journal of Medicine, August 5, 1999, Vol. 341, No. 6
(5) Schneider, E. et al, “Quality of care in for-profit and not-for-profit health plans enrolling Medicare
beneficiaries,” The American Journal of Medicine, vol. 118 no. 12, December 2005
(6) Eichenwald, K., "Hospital Chain Cheated U.S. On Expenses, Documents Show",
New York Times, December 18, 1997
(7) Steward, G., "Public Bodies, Private Parts: Surgical Contracts and Conflict of Interest at the
Calgary Regional Health Authority", Parkland Institute/University of Alberta, March 5, 2001
(8) British Medical Journal (May 15, 2004), "NHS overcharged for private surgery"
(9) Canadian Health Services Research Foundation, "Myth: A parallel private system would reduce
waiting times in the public system", 2001
(10) Harrington, C., "Does Investor Ownership of Nursing Homes Compromise the Quality of Care",
American Journal of Public Health (September 2001). Back to Top | | Maybe Not Just Yet.. issued 12-Mar-2009 | reply to | It seems the HSE is not as poor as they thought, for instead of €1.2 billion shortfall it is really only €480 million and the Department of Health has kindly decided to bring this down to €275 million. This means that the cuts will not be as drastic as first thought, nor will they have to select the closure of a number of hospitals in order to break even at the end of the year. This does not mean that they did not discuss the possibility of closing some hospitals and we are convinced that this was one method, which was on the table to help reduce the shortfall.
However, that is it for now, it seems, though one never knows these days what changes force a new scenario almost overnight. The closure of four hospitals was really going to be rejected and would have given rise to a backlash, which was not needed prior to the Local and European elections in early summer. Once they are over decisions like this can be made and in some cases will have to be made because the resources will be reduced to an unworkable and unsafe level.
Meanwhile our campaign carries on as we are still totally opposed to the removal of acute in-patient services and the downgrading of the Casualty Unit to a Nurse-led Minor injuries unit. Our next step will be made known shortly. It appears that the Minister and Cabinet in general were not in favour of the hospital closures so close to election time and therefore the Department took the pressure off them. But the question still remains and we will not get an answer to it but who is doing the accounting in the HSE that gets the figures so badly wrong - from €1.2 billion to €480 million?Back to Top | | More Double Speak.. issued 08-Mar-2009 | reply to | We smiled, sneeringly, when we read the statements reportedly made by Professor John Higgins, the medic appointed to oversee the implementation of reforms in the southern area, in relation to the future of Bantry and Mallow Hospitals last week. We in Monaghan heard this type of language, ad nauseum, for the past six years from Taoisigh, Ministers, TDs and Health Board officials but it was all double-speak.
When they say they ‘will not close a hospital’, they are likely telling the truth, though that might still be contradicted by their actions. They might not actually 'turn the key in the door', however they will remove all acute inpatient care, both medical and surgical, to a centralised hospital, miles away, and reduce the A & E to a Nurse-led Minor injuries unit, open a few hours each day. That is the HSE version of the Teamwork recommendations, which are being implemented in Monaghan, about to be implemented in the Mid-West, will then be applied to the South and eventually rolled out to all areas of the country.
This, they tell us is ‘for patient safety’ and to provide us with ‘better services’. Despite the mountains of ‘spin’, and the millions of euro spent delivering it, they have not convinced us that we will be safer or better off. As a matter of fact we know that we will be worse off and needless deaths will happen. Distance to acute care will be too far and the alternatives offered in the form of enhanced ambulances and advanced paramedics cannot replace hospital treatment within the ‘Golden Hour’. International research points to the dangers and difficulties of this type of care.
Added to this is the need for huge capital expenditure to get it in place but they are attempting to implement the reforms on a cost neutral basis, which will only add to the dangers for patients and their families. The only benefit to come from all this will be a ready market for the Private Investors and huge profits for them. This will be at the expense of the people who can afford health Insurance, and the tax-payer, who will have to pay for the treatment of the public patient in the private facility.
The people of Bantry and Mallow should join forces with the people of Monaghan, Nenagh, Ennis, St. John’s, Dundalk, Navan, Roscommon, Ballinasloe, Castlebar, Portlaoise, and the remainder of the 38 hospitals, which will all be downgraded to leave the 12 Regional Hospitals, as proposed by the Hanly report.Back to Top | | Total Closure? issued 08-Mar-2009 | reply to | When the HSE released the Transformation Plans for Monaghan General Hospital, which included the removal of all acute in-patient care and this being replaced with 26 rehabilitation beds, we stated that this was only a smoke-screen as no hospital was sustainable with 26 beds. We claimed that the real plan was to close Monaghan completely but we were scoffed at and accused of ‘scaremongering’. Now we have unconfirmed reports that the HSE has considered the closure of Monaghan, together with three other hospitals, and this to happen within the next couple of months, as they attempt to claw back €1.2billion savings, and we believe that they have subitted such a plan to the Department.
The Community Alliance has been given to understand that a decision on this will likely be made by Government Departments on Thursday next and then announced as part of the Mini-Budget on April 1st. The news has come as no surprise to the members of the Alliance, who have believed that this idea was always floating about in the background but that the closure was being done piecemeal.
The Government and HSE have oft repeated the claim that the Transformation Programme was ‘for patient safety’ and ‘to provide better services’. However the proposed plan to close hospitals has one aim - to save money. It is all about balancing the books and keeping within budget. It will also mean that the weakest suffer most.
The Taoiseach has said that we must all suffer some pain in these difficult economic times. Is he going to expect the people of Monaghan to bear the pain of travelling longer journeys to get relief, treatment and cure for pain? Is he going to expect the people of Monaghan to pay the extra costs involved in travelling to these distant hospitals for treatment or to visit loved ones? Is he going to expect us to bear the pain of losing a loved one, who does not make it in time to a Hospital because of the distance? Is this the pain he has in mind for Monaghan people? Is this to be our contribution to the welfare of the state? Is this the method he has by which Monaghan people can help solve the economic disaster? Is this our patriotic duty – that we are prepared to die in an ambulance on the way to Cavan or Drogheda in order to save money, which can then be used to pay huge salaries, expenses and bonuses?
The Community Alliance says that this price is too high and emergency meetings will be taking place next week and they will be then calling on the people of Monaghan to show their opposition to this latest demand from Government.Back to Top | | Monaghan Rejected - Again. issued 01-Mar-2009 | reply to | A letter from the Taoiseach refusing a meeting with our TDs is a further rejection of the people of Monaghan by this Taoiseach and this Government. We are totally unimportant in the scheme of things. So what have the people of Roscommon got that we do not have? Answer seems to be - a Minister and a representative, who is prepared to go the whole way to represent the needs of his community. However, if this Government can turn things around for one section of its people then, in justice and fairmess, it must do likewise for the people of Monaghan and our TDs should ensure that this happens, no matter what it takes.
However the letter also raises further questions. It gives us the feeling that our two Government TDs did not make proper approaches to the Taoiseach for a meeting until 'after' Deputies Crawford and O'Caolain wrote him a letter and accosted him on the corridors of power. That does not appear to be upholding the unified approach, which we thought was happening.
Secondly it is clear to us that the Taoiseach in under the impression that the Monaghan TDs are all interested in getting the 'move right'! We presume that this is the move of services from Monaghan General Hospital to Cavan. Does this mean that the Cavan TD is not interested in 'the move'? So is the Taoiseach inferring that we do not have one constituency here but two? Perhaps we need to sit down with Minister Smith and acquaint him properly of the consequences of 'the move' for the people of Cavan and the people of Monaghan - i.e. all the people he is supposed to represent.
We thought that Deputy Conlon was putting forward our case for the retention of services in Monaghan but then we should have known that she was constantly talking about having the 'better services' first - in other words she agrees with the move of services, as long as a few things are adjusted in Cavan first. Deputy O'Hanlon has always given us to believe that he was in favour of the retention but now we hear that his tune has changed and that the doctors in our Treatment Room cannot give us as good a service as advanced paramedics in a rocking rolling ambulance on the road to Cavan. If they are saying other wise we need them to come out in public and say so clearly as it is far from clear now what exactly they are saying on our behalf in Dublin.
Indeed it would be helpful if this Government were to come out publicly and tell us why Monaghan is being rejected. Has it anything to do with how the people of the county have voted in the past two General Elections? Is this a punishment for the people of Monaghan?
The letter also confirms that the Minister is directly responsible and accountable for the health services in Monaghan, but this Government does not act as individuals but as a collective cabinet with agreement. Therefore this entire Government must be responsible and accountable for what ever happens in Monaghan as a result of their decision and we intend to hold them to that. We know the Greens sold us out long ago but they too must bear their share of the blame and responsibility both as members of Government and as individuals, who gave up their integrity for personal ambitions.Back to Top | | Must 'Spin' always win? issued 01-Mar-2009 | reply to | Prof. John Crown has a very interesting article in today's Sunday Independent, where he questions the use of 'spin' to achieve purposes and applies it to the HSE and Department of Health. He was not in total sympathy when he heard that Minister Hocter's speech at the Nenagh Rally was 'suppressed' by the people present. It was he says -'the Department getting a taste of their own medicine'. We here in Monaghan know what it is like to be ignored and shouted down by the HSE, the Department, the Minister and indeed the Government TDs. Prof. Crown decries the wastage of public money on this 'spin' at a time when patient services have to be cut to save money and that this 'spin' is against 'public interest'. He draws attention to occasions when dissident vuiews are gagged and where open debate with informed commentators,who are opposed to the official line, is avoided. He also recalls times when Ministers insisted that they spoke firstly and then left before the dissenting opinions were expressed, again avoiding having to debate the matters. Prof. Crown says that, in a war like this, Truth is always the victim.
WE have noticed this type of treatment by the media and the powers that be. On local radio HSE personnel and Government TDs had their contribution pre-recorded and played after the interview with the local 'dissident'. This gave them the last word and an opportunity to splurge their spin unchallenged by informed minds. We would wonder what efforts were made to lobby the radio station or to influence how they produced the programme? We would also question the amount of money being spent by the authorities on the spin at a time when the patient is suffering due to lack of funding.Back to Top | | Trust is gone.. issued 01-Mar-2009 | reply to | We have said it before and we say it again - we have no trust in the authorities and what they tell us. Too often in the past we have been fooled and given untruths, just to keep us quiet for the time being. We called it the 'Valium Treatment' and it did not matter how much this medication cost them - they were prepared to spend it and, despite what else had to be cut, they had no problem getting their hands on the cash to pay for the spin.
Unfortunately for us the media and general public swallowed it hook, line and sinker. 'International best practice' was trotted out to give credence to their claims but no one questions what they mean by this bold statement. There is indeed no 'international best practice' as there are as many systems as there are countries in the world. They select some aspect of a system, which is working in some place and this becomes 'best practice' even though the conditions between the two places are totally different. For example - in a place like Greater London or Greater Manchester it might be acceptable to claim that one Regional Hospital should treat 350,000 to 500,000 people but to find 350,000 to 500,000 people in Ireland will be in a much greater area with lesser and poorer infrastructure and resources. This means that travel distance over poorer roads would be a necessity for the Irish patient to access the same services.
People also swallow the claim that outcomes are better in a hospital carrying out higher volumes of work. Again this has not been challenged and the authorities have not been asked to produce the evidence, much of which was carried out by vested interests and supported by vested interests and paid for by vested interests. How much trust can we place in the results of such research? Add to this fact that rural populations and isolated areas will be bereft of services and suffer the consequences of 'distant decay' - something which every other country has taken steps to avoid.
Then we are being forced to accept new systems and do we ask where they have been piloted in similar conditions to the Irish situation? We must accept that Advanced Paramedics offer us a better chance of survival in emergencies but have we studied the problems encountered by the use of advanced paramedics as, for example, in Auckland, where mortality rates doubled when AP were introduced, and where intubation by AP is in serious question?
Is it that we are gullible to accept the spin or is it that we could not care less about our health and more about the euro in the pocket? Well we in the Alliance have questioned the claims and the spin and we do not trust those who are forcing us to accept it. As well - we do not accept their promises and their claims. Some months ago 'economic dissidents', who were alerting us to the impending economic doom, were told to go and 'commit suicide'. What advisors were the authorities listening to? Had those advisors a vested interest? We know now what was going on behind our backs in financial institutions and we know now what we have to suffer because of the lack of foresight and understanding of what was happening. We know now that the people who could have taken action sooner were listening to the wrong commentators and advisors and we are claiming that they are doing it again in relation to our health services and we will suffer again for that and so too will our children. Please do not put us in the position where we can say - we told you so.Back to Top | | Getting rid of the fat cats.. issued 19-Feb-2009 | reply to | We publish here another letter from the pen of Marie O'Connor:
A week with 'a bunch of corporate fat cats in Harvard' changed his life: the course was called 'Re-Engineering the Corporation', the fat cats were from companies such as Coca-Cola, and the man whose life was changed was the director of the State's 'cancer control' programme.
THE HSE has recently been working overtime to repair the damage done by Tom Keane's wandering emails. In one, Keane described HSE bureaucracy as 'intolerable'. Last January, the professor wrote to the Department of Health to unburden himself. He said he felt he had no real support from the HSE and could not get agreement on what responsibilities and resources would be transferred to his new cancer unit. The HSE dismissed the offending emails as a 'snapshot in time', after they appeared on irishhealth.com. and Tom was dispatched to get back on message.
A compliant media gave us wall-to-wall Keane for several days. The Irish Times gave him a full page ('The Saturday Interview'), followed by yet more space on Monday, in case we still hadn't got the message. Yet more Keane column inches appeared in the Sunday Business Post, while RTE Radio 1 rounded things off by giving him a spot on its yawn-inducing 'This Week'.
Kathy Sheridan's interview in the Times was studded with inaccuracies. Bizarrely, for a country that has a significant for-profit health care industry, Canada was presented as having 'no private health care apart from cosmetic surgery'.
Keane's sense is that those who oppose cancer cuts are being parochial. He finds the 'real worries' of campaigners, who are concerned about the downgrading of their hospitals, almost incomprehensible. He related this anxiety to job losses. The hospital as a significant local employer, that he can comprehend. But the hospital as a place of succour for the sick, that he cannot understand.
He is equally mystified by what he sees as another non-issue: transport. As someone who has lived for more than 30 years in British Columbia, he cannot be expected to have any knowledge of Irish roads, Irish public transport, Irish demographics. But to say that transport doesn't matter is to say that distance is unimportant. Try telling that to cancer sufferers in Inishowen who have make a round trip of up to 12 hours to see a doctor in St Luke's and who have been disenfranchised by the cancer strategy.
Nor does he get the beds argument, attacking county councillors 'who still live in that world, that 'we need more beds world'. This shows a certain contempt for opposing views, as well as a lack of awareness of just how poorly resourced the Irish health care system is. Ireland's beds to heads ratio is abysmal. In 2005, for instance, we had just 2.8 acute hospital beds per 1 000 people, compared with an OECD average of 3.9.
People here oppose the cancer strategy not because they are parochial but because they are fair-minded. They are opposed to death by geography––and by income. Implementing the Government's strategy would significantly exacerbate existing inequities in access to health care.
While the main Dublin private non-profit or 'voluntary' hospitals succeeded in grabbing a cancer centre each, the cancer strategy ignored 800 000 people, those living in that world north of a line from Dublin to Galway. Moreover, outpatient services generally come free of charge. Services in the new primary care centres will likely come with a price tag. Those without a medical card will find themselves severely disadvantaged.
The Saturday Interview did not raise the issue of the Americanisation of our health system, did not ask why cancer has been chosen to lead the band, or why cancer patients were being turned into commodities. Did not query the double standard that will see public cancer services restricted to eight sites, while every Tom, Dick and Harry in the private sector is free to provide whatever cancer services they please. Why Beacon Hospital is looking forward to a HSE contract for breast cancer surgery, while it is being withdrawn from much bigger (public) hospitals in Sligo, Castlebar and Tralee.
Setting aside the rather sweeping statements about cancer diagnosis and treatment, Keane's claim that people in Scandinavia have a 55 per cent chance of being cured of cancer compared with 45 per cent in Ireland seems a bit dodgy. Global statistics of this kind are rarely reliable.
But if we cannot be persuaded to believe such claims, there's always the shock doctrine. Keane described health 'reform' in Canada as 'brutal redesign', carried out on a population 'softened up' by recession. He predicted that a 'much more compliant environment' would soon be seen in Ireland. Clearly, the battle plan is to use the economic melt-down as a way of bludgeoning us all into submission.
Re-engineering is about shedding jobs, lots and lots of them, about eliminating bureaucracy. Maybe the good professor should now direct his attention towards those HSE fat cats, the ones believed to be sitting looking out at the plains of Kildare, all 560 of them with nothing to do, admiring the view. Now that spring has come, maybe the time has come to put them out to grass.
-- Marie O'Connor
Author: 'EMERGENCY: Irish hospitals in chaos'
Back to Top | | Press Release 19/02/06 issued 19-Feb-2009 | reply to | Health lobby groups have strongly criticised recent interviews given by Prof Tom Keane to the media. The Heath Services Action Group (HSAG) says it is alarmed by the lack of understanding of Irish conditions shown by the cancer chief.
Tom Keane attacked elected representatives who still lived in that 'we need more beds' world. HSAG Acting Chairperson Peadar McMahon says:
'to dismiss the argument that we need more acute hospital beds shows a complete lack of awareness of conditions in Irish hospitals'.
'Ireland has a low acute hospital bed per population ratio. At 2.8 per 1 000 (in 2005), it compares badly with the OECD average of 3.9.
Against this background, closing thousands of inpatient beds as the Government plans to do just doesn't make sense - unless you want to privatise the system.'
Tom Keane has lived in British Columbia, Canada, for over 30 years. He was brought over the by Minister Mary Harney to implement the cancer programme, which HSAG PRO, Marie O'Connor says, is 'privatisation by stealth'.
She says 'people around the country oppose the cancer strategy not because they are parochial but because they are opposed to death by geography––and by income'.
'Implementing the national cancer strategy would significantly exacerbate existing inequities in access to health care. People will be denied access to services on the basis of where they live, and what they earn.'
Peadar McMahon finds the national cancer strategy difficult to understand: ''only eight public hospitals will be allowed to provide cancer care. No such cap is being applied to private hospitals: they can provide whatever cancer services they like, no matter how small they are.Back to Top | | Hanly in a new rhinestone tuxedo... issued 13-Feb-2009 | reply to | This article was first published in the Northern Standard of February 12th 2009:
The Private Members' motion put before the Dail by Fine Gael on Tuesday called upon the Government 'to proceed with the planned upgrade of Ennis and Nenagh Hospitals'. This sounded good until the penny dropped: the planned upgrade is, in fact, a downgrade. And we thought Fine Gael had abandoned their classic doctrine on Hanly: 'no hospital closures until something better is put in their place'.
The Fine Gael motion was set in the context of the HSE Teamwork/Howarth Report of Acute Hospital Services in the Mid-West. Fine Gael appears to accept Teamwork's conclusions: the so-called upgrade of Ennis and Nenagh Hospitals is to ensure 'through new capital build/refurbishment if necessary, that Ennis and Nenagh are 'fit for purpose' as new local 'centres of excellence'.
The future for these hospitals according to this noxious report is day care: day surgery––limited to 'lumps and bumps' (because of the absence of overnight beds), plus rehab. Fine Gael was, in effect, demanding that these hospitals be 'upgraded' to glorified nursing homes, housing primary care, outpatients, minor injuries, lumps and bumps, rehab and (some minor) diagnostics.
Among the Teamwork recommendations––familiar to readers of this newspaper– now apparently backed by our main Opposition party are: no provision of critical care at the 'local' centre' (p 68); the removal of acute services in small and medium-sized hospitals (p. 123); the closure of all inpatient beds in Ennis, Nenagh, St John's, St Munchin's (maternity) and St Nessan's (orthopaedic) Hospitals p 59); the possible selling off of St. Munchin's, Limerick and St. Nessan's, Croom (p83); the development of 'clinical networks' for emergency care, critical care, planned care, radiology, pathology, cancer and other chronic diseases.
But the new paramedic services are little more than an experiment, untried, untested and, in many key areas, unproven. Controversy dogs the role of advanced paramedics all over the world: scientific research shows that intubation in paramedic hands can be highly dangerous. Many Irish doctors regard the pre-hospital use of clotbusters as extremely risky. So, contrary to what Teamwork claims, the use of paramedics does not overcome the problem of 'golden hour' access.
In 'rural and remote locations', the report goes on, 'it should be recognised that the local first responders may not be in traditional ambulances, and may utilise other rescue services, including fire and mountain rescue teams' (p 117).
It gets better. What is being planned, Teamwork says, is nothing less than 'a whole system change', in which they themselves are the experts, 'mentoring' health personnel (at enormous cost to the public purse). The ultimate aim? Best (private for profit) practice. Teamwork sees itself as masterminding –– funding, devolving and delivering 'integrated' care across both the public and the private sector.
The fingerprints of private for profit operators are all over this report. Health services are to be devolved to networks––newly created units within HSE charged with putting services out to tender. This is a move that will see more and more of taxpayers' money going to for profit entities, such as UPMC. These business units will ultimately control all services for, for example, chronic diseases,––including diagnostics and 'other clinical support services' provided by hospitals, general practitioners, community teams, and social care workers. Cancer patients are the first to be turned into commodities by our Government: all cancer services will now be bought and sold on the open market, as in the United States (p123). This is what Tom Keane has been brought to Ireland to do. These unaccountable business units will, over time, eviscerate our public hospitals, as they will be forced to compete with for profit facilities for disease (service) contracts; and this will over time have a deeply destabilising effect on the public health system.
The new 'integrated chronic disease management systems' have been imported from the US. But far from integrating the services, as claimed in this report, the Americanisation of our health system will actually fragment them. One clue to the fragmentation that privatisation will bring is where Teamwork talks about 'the potential to separate the processing of the [laboratory] test from the reporting of the results' (p 124).
Implementing the Teamwork approach has resulted in the wholesale closure of public hospital laboratories. Labs closed wholesale after Quest was given a national two-year contract for smear tests. The emigration of some of Ireland's top lab scientists is one tangible result of the 'separation' that Teamwork boasts of.
Another glimpse of the privatisation that is planned can be seen in Teamwork's statement that 'typically, acute regional "centres of Excellence" will provide co-located 24/7 services (p 116). In another example of fragmentation or segmentation, planned care in hospitals is to be 'streamed separately' from unscheduled care, presumably to facilitate the hiving off of elective care to profiteers. The regional Centre, Teamwork says, will do only 'complex planned surgery'. This suggests that all non-complex planned surgery will be done in the private sector.
Best (private for profit) practice is clearly the ultimate aim, to be achieved by stealth. Public support for a US-style health system cannot be assumed. Weasel words like 'reconfiguration' and 'regionalisation' are newspeak for cuts and closures. Closing public hospital A&Es is strategic. Three out of four hospital inpatients are admitted through A&E. So shutting A&E closes off those admissions, and makes it possible to remove those inpatient beds. And closing inpatient beds is key to growing the market for private care.
The so-called 'new' model of patient care is simply Hanly, dressed in a new rhinestone tuxedo courtesy of Horwath/Teamwork at a cost of €160 000 for six weeks' work. The centralisation of all acute hospital services, the classic minimum population threshold of 350-500,000 said to be 'needed' for a regional hospital, all of this was first proposed by the Hanly Report.
Finally, Teamwork repeatedly quotes the Institute of Public Policy Research, 'the Blairites' favourite thinktank'. Former members of staff include Patricia Hewitt and David Miliband.
Marie O'Connor Press and Public Relations Officer Health Services Action Group Author: 'EMERGENCY: Irish hospitals in chaos'
086 81 80 254Back to Top | | Peep at the real truth.. issued 11-Feb-2009 | reply to | We are getting a peep at the real truth about the cancer programme now – it might take 20 years for us to see IF this reorganisation of services has brought about an increase in survival rates in Ireland. These are not our words or opinion but that of Prof. Keane, who has been in Ireland making sure that the Government’s programme is put in place and to take the flak and save the Government. But then were we not told by him and by the Minister and by umpteen Government TDs and Senators that these changes would bring about a 25% increase in survival rates and we were given to believe that this would happen as soon as the eight ‘Centres of Excellence’ were set up and the cancer services removed from those pitiful little hospitals down the country.
If you check back to our posts on this site you will find that we constantly claimed that it is pre-screening and early detection mainly that brought about the better survival rates. Now they are all for pre-screening and not only for Breast Cancer but for prostate, colon and lung cancers and say that this will bring better outcomes.
However they have put a big hurdle in the way of this progress. Their method of re-organisation will deter people from going for early diagnosis. Prof. Keane has stated that there were cultural reasons for people delaying going for tests. Those cultural reasons still exist and are amplified as rural people will delay having to travel to a distant ‘Centre’ longer than they would have delayed going to their local hospital. The obvious solution was to improve the cancer diagnostic services in the local hospital by doing what they do in Canada and elsewhere – link the local hospital, using modern telemetry, to specialist centres for diagnosis checks. This method is common place for many areas of medicine including surgery in remote hospitals much smaller than Monaghan.
But no – there is another agenda here and it is being driven by vested interests and not the ones Prof. Drumm talks about but vested interests like those which have landed us in the economic mess we are in with financial institutions and profiteers. Privatisation of the various services for diagnosis and treatment of cancer will bring hefty profits for investors and those who can grasp the opportunity presented by Minister and this Government and the patient, especially the public patient, will pay an exorbitant price – but then – what’s new?Back to Top | | Essential Reading.... issued 05-Feb-2009 | reply to | The following article by Marie O'Connor, and published in the Northern Standard, should be essential reading for every citizen of this country. Why not print it off and get your friends to read it too.
The politics of emergency care.
HSE has claimed that its new 'model' of care whereby paramedics in first-responder vehicles stabilise and treat patients at the scene before––or instead of–– transporting them to a hospital will be 'safer' than existing in-hospital A&E services.
Nothing could be further from the truth. For a start, the role of advanced paramedics in pre-hospital emergency care remains highly controversial. In countries such as Australia and New Zealand, debate rages on the safety of procedures such as intubation in paramedic hands. In Ireland, this discussion has not even begun, although the safety of HSE's pre-hospital emergency services as currently planned has yet to be established.
There is no evidence for HSE corporate's claim that the new service will be 'safer'. On the contrary, there is a significant body of scientific evidence that shows that making ambulances or other emergency vehicles the 'new hospitals' may be dangerous to patient health.
Dr Conor Egleston, emergency consultant at Our Lady of Lourdes Hospital Drogheda, has drawn attention to the fact that severe trauma victims are two and a half times more likely to die if given advanced paramedic care, pre-hospital, compared with those in receipt of basic life support or traditional ambulance care.
Practices and procedures associated with intensive care, such as intubation and ventilation, not to mention the power to make a medical diagnosis, all have been devolved to paramedics in recent years, as cost cutting governments close hospital A&Es in the guise of 'health reform'.
Advanced paramedics are allowed to perform highly invasive and potentially dangerous medical procedures once permitted only to doctors and specialist nurses. Opening patients' airways and giving powerful drugs intravenously were all off limits until recently. But many of the pre-hospital interventions initially believed by doctors to be beneficial to patients have turned out to be harmful.
Against this background of certain controversial and unproven pre-hospital emergency care practices, HSE's decision to introduce first-responder vehicles in the North-East as part of its 'health reform' platform shows that cost cutting is being prioritised over patient safety. This is a scheme that was tried, tested and abandoned in Wales. It did not prove appropriate to the needs of people living in remote rural areas in the Welsh valleys, so the Welsh ambulance service is now reverting to a full ambulance service, crewed in the traditional way.
Here in the North-East, ignoring the Welsh experience, Ireland, first-responder vehicles manned by one are being substituted for ambulances that are crewed by two. But the sole paramedic manning that first-responder vehicle cannot deal as effectively with a heart attack as a two-person ambulance crew. The Pre-Hospital Emergency Care Council stresses the crucial importance of maintaining cardio-pulmonary resuscitation (CPR), for example, uninterrupted. But the lone paramedic cannot do CPR, defibrillation or airway protection optimally, as each intervention can only be done sequentially. As Ian Paisley Junior told the Northern Ireland Assembly recently, quoting ambulance staff, stop-starting these interventions constitutes 'sub-standard care'.
The ambulance staff also raised the difficulty of injecting drugs safely, in the absence of a second person at the scene to check the dosage [and the drug]. Moreover, a patient needing to be transported to hospital will require an ambulance: But the sole paramedic manning that first-responder vehicle cannot care for the patient as well as
drive. For the patient or patients who need definitive care in hospital, this will inevitably give rise to yet further delay, exposing them to additional risk.
'Solo-responders' driving estate cars or 4x4s carrying ambulance equipment became popular in England in the 1990s. Contrary to HSE PR-speak, they have never been 'best practice': they were brought in at a time when the ambulance services were coming under heavy pressure from government to meet targets in relation to response times. The only way these targets could be met on a 'cost-neutral' basis was by halving the manning levels.
Since April 2008, many two-person crews in England have been replaced by solo-responders. Ambulance unions and doctors criticised the downgrading of the emergency services on patient safety grounds, to no avail. The latest target set by government requires that three quarters of the most serious emergencies must be answered within eight minutes of the call being taken (before patient details have been logged).
In Ireland, no such targets exist. But HSE appears to have seized on the idea of solo responders as a way of providing pre-hospital emergency care on the cheap, selling it to the population by dubbing the vehicles 'rapid response vehicles', as though they could somehow arrive at the scene more quickly than a fully crewed ambulance.
Moreover, some of these solo responders may still be in training. Paramedics newly deployed in the North-East completed the theory part of their training just before Christmas: they are now reportedly engaged in a one-year internship in the region. At the end of this year, these trainees will be eligible for registration as paramedics on the Pre-Hospital Emergency Care Council register, if they successfully complete their case studies, professional development and competency assessment.
Are they now, at the beginning of their probationary period, expected to deal single-handed with medical emergencies as solo responders? An internship in a hospital, for example, offers a learning environment that contains other, more experienced professionals. Are these interns expected to work entirely on their own, after just 28
weeks of formal instruction plus some supervised clinical practice? The fact that the basic EMT course lasts a mere five weeks may help to put this into perspective.
If these apprentices are now required to deal with life and death emergencies unsupervised, in a situation where hospital closures spell hugely extended transport times, is this not the worst of all possible worlds, both for the patient and for the paramedic? Surely it would have been more sensible––and fairer to the trainees themselves––to deploy them in urban areas where speedy access to hospital emergency departments was guaranteed? Or is this the 'guinea-pig' aspect of the new service? Has the HSE chosen Monaghan as the pilot region for its Decimation Programme, because, as one HSE bureaucrat was quoted as saying, 'we can't use Dubliners as guinea-pigs'.
This admission, and it is a damaging one, suggests that the new service is an experiment, and that furthermore, it is a potentially dangerous experiment, one that can be risked in Monaghan, but not in Dublin. If the health authorities are prepared to gamble with people's lives in the North-East in this way, could this be related to the fact that the Fianna Fail vote is (was?) secure in Monaghan, while, in Dublin, the party's vote is low? Just how politically driven is the HSE? Where does the the Pre-Hospital Emergency Care Council stand on the issue of patient safety in the North-East? Just who will take responsibility in the case of an adverse event?
First published in the Northern Standard, on Thursday 5 February.
Marie O'Connor
Author: 'EMERGENCY: Irish hospitals in chaos'Back to Top | | Interesting or what? issued 30-Jan-2009 | reply to | Below is an extract taken from the Clare Champion of January 19th, 2007. It has been sent to the Alliance by the Ennis Hospital Development Committee.
TOUGH QUESTIONS ON ENNIS HOSPITAL:
Question 3: As a pre-election position, will you now give an undertaking to resign your seat, in the event your political party is part of a government that removes acute care facilities from Ennis Hospital?
Answer Tony Killeen - Fianna Fail
“There are no circumstances in which a Fianna Fail led Government would remove acute care services from Ennis Hospital”
Answer: Senator Tommy Dooley – Fianna Fail
“There are no circumstances in which a Fianna Fail led Government would remove acute care facilities from Ennis Hospital.”
Answer: Brendan Daly – Fianna Fail
“There are no circumstances in which a Fianna Fail led Government would remove acute care facilities from Ennis Hospital.”
Mr Dooley and Daly were cute - they used the word 'facilities', which could still be true but Mr Killeen used the word 'services' , which we now know are going to be removed by a Fianna Fail led Government. The 'facilities' may be left behind but the 'services' will be gone. Is Mr Killeen a member of the Green Party? That is what they told us before the last election.Back to Top | | Letter to the public.. issued 29-Jan-2009 | reply to | The following letter was published in the Independent recently:
Madam - I wish to register my deep dissatisfaction with the HSE's plan for the North-East region which will see the closure of Monaghan General Hospital as an emergency centre in the near future. As a citizen of Co. Monaghan, I echo the sentiments of many of our TDs that a removal of services from our county hospital, which has proven itself to be an efficient and effective centre since the 1930s, will represent a major crisis for those of us in need of emergency treatment, particularly in the extreme north of the county, an area which is a most considerable distance from alternative hospital sites in counties Cavan and Louth.
It is clear that the HSE has misled the public in its affirmation that services at Monaghan General would not be withdrawn until a safe alternative was put in place in the region as no such alternative has been presented in the wake of the shelving of the HSE’s plans for a new north-east regional hospital. Instead, we are faced with severe overcrowding at Cavan General Hospital and Our Lady of Lourdes Hospital, Drogheda, and I speak with particular reference to the 50 patients waiting to be seen at the admissions unit in Cavan General in recent days, which has led to a cancellation of all non-emergency surgery, even before the unit has had to deal with the overflow of patients from Monaghan as a result of the impending closure of the casualty facility at Monaghan General.
I feel most strongly that the evident disparity that exists between HSE statements and HSE actions is utterly contradictory and unacceptable and is frankly inexcusable when lives may be at risk. The undeniable facts recognised by medical practitioners, politicians and citizens in Monaghan are that the removal of services from Monaghan General Hospital is dangerous and contravenes even the HSE's own guidelines in relation to patient safety and therefore must be reversed in order to ensure that as equal and egalitarian a service may be provided for each individual in Ireland, regardless of geographical factors. I am confident that my views are those shared by the majority of my fellow Monaghan citizens and would like to raise greater national awareness of the gravity of the situation faced by the people of Monaghan at the present time. As taxpayers, the citizens of Co. Monaghan are entitled to a safe local hospital service in the same way that others elsewhere in this country are and any attempt by the HSE to deprive us of such services can be seen as nothing more than victimisation and marginalisation in order to balance a budget, something which, when it comes to the health and safety of the people under HSE care and the provision of the medical services that are our entitlement as citizens of a democratic nation, should never be a decisive factor. I truly believe that if the HSE is honest, it must recognise such a step for health services in the north-east region as representing an error and an injustice and regardless of whether or not the generic policy-driven response to our pleas that I must unfortunately admit to expecting from the HSE is reflected in the realisation of this scheme, I would nonetheless like to hope that there is enough empathy and nobility left in HSE quarters to ensure that such a drastic and perilous plan for health services in county Monaghan can be averted.
Mr. Myles Campbell
Cavanmoutray
Killybrone
Co. Monaghan.
Back to Top | | Another letter.. issued 29-Jan-2009 | reply to | This letter appeared in the national press recently:
It was almost with complete disbelief that I read in the Irish Independent that once again the HSE is considering implementing a further closure of services at Monaghan General Hospital.
Just last week my own mother had a major stroke and were it not for the existence of emergency facilities at Monaghan hospital she would have died on the much longer journey to Cavan General Hospital which itself is bursting at the seams.
When is this madness in our health service going to stop?
Have there not been enough tragic deaths already directly attributed to the downgrading of services at Monaghan General Hospital?
It seems at times that there is almost a determination to leave the people in Monaghan with little or no accessible acute medical facilities.
Everyone recognises the advantages and supports the HSE's plan to create Centres of Excellence, but not at any cost and certainly not at the cost of removing essential emergency services in a county such as Monaghan which has a growing population.
The minister for health seems to have disappeared from public view and certainly any controversy. She needs to take control of the health situation in this country and rein in the HSE.
HSE bosses reward themselves with large bonuses while the service is falling apart around them, and indeed are privatising parts of the health service by stealth.
Perhaps it should be renamed the Human Sacrifice Executive.
If they cannot do the job then for goodness sake get rid of them.
As for local politicians in Monaghan, I say shame on you, you do not represent your constituents or else you would fight to the point of resignation in defence of your local hospital.
As for opposition parties in this country, you are ineffective and redundant, especially on health issues, and one wonders why you are in existence.
As a lifelong Fianna Fail supporter I am disgusted at how far removed from the people of Ireland they have become.
If there is not enough money then for goodness sake release more funds, we would rather have a decent health service than beautiful roads. We are a wealthy country and lives and good health are more important than budgets.
I say to the people of Monaghan, do not accept the loss of your right to a full service hospital, stand up and fight to the last. I say to the people of Ireland wake up and take note of what's happening in Monaghan and other parts of Ireland because your area may be next!
G MCCABE, KILLINEY, CO DUBLIN Back to Top | | THE PARROTING OF 'PATIENT SAFETY' issued 23-Jan-2009 | reply to | There is something familiar about the closures recently announced by the Health Service Executive in the Mid-West. The parroting of 'patient safety' and 'clinical risk', the use of words such as 'unsustainable' and 'key stakeholders', all belong to a script first written by Teamwork for the North-East in 2006. In both regions, surgeons have been chosen to lead the HSE's Decimation Programme. The Executive is now readying itself to effectively close five hospital in the Mid-West, three general hospitals (Ennis, Nenagh and St John's) and two 'stand alone' specialty hospitals (orthopaedics in Croom and maternity in Limerick City).
The writing has been on the wall for at least five years. These closures were recommended by the Hanly Report in 2003. Fully implementing Hanly will close around 40 public hospitals, as well as umpteen psychiatric hospitals.
Last January the PA Report spelt out the monstrous scale of the Government's bed cutting ambitions: 40 per cent of Ireland's public patient beds are set to close by 2014. These closures should ensure the viability of those private for profit hospitals that have been sprouting up around the country, like ragwort, in recent years.
Public hospital closures are central to the Government's privatisation policy. As the cancer strategy shows, centralisation is a proxy for cutting the public health service. Looking to the for profit sector is at the core of Government health policy. US models of 'disease management' have now been adopted in Ireland, as part of HSE's Decimation Programme. Services for Ireland's leading diseases are being outsourced in the name of 'excellence'.
Public hospitals are being hollowed out from within: taxpayers' money, until now earmarked for cancer, will soon be available to American health care giants, some with a background in fraud. Many of these for profit entities are far smaller than the public hospitals whose services have been stripped from them on so-called 'quality of care' grounds. Beacon Hospital, for example, opened with just 26 beds. Today, Monaghan General, with 50 beds–– a hospital with one of the best coronary care services in the country––is on the point of closing. The 'critical mass' requirement appears to be little more than a device to shut down public services. Public hospital cancer service that do not have high volumes of patients are being closed by the HSE, while private for profit hospitals with equally low, or lower, patient numbers are given lucrative HSE contracts.
Ireland's health services are being restructured to facilitate privatisation. Services that are known to be profitable are being moved out of the public system into the for profit sector. These money spinners include elective care, radiology, pathology, and chronic diseases. Their funding is being removed from public hospitals and given to new HSE 'business units' to control and manage. Services for heart disease, stroke and diabetes are among those scheduled for commercialisation in these so-called 'centres of excellence'. These business units or 'networks' will operate across community, hospital, continuing care and hospice settings. With power being transferred to these new unaccountable entities, public hospitals will gradually lose their ability to control the services they provide. The effect of this radical restructuring of the country's health system is likely to be disastrous, as the recent closure of public hospital cytology services shows. Radiologists have reported that the laboratory tender was rigged to favour Quest. Laboratory specialists say HSE bureaucracy prevented some public hospitals from 'competing'. Public hospitals are unlikely to be able to compete with for profit entities for disease contracts, as, unlike most private hospitals, they employ 24/7 medical staff. Hospitals need patients. If these institutions lose their core business, their survival as public hospitals may be threatened in the longer term.
These Government policies will place patients, particularly the less well off, at risk: hospital A&E and maternity services that used to be accessible will become remote, while outpatient services that used to be free are likely to become fee-paying. Meanwhile, a new bill is preparation which, like the Unfair Deal' for the elderly, is expected to reduce people's entitlements to free medical care. The quality of patient care is also likely to be compromised: American research shows that care in for profit hospitals is of inferior quality, despite costing government substantially more. Hospital staff are also in jeopardy. Those who succeed in retaining their posts will be required to show 'flexibility', by rotating permanently across the full spectrum of community, hospital, nursing home and hospice settings, like agency workers. The nursing shortage in Ireland, already acute, is likely to intensify: many will leave rather than work under such onerous conditions.
Not a shred of evidence has been produced by the Government, the HSE or the Department of Health in support of the new privatisation programme. There is no good evidence for centralising the common cancers, for example, nor for centralising routine surgery. But as the Quest contract for women's smear tests shows, commercial interests, not quality of care, has become the driver.
Marie O'Connor
Author: 'EMERGENCY: Irish hospitals in chaos'
Back to Top | | Typical HSE issued 22-Jan-2009 | reply to | In typical HSE fashion they use subtle psychology to introduce their changes. Over the years they have frightened people from using services by suggesting that those services are not safe. This reduces the numbers availing of the service and this suits the HSE tyhen to quote the small numbers to justify their claim that it is not sustainable.
Another trick is to begin using a different name which suggests a difference in service and people will believe that the service has changed. The A & E is a typical example. When they wanted to downgrade it they changed its name to Treatment Room - a new term in medical language and one that had no basis in medical systems. This meant that they could put whatever they wished in there and it was fulfilling its purpose, according to them. They announced that the Treatment Room would become a Nurse-led Minor Injuries Unit when acute services were removed from Monaghan. We are also told that that will not happen now until March possibly. However they have already downgraded the name of the Treatment Room to 'Minor Injuries Unit'. They have begun using that term when they refer to it. If you phone the hospital you are asked to press certain numbers for specific areas fo the hospital and one of these is 'The Minor Injuries Unit'. People listening to that might assume that it has already been downgraded and therefore not go there. That again is what the HSE wants - reduce the numbers and it will be unsustainable. They used reduced numbers in the A & E in Monaghan before to downgrade it and get doctors out of there. They used nhumbes attending the Unit when the hospital was 'off call' and only counted those who presented in private transport. This is how the HSE works - by stealth and subterfuge. However we have not been fooled and future generations will know the real story and the real faces behind this.Back to Top | | Not Safe.. issued 18-Jan-2009 | reply to | On January 5th last we told of the removal of the full anaesthetic cover from Monaghan general Hospital. We said then that it was compromise patient safety and we would be able to give an example in the near future. According to reports we did not have long to wait. One day during the past week, according to these reports, two patients were put at added risk due to this system, put in place by the HSE.
One patient needed transfer to Cavan for Emergency Surgery and, as the words imply, it was an emergency and time was important. It also means that this patient was seriously ill. However the report states that this patient had to be transferred to Cavan without anaesthetic accompaniment, as outlined in protocol. We have also heard that the patient had then to be transferred to Drogheda, as they did not have a spare ICU bed in Cavan. All this delay for an emergency patient is unacceptable.
Later that same day another patient presented in the Treatment Room with head wounds, which required scanning to ascertain the severity. This of course had to be done in Cavan, since the Government, since Michael Martin promised, has refused to ensure that Monaghan had its own working and staffed CT Scanner. The patient needed anaesthetic cover for the transfer but none was available and there was a very considerable wait until they were able to get the cover over from Cavan. Again this long delay was not in the interest of the patient and certainly did not make life easy for the staff in Monaghan.
It seems that the HSE has denied that this has happened though we have not seen a Press Release from them but then they do not normally comment on individual cases due to confidentiality. Whatever, our sources are usually reliable and we are convinced that we were lucky this time but, unless they change the set up, there is going to be a disaster. This time we are flagging it - the system in place will lead to a needless death unless the proper staffing levels in the anaesthetic department are in place.Back to Top | | How silly? issued 18-Jan-2009 | reply to | There seems to be another protocol for the staff in Monaghan re. patients on trolleys. When they have more than three patients waiting for a bed in Monaghan, they must transfer those extra patients to Cavan.
Now consider the situation - Cavan has 49 patients on trolleys, Monaghan has six patients on trolleys. Protocol demands that Monaghan send three patients over to Cavan. Now Cavan will have 52 patients on trolleys i.e 52 patients waiting on a bed. If you were patient 4, 5, or 6 in Monaghan, which would you prefer - to stay in Monaghan and expect a bed within hours or make the journey to Cavan with much greater chances of lying on a trolley for much longer. I know what I would do if I had the choice.
Drogheda and Cavan have been overrun this past week and staff were working over and above the call of duty. Again we claim that this is not safe for patients but then - who in authority cares?
It is not safe for staff either and, if anything goes wrong, you can be sure that the blame will be pasted at the door of some unfortunate staff member. It has happened before.
The answer coming from HSE sources is that due to flu epidemic and winter vomiting bug there is an unusual demand for services and beds. Are they going to tell us that, when they transfer all services from Monaghan to Cavan, there will never be another flu epidemic or an outbreak of the vomiting bug. Of course there will and they will then have no beds in Monaghan to fall back on. It will then be a case of finding a bed in some Dublin hospital for Monaghan patients, but of course - they can make guinea pigs out of Monaghan people but not the Dublin elite!
We wonder continually - what are the Cavan people thinking? Are they not annoyed that Monaghan people are taking up their beds in their hospital? Are they not annoyed that their treatment is delayed so much because Monaghan patients are taking their places? Are they not fearful that, because of the massive overcrowding in their hospital, the incidences of MRSA and C-Diff will increase dramatically and that they themselves will also suffer the consequences? A hospital, like Cavan, which is working at 110% bed capacity, cannot be maintained at a high level of hygeine, as is required to avoid the spread of the bugs and viruses. Some one needs to smell the coffee real soon.Back to Top | | HSAG Release issued 18-Jan-2009 | reply to | The following statement was released to the media by the HSAG this evening:
For further details, please contact Peadar McMahon, Acting Chair, HSAG, on 086 0443300; or Marie O'Connor, PRO, HSAG, on 086 81 80 254.
FAILTE ROIMH AGALLAIMH AS GAEILGE
Taxpayers' money rerouted to the private health care sector as Government cuts public hospitals
Health groups say commercial interests, not quality of care, are now driving the Government's health policy. Peadar McMahon, of the Health Services Action Group (HSAG), says: 'Health care funding is being shifted from the public sector to the private: public monies are being rerouted to private health care operators while public hospital services across the country are being terminated'.
It is no coincidence, HSAG says, that the next round of public hospital cuts is scheduled for the Mid-West, 'a region where no fewer than three private hospitals are in the pipeline'. Other regions where cuts are being accelerated include the North-East, while the South is also bracing itself for hospital closures.
HSAG PRO Marie O'Connor says US models of disease management have been adopted by the Department of Health. 'The parroting of patient safety cloaks another agenda: the Government's privatisation of our health system. Services for common conditions, such as heart disease and stroke, are being outsourced to new business units within the HSE. These unaccountable entities will be tasked with contracting out the services: all public monies spent on cancer, for example, will soon be available to private for profit operators under the banner of what is called 'the cancer control programme'.
Medical opposition to the public hospital cuts is growing. General practitioner groups in the Mid-West and North-East have strenuously opposed these cuts in the name of patient safety. HSAG Acting Chair Peadar McMahon says that: 'contrary to what HSE claims, the ambulance services cannot safely substitute for public hospital A&Es. Clotbusters, for example, touted by HSE as offering patient safety in the event of a heart attack, can kill, particularly in the hands of non-doctors.'
'Public safety is being put at risk, while the public hospital system is being hollowed out from within', Marie O'Connor maintains. 'At the heart of the HSE's so called 'transformation programme' is the woodworm of privatisation: our health services are being radically restructured in a way that will see all profitable services from cradle to grave––from hospital to hospice–– privatised.'
Chipping away at hospital A&Es, acute and elective surgery, at maternity and other services, is strategic but unsafe, Peadar McMahon emphasises. 'The chaos in the North East is proof that these plans are dangerous. Hospital services have been selectively rerouted to Drogheda since 2001, the result being that the Lourdes is now at a standstill. These cuts serve the Government's bed cutting programme, a plan that will see 40 per cent of all public patient beds taken out of the public system over the next few years.'
ENDSBack to Top | | Medical Opinion issued 14-Jan-2009 | reply to | The GPs of Monaghan have written a letter to Mary Harney telling her that the HSE has not obtained theoir approval and cooperation for the transformation programme and for the removal of acute services from Monaghan General Hospital. The contents of that letter are here:
Dear Minister Harney,
We the General Practitioners of North Monaghan wish to clarify a number of statements made during a meeting held with you last Wednesday, 10th December 2008.
We wish to begin by stating clearly that as medical doctors we have grave concerns about the proposed closure of acute medical services and casualty services in Monaghan Hospital. The hospital has provided safe, efficient and accessible healthcare to our patients throughout the years. Evidence of the high standards achieved in the hospital was proven in the audit of coronary care admissions undertaken earlier this year.
Contrary to statements made at last weeks meeting the GPs in Monaghan are not supportive of the impending plans. Indeed there has been no consultation with the GP group at any stage regarding the future provision of services for our patients and no consideration to the resultant workload implications for our practices. We believe that no safe alternative to the present excellent services in Monaghan has been proposed.
The decision to close over 50 acute medical beds in Monaghan Hospital is in our clinical opinion not safe. While we welcome the opening of a Medical Assessment Unit in Cavan Hospital we feel this can only be of benefit to the ongoing crisis in Cavan's casualty department. Given the experience of MAUs elsewhere, particularly in Kilkenny, the role of the MAU is to streamline the referral process to a hospital's casualty. In no other region has a MAU been expected to 'replace' the acute services of another hospital. Also, for such a unit to function efficiently it needs the full co-operation of he referring GPs and all hospital consultants. There has been no consultation with the GP group in either Cavan or Monaghan and limited consultation with the consultant group.
The issue of primary care teams has somehow been added to the equation. We as a group are fully supportive of the development of primary care teams and all general practitioners in the area have agreed to be part of these teams. However, at no time has it ever been stated that these teams would or could replace acute hospital services. Any suggestion by local HSE management that acceptance of primary care teams by local GPs means acceptance of the planned closure of acute hospital services is false. It would also show a total lack of understanding of the role of primary care teams. An increase in community services will be of benefit to those with chronic conditions. It will not assume responsibility for acute conditions requiring hospitalisation.
Therefore we wish to make clear that any announcement about the development of these primary care teams is not to be presented to the public as being a replacement of acute hospital services locally.
As you are aware there is an ongoing manpower crisis within general practice. This is particularly so in both Cavan and Monaghan where many practices have had to close their lists to new patients. One of the major problems faced by us is the increasing workload being transferred to general practice from the hospital setting. The closure of Monaghan Hospital will have major implications for our practices. Already patients
are being warned that services such as the Warfarin clinic will be closed. As you are all too aware this is but one of the many services that are not funded in general practice. The HSE have also repeatedly spoken of home care packages that are to be available for patients in an attempt to reduce hospital admissions. These packages will also mean increased workloads for GPs with an obvious increase in home visits. Yet again there has been no consultation with the GPs regarding any of these proposals and it would seem obvious that they are doomed to fail without our input and support. Any additional pressure on thealready overstretched genera practice will compromise the excellent stands of care being presently provided
We would like to finish by again stating clearly that the proposals to close acute services in Monaghan Hospital will impact detrimentally on our patients ability to access acute medical care in the hospital setting and we are concerned that the resultant impact on general practice will also affect our ability to provide a safe and accessible service to our patients.
We therefore demand that the decision to close acute services in Monaghan
Hospital be reversed and that as a matter of urgency the manpower crisis in general practice be addressed It is worth noting that our last letter to you related to our concerns regarding the loss of surgical services in Monaghan Hospital. Only weeks following this letter Pat Joe Walshe died. It is vital that you take heed of our advice and views on this occasion to prevent further patient suffering.
Yours sincerely,
Dr. Dermott O ‘Gorman
Dr. Illona Duffy
Dr. M.McGinnity
Dr. M. Watters
Dr. F.Balmer
Dr. E.Duffy
Dr. M. Smyth
Dr. K. Bourke
Dr. G. Schoonbee
Dr. O’Sullivan
cc.
Prof Drum
Mr.Stephen Mulvanney
Mr. Dermot Monaghan
Mr.Leo Kinsella
Consultants in Monaghan Hospital
TDs in Monaghan Cavan
Back to Top | | No Meeting.. issued 14-Jan-2009 | reply to | It is reported that Taoiseach Brian Cowen has refused to meet with the four TDs from Monaghan in relation to the Hospital issue. This cross-party agreement to seek the meeting was progress for the people of Monaghan and now the leader of Fianna Fail has refused to meet a delegation which includes two Fianna Fail TDs. IOt beggars belief.
However he did advise them to have a chat with Mary Harney. Perhaps that is not a bad idea. Michael Finneran went to her and sorted Roscommon. Surgery and all acute services have been left in Roscommon. She and this Government cannot treat another county and its people differently -- or can they? This snub could have serious consequences for those looking for votes in the coming local elections.Back to Top | | More Stealth....? issued 05-Jan-2009 | reply to | After the meeting between our TDs and the HSE on the week prior to Christmas we were told that the HSE stated that the services would not transfer from Monaghan General Hospital till March or later. Now they seem to have engineered a situation in the hospital which will basically mean that the hospital will have to go 'Off Call' within the next few days, due to lack of adequate Anaesthetic cover. They have also issued a protocol for the transfer of critically ill patients from Monaghan to Cavan. It would mean that the patient would have to be retained in Monaghan till an anaesthetist came across from Cavan to accompany the patient back to Cavan. What will this delay mean to the ill patient? We are sure that we will not have to wait too long before we will be able to give you an answer to that with an example.
Surely they are not hoping for another major disaster to occur in the hospital so that they can claim that it is unsafe and then state that for that reason they must move the services to Cavan immediately. That would fit their plan nicely. After all any enquiry afterwards would find a scapegoat somewhere.
On the day that Patrick Joe Walsh R.I.P. was transferred to Monaghan, we were meeting with HSE managers in the hospital and begging them to restore emergency surgery immediately or someone would lose their life in a disaster in the hospital. Our pleas were ignored and twelve hours later Pat Joe passed away in horrendous circumstances. Today, now, we are begging the HSE to restore the proper staffing to Monaghan and replace the resources in order to make it safe or we will be looking at another needless death.
The HSE response is that they are setting up a joint Department of Anaesthesia between Cavan and Monaghan. We know what that means - setting up a department in Cavan and have them travel across to Monaghan on the odd occasion. This is what has happened with the Joint Surgery Department for Cavan/Monaghan. All we have to do is count the number of times that surgical personnel travelled from Cavan to Monaghan during the past three weeks? How many of them will want to travel on the roads when they are icy and fog-bound? What added travel expenses will the HSE have to pay out for all this travel?
The HSE also claims to be recruiting Registrars to replace those let go from Monaghan. Three questions - 1. They had registrars and let them go -why? 2. Where will the new Registrars be based - answer is Cavan and that is why they let the Monaghan boys go so that they could base the new ones in Cavan. 3. What about the meantime for patients in Monaghan? Answer - they can take their chances and wait for people to come over from Cavan. That is the safe and caring decision the HSE has made!!!
Once again our lack of trust in the HSE has been confirmed and once again they have convinced us that we cannot trust them. Will those responsible for setting up the alternatives now deliver? We were given to understand that they had everything in place - that the GPs were ready and willing to step into the breach, that homecare packages were set up and ready to roll, that services could be moved to Cavan at any time - and it would need to work because one death will cause anger as not seen before and this time we might just hold our own enquiry and point the finger of blame accordingly.Back to Top | | The HIQA Hygiene report.. issued 22-Dec-2008 | reply to | We are delighted, though unsurprised, at the rating for Monaghan General Hospital in the latest HIQA Hygiene Review in October. Monaghan, which was rated very low originally and acheived a FAIR result last year has gone one better to GOOD. This is satisfying but would be more so if we knew that the in-patient facility would continue indefinitely.
However there are a couple of confusions arising from the Report.
1. The Report mentions that fact that outpatients clinics are being held at St. Davnets - 'As a result of the major current refurbishments of two inpatient wards'. We thought that they were already refurbished and officially opened? or are they referring to the day-wards?
2. They refer to the 65 medical in-patient beds - there are more than we thought! We will have to count them again.
3. We note that they include ENT as an out-patient service. Could what we have at the moment really be called that?
4. We note, annoyingly, that they have already downgraded the Casualty Unit to a Minor Injuries Unit, which we thought was not going to happen until March 2009. They do not mention the Emergency Medicine facility at all.
5. The state that - 'a number of patient advocates consulted regularly regarding needs assessment for hygiene services'. Where did they get these from? How was the consultation carried out? What does 'regularly' mean?
All in all these question unsettle us as to where they are getting their information and how accurately they carried out their inspection. It would be nice to know that we were judged 'GOOD' by those who knew eactly what was going on in the hospital. Perhaps they would even reach a 'VERY GOOD' in those circumstances.Back to Top | | Meeting with HSE issued 19-Dec-2008 | reply to | Today, Friday Dec 18th 2008, four of our TDs met with top brass from the HSE to get briefed on the plans to transfer acute in-patient care from Monaghan General Hospital to Cavan. Our TDs were: Caoimhghin O'Caolain TD; Margaret Conlon TD; Rory O'Hanlon TD and Seymour Crawford TD , (named alphabetically). Prior to the meeting we had asked that all four 'sing off the same hymn sheet' and stand united as one voice for the same proposals for Monaghan General Hospital. This was very important as this means that we are all of the same purpose and have the same immediate objectives. We were being told that this was the case but we had no direct proof that everyone was on the same wavelength.
We have not as yet received a briefing on what happened inside at that meeting and we can only go on the statements made by Caoimhghin O'Caolain and Seymour Crawford in an interview on local radio afterwards. We were, therefore, delighted to hear them state that both Fianna Fail representatives had argued for the same purpose and argued with conviction and passion. This gives us hope that we now have the strength of our entire representatives working on our behalf and that has to be better than contradictory stances appearing which would weaken the argument for Monaghan.
However the HSE representatives were adamant that the removal of the services would proceed, though perhaps a little later than originally thought. We did not expect anything else from them - that is what they are being paid to do and, as it was reported, Stephen Mulvanny said at the meeting that this was a political decision and that if they were ordered to implement a different plan they would have to do so. This now kicks the struggle back to Leinster House and puts the spotlight back on the Government. Our TDs must now, as a unit, meet with the Taoiseach at a very early date and put the pressure on there to get the Minister to change the policy. In the present circumstances that should not be too difficult as this new configuration is going to need millions to get going and maintain, millions that are not there and were never earmarked, not to mention the fact that the plan will never work as it depends on so many others co-operating, which is not going to happen in the foreseeable future.Back to Top | | Worries !!.... issued 19-Dec-2008 | reply to | | We have niggling worries about what is happening in relation to Monaghan and the transfer of acute care to Cavan. Somehow we cannot get it out of our minds that everything is being set up to award the 200million euro for extensions to Cavan, once they get the services out of Monaghan. It is easy to shout at meetings with HSE but the real 'shouting' must be done elsewhere. It would be easy to claim that the best that could be done was done but will that satisfy the people of Monaghan if the services are still moved out or will that be sufficient to make up for those who suffer and perhaps die as a result of the removal of those services. Surely we could not be tricked like that and that all that money would suddenly surface? If they transfer the services and then discover that it does not work as there is not sufficient facilities at Cavan - it would be very likely that they would then come up with 200 million very easily but that would be a betrayal of the people of Monaghan but it is a scenario that is not without possibility.Back to Top | | Alliance Statement – Dec 17th 2008. issued 18-Dec-2008 | reply to | We are aware that the HSE management are meeting with Cavan/Monaghan Oireachtas members in St. Davnets on Friday, December 19th at 10am in order to brief them on the reconfiguration of hospital services and in particular the transfer of acute medicine from Monaghan to Cavan. After much discussion the Community Alliance has decided not to hold a ‘Protest Meeting’ adjacent to and concurrent with that meeting. It must be pointed out that we have not abandoned protest as a method of displaying our utter rejection of the proposed plans to remove all acute care from Monaghan General Hospital.
In the Northern Standard edition of May 22nd 2008 both Deputy Margaret Conlon and Deputy Rory O’Hanlon stated that meetings were better than “megaphone diplomacy” They both indicated that they preferred to meet with the authorities and to discuss issue and that this will be more productive than engaging in public protests. They will have a further opportunity to do that on Friday and we will await anxiously to hear a positive outcome from that meeting. We are expecting that ‘the meaningful dialogue’, favoured by Deputy Conlon, will provide us with the outcomes we have been seeking for the past decades. We look forward to all our public representatives coming out from this meeting on Friday and standing together as a unit, as called for on many occasions by Deputies Crawford and O’Caolain. We hope to hear that they spoke with one voice on behalf of all constituents, for the one set of proposals on behalf of the people served by Monaghan General Hospital and that they received a positive response from the HSE and that the future of Monaghan General Hospital as an in-patient acute facility is secure. This is the time to show that dialogue and meetings work.
Back to Top | | Powerof Prayer... issued 14-Dec-2008 | reply to | Last week a well-attend4ed public meeting was held in the Hillgrove Hotel, Monaghan, to launch the 'Power of Prayer campaign' for the retention of acute servcies in Monaghan General Hospital. The meting was led by Eugene Flood, Truagh; Francis Meehan, Ardaghey, and Rev. Margaret Pringle, Church of Ireland Truagh, Donagh and Tyholland. Other Minister from various churches attended and they were joined by individuals involved in different pryer groups around the region. The Alliance was represented by two members to show support for the campaign and to answer some questions.
Rev. Pringle praised the work carried out in Monaghan General Hospital over th years and said that many could bear testimony of this. She outlined the many important reasons why sacute services should remain in Monaghan.She encouraged all to pray that God would intercede.
Eugene Flood highlighted the increased suffering and loss of life that we can expect when the acute services are removed to Cavan. This, he said, made this a moral issue and that the Churches should not be afraid to let their voices be heard. He pointed out that there was no room at the Inn for the birth of Jesus and the people of Monaghan are fearful that there will be no adequate care or place in hospital in the hour of need. He said that we must believe in the power of prayer and that nothing is impossible to God.
Many other contributed and made suggestions as to the path this campaign might take going forward. A number of items were adopted and action will be taken on these over the coming days but in th meantime eevryone is urged to have the Retention of acute services as major intention in their prayers.
Back to Top | | In-Committee meeting.. issued 14-Dec-2008 | reply to | | The HSE has invited all Oireachtas members for Cavan Monaghan to an in-committee meeting in St. Davnets Hospital on this Friday from 10am to 12pm. The purpose of this meeting is to brief the oireachtas members on the Hospital configuration in Cavan/Monaghan and in particular with reference to the transfer of the acute medical unit at Monaghan to Cavan - as if they did not know exactly what is planned. It is just another opportunity for the HSE to issue 'spin' and claim some inches in the local media to counteract what others have been saying.Back to Top | | Politics issued 23-Nov-2008 | reply to | It is somewhat baffling to hear Prof. Barry O'Donnell praising the HSE for having removed politics from Health. He was being interviewed by Ryan Tubridy during the past week. We ask how he came to this conclusion or does he mean that the formation of the HSE removed all local power and centralised it. After all local politicians have no power in the new establishment and this is a downgrading of democracy. Then at national level the Board members of the HSE are appointed by whom? The majority of the Medical Council is now lay appouinted by whom? The CEO of the HSE is appointed by whom? The policy to be implemented by the HSE is decided by whom? The answer is politicians but only the Minister has real power and he/she is able to manipulate without any consultation with local politicians or local people. That is cwertainly not removinmg politics from Health - as a matter of fact it is a very dangerous step backwards as democracy is being constantly centralised into the hands of a few and history tells us what happens next.
If Prof. O'Donnell of course is coming from a different stand-point in that he is a member of the medical consortium driving change which we would see as isolating rural communities and centralising medicine, agasin into the hands of a few, which once again is dangerous for patients but profitable for those who can manipulate the system.Back to Top | | Proposals We demand. issued 22-Nov-2008 | reply to | Present Services
General Medical Team
Presently there are 3 consultant physicians with a full team of NCHDs.
They provide a 24-hour acute medical service to the hospital, meaning that the hospital is 'on call' to all medical emergencies.
There is a coronary care unit which caters for patient with heart attacks and other cardiac emergencies.
There is a 24-hour echo service available due the presence of bedside echo equipment.
There is a cardiac rehabilitation unit, the first outside Dublin, which provides specialised care for patients post MI (heart attack).
There is a well established Exercise stress testing department to provide the necessary investigation of patients with cardiac problems.
The medical consultants provide an endoscopy service, which allows direct GP access for colonoscopies and OGDs.
Although the 3 consultants provide a general medical service each also provides a sub-specialisation; Dr Mac Mahon is a cardiologist, Dr Muragasu provides geriatric services, Dr Muthu provides a diabetic service.
Anaesthetic Team
There are presently 3 consultant Anaesthetists complemented by 5 registrars.
It is worth noting that this provides the hospital with more anaesthetic cover than many other hospitals (Nenagh, Ennis, Ballinasloe, Mallow, Dundalk).
The anaesthetic team is essential for the hospital to remain on-call for medical emergencies as they cover the HDU (high dependency unit)/ CCU (coronary care unit) and facilitate any necessary ventilation of patients.
They also provide the anaesthetic care of patients during surgery performed by the visiting surgical teams.
Radiology
There is presently only one consultant radiologist who provides a comprehensive service. A number of visiting consultants provide some cover for reporting of radiological examinations.
An important aspect of this service is the open access provided to GPs in the area. Monaghan hospital provides direct access to ultrasounds, IVPs and barium investigations for patients referred by their GP. This service is not available in the
majority of hospitals in the country.
The radiology staff have agitated for the provision of a CT scanner to the hospital as this is now becoming more and more vital for the provision of acute medical care in the hospital.
Surgical Service
At present surgeons from Cavan Hospital provide a visiting daily service from Monday to Friday. This service consists of outpatient clinics, endoscopy and minor surgery.
They also provide a surgical opinion on medical in-patients in the hospital.
Unfortunately the surgery provided has been very much limited to minor procedures and not to the intermediate level as originally proposed.
Obstetrics and Gynaecology
The 3 Cavan based consultants provide a visiting service 3 days per week. This consists of antenatal and gynaecology clinics and minor gynaecological surgery.
The present temporary placing of the outpatient clinic continues to cause problems. Space limitations have meant reduced numbers attending clinics and the consultants have complained about the difficulties in providing antenatal scans.
There is a fortnightly colposcopy service which again has suffered as a result of the hospital renovations that occurred in the past 2 years leaving it with continued substandard placement in the hospital building. Unfortunately, this has meant that many patients with abnormal smear results again have to be referred outside the region due to the unacceptable waiting list.
Casualty
The casualty unit is provided in a state-of-the-art department. The 24/7 service is provided by 5 registrars and a clinical nurse practitioner. In January 2008 the 2 surgical consultants who also provided a 24\7 service to the department were told that their contracts were not being re-newed. This department has remained busy despite attempts by the HSE to encourage patients not to attend the unit.
ENT
This service was provided by a visiting consultant from Omagh until he became ill this summer. The service remains limited due to a failure to replace the consultant and another consultant who visits Cavan attempts to see urgent cases. The disruption in service has meant that GPs are forced to refer patients outside the region.
Orthopaedic
This service consists of an out-patient clinic only and presently has a waiting list time for first appointments of over 18 months
Other clinics
There are a number of other visiting clinics including the St. Luke's radiotherapy clinic at which cancer patients are reviewed.
The Future
The HSE have recently re-stated their proposals for the hospital. This was given to hospital staff and clearly stated that;
1.. Acute medical care will transfer to Cavan. This will mean that the hospital will go off-call and all emergencies will be diverted to Cavan or Drogheda.
2.. The casualty unit will be reduced to a nurse led minor injury unit with limited opening hours. As is obvious, this effectively means the closure of Monaghan General Hospital as an acute unit. This goes against all the statements made by both Prof Drumm and Minister Harney. There will be no better service provided and the evidence is available to show that patients from the Monaghan catchment area will be severely disadvantaged.
During the 2 ½ years when Monaghan was off call the impact of this plan was seen with increased morbidity and mortality in Monaghan patients. The deaths of patients such as Philip Courtney and Benny McCullagh were well documented at the time.
Evidence
A recent audit of admissions to the Monaghan Coronary care unit in Monaghan over a 1-year period showed an excellent standard of care for these patients. The level of care was actually shown to surpass that of other hospitals in similar audits.
Proposals:
1.. The medical department must be protected and enhanced to allow it continue to provide the acute service it presently does. Any decision to remove this service can only be done when it can be proven that a better and safer service is available elsewhere. Given the present level of care available in Monaghan this would seem impossible.
2.. The anaesthetic service must be also safeguarded. This will involve increasing the present workload they presently have. An enhancement of surgical services would allow this.
3.. The initial proposal that intermediate surgery be provided in Monaghan should be revisited. This would increase the numbers of patients requiring anaesthetic services and thus prevent the team becoming deskilled. There continues to be a problem with lack of space in Cavan hospital, which is impacting on the amounts of elective surgery that can take place. By allowing more of the surgery to take place in Monaghan the pressure would ease in Cavan.
4.. The present casualty service should be maintained in Monaghan Hospital. Improved links with the Cavan site would allow easier transfer of patients requiring surgical admission. The Monaghan casualty reduces the pressure on Cavan by allowing the assessment and initial investigation of many patients. Without the Monaghan unit these patients would join the queue in Cavan.
5.. The proposed development of the CCU/ HDU has already been approved and costed. This should be progressed upon as a matter of priority.
6.. The provision of a CT scanner was promised by Minister M Martin, as he departed from the Department of Health. The present cost of transferring patients to Cavan for these scans over a one year period exceeds the cost of an actual scanner. Therefore it makes no sense not to provide this vital piece of equipment.
7.. All services should be maintained and developed until the proposed regional hospital is built, when the transfer of services can again be reassessed.Back to Top | | Hospital closures serve privateers issued 17-Nov-2008 | reply to | The closure of Monaghan General Hospital now looms, a New Year gift to private for profit companies. Whatever additional supports are to be put in place in Cavan Hospital, they do not appear to include additional beds. Home nursing is unlikely to be free. Indeed, the only care likely to be on offer is an expensive home care package provided by a private for profit firm.
Closing Monaghan General is part of a national bed-cutting programme that will see public patient beds slashed over the next six years, if a recent report done for the HSE is any indication. By 2014, according to PA, the north-east is set to lose two-fifths of its public patient beds, down from 805 to 461.
Closing our smaller public hospitals has yet to be recognised for what it is: an assault on people's right to decent health care. 'Not until something better is put in its place': this is what Dublin hospital consultants say, even those who are socially minded. This is what Fine Gael's spokesman on health, Dr James O'Reilly, has said.
But nothing better can be put in place of Monaghan General Hospital. There are no good alternatives to acute hospital services. When a newly trained paramedic opens a vein for the first time, who wants to be the owner of that vein?
The HSE would have us believe that paramedics can safely compensate for the enormous extra distances patients will have to travel to access a hospital A&E. This is nonsense. In the vast majority of cases, paramedics are irrelevant. Four out of five people in Ireland who attend a hospital casualty unit arrive by private transport, not by the ambulance service.
Even the Royal College of Surgeons in Ireland recommends that patients be brought to 'definitive care' within one hour. In 2003, the College recommended that ambulance personnel should transport severely injured patients to an operating theatre, intensive care or rehabilitation unit within 60 minutes.
Meeting the Government's bedcutting targets will leave hundreds of thousands of people two hours' drive or more from a public hospital casualty unit. Hanly, which is Government policy, proposed a population standard of up to 500 000 for a 'viable' hospital A&E unit. Implementing that threshold will require each A&E to serve an area of 2 300 square miles.
Moreover, Ireland's ambulance services are grossly under-funded. Ambulance cover is sparse, even in urban areas. Country areas carry additional hazards: expecting an ambulance to reach a person within a narrow time frame may not be realistic. Locating a person may be difficult. Gaps in cover will inevitably arise. In the event of a second crew being required at a road traffic accident, for instance, several hours may elapse before that ambulance can be at the scene. Ambulance response times have been shown to be poor, overall, in Ireland. National standards do not even exist.
Even if our ambulance services were properly resourced, paramedics cannot be relied upon to save lives. Trauma victims attended by paramedics are actually more likely to die. There is good evidence to show that, in cases of severe injury, those looked after by paramedics are two and a half times more likely to die than those looked after by emergency medical technicians.
Emergency medical technicians (EMTs) and paramedics are being asked to diagnose what is wrong with patients without having the training to enable them do that. After just 4 weeks and 10 weeks' training respectively, EMTs and paramedics are expected to be 'mini-docs', substituting for medical practitioners whose training takes up to 10
years, and considerably more in the case of emergency consultants.
Primary or community care, according to HSE, will somehow make up for the mass closures planned for inpatient hospital services. This, too, is piffle. There are limits to what primary care can achieve. Similar cost-cutting exercises in Britain have failed. General practice there has been shown to be unable to safely compensate for the closure of acute public hospital beds.
People with chronic diseases can be cared for in the community, we are told. But the promised roll-out of primary care teams has not taken place. In 2001, the Government promised to have 400-600 primary care teams in place by the end of 2011. Seven years later, just 97 of these teams have materialized. What they actually consist of, no one knows. But one thing is certain: HSE 'went to the market' when putting them together, so their services are unlikely to come free of charge.
Monaghan General Hospital is being closed, not for reasons of patient safety, as claimed, but in pursuit of an agenda, the privatisation of our public health services. Implementing this agenda will effectively close around 40 of Ireland's 53 acute public hospitals. Hospital services are now being unbundled, like track from train, so that private companies can profit from the sick. Smaller public hospitals, such as Monaghan's, are being closed to release public monies for so-called 'centres of excellence' or freestanding disease entities, an American approach to 'chronic disease management'. Cavan Hospital has no future, ultimately. Whether it is upgraded to
regional status or not hardly matters. The Government has other plans. Services for the main killer diseases in Ireland, cancer, cardiovascular, stroke and diabetes, are now being removed from the ambit of public hospitals, fragmented into stand-alone 'networks' outside public control. These networks will probably be free to enter
into partnership with private for profit companies. Services for these diseases will be supplied only on a contract basis. This is an approach that will force public hospitals to compete with private for profit operators. Public hospitals will be left to provide intensive care and A&E, high cost, unprofitable services that will soon threaten their viability. How long will hospitals such as Cavan's and Drogheda's survive private sector competition and public sector number-crunching?
We have a Government that has decided to ignore the health needs of communities living in non-urban areas, such as Monaghan, in order to boost the private health care industry. Asthma kills more people in remote areas. Trauma deaths are three times higher in country areas than in cities, particularly in the absence of an accessible hospital A&E.
Death by geography is an ugly reality. Are we going to accept it?
Marie O'Connor
Author: 'EMERGENCY: Irish hospitals in chaos'
Back to Top | | Public Meeting issued 06-Nov-2008 | reply to | A very important Public Meeting will be held on Thursday night next, November 13th at 8pm in the Four Seasons Hotel, Monaghan. The main speaker will be Dr. Maurice Neligan, whose views on the state of the present public health services in Ireland are well known and not very complimentary to those who are in charge. He is appalled at the methodfs being used to reform the servcies in the North East and he is sure to provide us with a very important insight into where we are and where we are going. The meeting will also be addressed by Janette Byrne of Patients Together. Janette, who knows what it is like to be 'let down' by our Public Health System, and who is contacted by patients on a daily basis, has been a supporter of the Monaghan Cause for some time and we apprreciate her travelling from Dublin to be with us.
Lets hope that the people, who depend on Monaghan Hospital will see the need to travel to the Four Seasons to show their support but also to become active in the campaign. Back to Top | | 130 jobs to go in Monaghan. issued 23-Oct-2008 | reply to | 130 jobs in the Health Sector, attached to Monaghan General Hospital, will go over the coming few months as the HSE remove services from Monaghan. Of these almost 50 will be nursing staff, two thirds of the administrative staff and over 60 support and non-clinical staff. All of these will have options – take retirement or be redeployed elsewhere and that is mainly to Cavan to staff the new Medical Assessment Unit there.
Apart from the economic blow to the community this spells the end of acute services in Monaghan General Hospital. We are told this will provide us with better and safer services. The audit, which was carried out on medical services in Monaghan last year, showed outcomes matching some of the best hospitals in the country and we are expected to believe that they can improve on that.
The big problem is going to be the travel. Patients will have to be kept alive in very difficult circumstances for a long and rough journey to Cavan or Drogheda. In some case that will not be achieved and we can expect the answer we will get is – ‘they would have died anyhow’, but it is now very clear and obvious that they have agreed to ‘an acceptable mortality rate’ for Monaghan. Then they are training personnel to administer the Thrombolysis in the community. This has serious risks for the patient and for the person giving it. The patient could bleed to death in a very quick time and can the paramedic make a proper diagnosis at the scene before giving the injection? Who are the expert cardiologists taking control of the people who are charged with administering the drug? How are they being trained and how many patients will they attend before being sent out on their own? How will they maintain their skills since we are told that there are not enough patients in the system at the moment to maintain skills of those in the hospital?
Secondly the patient or family will have to pay the cost of that travel. Families wanting to visit loved ones will have to provide and pay for their own transport to Cavan or Drogheda. There is no public transport service available but then they might expect a voluntary organisation to raise money and fund such transport because you must remember that not everyone has a car, not everyone can afford to pay for transport and it will be the poor and the aged who will suffer most.
Let us also take the scenario of a parent in hospital and he/she takes a sudden turn for the worst and the family is called in – how long will it take for people to get there? How many will fail to get to the dying relative before they breath their last – a time which is so precious to so many people. But then humanity, feelings and dignity do not count with these decision makers.
We have 52 beds in our hospital at the moment and the two wards, where those are located, were opened with a great flourish a year or so ago. They cost millions and are ‘state of the art’. They were extremely comfortable as Peadar can assure you, as he spent a week there last year. However there were basic faults with them and he pointed these out at the time. However it now appears that they will have to be pulled apart to change them into ‘Rehabilitation Units’ and ‘Step-down Units’, as they have to have different criteria to suit their purpose. What a waste of money if this is the case? Our information is that it was advised at the time to build the rehabilitation units but it was decided that it would be politically inappropriate to do so and so acute wards were built instead to confuse the people of Monaghan. We wonder if this could be true? Can anyone enlighten us?Back to Top | | Closer and Closer... issued 21-Oct-2008 | reply to | The time for removing all acute services from Monaghan General Hospital is getting closer and closer - indeed this Bank Holiday weekend would be an ideal time for them to work at their evil scheme. In that way they would have achieved victory ahead of schedule and would be worthy of an even greater bonus. Temporary and Agency nurses will not be required any longer in Cavan, as it seems there is a rush of nurses wanting to get their places there.
It is like the sinking of the Titanic - every man for himself. Those who have no lifeboats cry for help and their voices are not heard. Ship's officers make loud noises about peoples' safety and that everyone will be saved but we know what happened. However the people on the Titanic did not see the Iceberg tiowards which they went at speed but the people of Monaghan have been warned and warned and warned but decided to sit in their lounges and remain comfortable claiming that the crew would not do that to them - after all they would be putting their own lives in danger. BUT in this case the crew was not on the boat - they were already in relative safety on dry land in another county having abandoned the passengers to the will of the ocean. Back to Top | | Ready, Steady, Go.... issued 20-Oct-2008 | reply to | We have been informed, by our sources, that during this week the HSE will inform the staff in Monaghan General Hospital that it is time to move. The Medical Assessment Unit in Cavan is about ready to receive patients - ready that is except for staffing. So where are they going to get the staff - You guessed it - in Monaghan of course. That is also the purpose of the meeting on Thursday - to entice staff to Cavan. We wonder what incentives will be offered and we also wonder what the INO will have to say. This Union has been seen to support our campaign - are they going to betray us now? Are they going to accept good financial offers despite their support for services to remain in Monaghan? Are they going to be bought off too?
Once the staff move from Monaghan and, since they are not going to be replaced, there will be insufficient numbers remaining to continue providing the level of acute services we have at the moment. This means that something has to go but by taking acute medicine they also remove A & E (put the hospital off call for all emergencies) and the high dependency unit, which means that the hospital will not be able to deal with emergencies who present in private transport - so it is ready, steady, go, even though all the necessary measures, deemed so important prior to or in parallel with the removal, will not be in place and no hope of them ever being in place.
Where now is their concern for patient safety? Where now are all their promises? Where now are our Government representatives, who are sitting back and allowing this to happen. Have we no Joe Behans in Monaghan? Why do we need any public representatives since those in Government do not represent us? Do we need any public representatives as it appears that Monaghan does not exist as far as this Government is concerned?Back to Top | | Power of People Power. issued 17-Oct-2008 | reply to | The latest U-turn by Government over the 70's Medical Cards shows just how powerful people are when they have backing from backbenchers and opposition. How the Government allowed themselves to get into this situation is another subject that needs debate, but it was embarrassing to listen to their representatives wriggling their way in and out, with confusion reigning among the FFs and PD.
Again it is not for us to discuss the rights and wrongs of such a scheme in the first place but again it does need debate.
However once the public debate opened on this subject this week all hell broke loose and it was obvious that a pull-back had to happen and happen it did. We would like to draw similarities here with the campaign, not just in Monaghan, to secure local hospital services. It is amazing that people were so angry and became so vocal at the loss of financial cover for health services but are so quiet when health services are being removed from their local hospital, the result of which is that they will have to pay for the travel costs to access those services in future and may even be dead by the time they reach those services in an emergency. So once again money seems to be the driving force for everything in this country.
The final point is that, on this week's issue, Opposition parties kicked up stink like never before, Greens were invisible like on the Monaghan issue, national media were willing to swamp outlets with coverage, backbenchers somewhat openly spoke up for their people and a rethink happened. Had the same happened over local hospitals there would have been a rethink too. The only exception is Roscommon and we need to know what the deal is there, a deal which the opposition seems to have accepted.Back to Top | | Ministerial Meeting. issued 17-Oct-2008 | reply to | | Today, again, we have requested a meeting with the Minister for Health, or failing that a list of her Clinic venues and times, so that we can go to meet her there. So far we have been told that her diary is too full or that she has a very busy schedule but we will keep trying and we will let you know the reply we get this time.Back to Top | | Third Ambulance issued 16-Oct-2008 | reply to | Contradictory information is now on the rounds regarding the third ambulance promised prior to the removal of acute inpatient services from Monaghan General Hospital. It seems TD Caoimhghin O'Caolain has been told by a reliable source that the HSE intends to locate the ambulance at Ardee but the HSE has responded that it may not be in Monaghan Town but it will be in County Monaghan and not in Ardee.
Now at the moment we are not going to get into the debate on location other than to say that it would appear obvious that the isolated area would need the extra back-up. However we make a very serious point here and one that holds great concern for us - In the HSE letter to Caoimhghin O'Caolain, which we have seen, it is stated that certain measures MUST be in place prior to the removal of acute inpatient services from Monaghan and the first one mentioned in that letter is that a third ambulance Must be located at the Monaghan Ambulance Station prior to the removal of services. Now it is obvious that this has changed or indeed may never have been the case. In other words we cannot believe anything we have been told of what will be in place prior to the removal of services. Of course this is nothing new as the goalposts have been constantly moved over the years of our campaign and we could never trust statements made to us. History will judge them on their methods.Back to Top | | Centralisation issued 16-Oct-2008 | reply to | | The truth comes out eventually and Prof Drumm has stated that services, as well as cancer services, must be centralised. He says that High Dependency Units, A & E Units, and many other specialities must be centralised into 'Centres of Excellence'. Where did we hear that before - Oh yea - the Fitzgerald Report, The Hanly Report, the Yeamwork Report, The Bonnar Report, The Kinder Report, etc ad nauseum. OIf course they want hospitals to be reduced in number till they have ten or twelve left in the country and if possible, none north of a line from Dublin to Galway. This would free up many managers for other duties like HSE Social Club Managers or whatever. It is amazing that there has been such a rumpus over the tighteniong of the means test for Over 70's Medical card and so little concern about the removal of acute services from local hospitals where the old, the poor, the young and women will suffer most. Yes - there are none so blind ....Back to Top | | National Rally –Dublin – Oct. 11th 2008. issued 16-Oct-2008 | reply to | 18 months ago economists were predicting a down-turn in the economy and the on-set of a recession but Government told these prophets of doom to shut up and go away. Today I am predicting that ‘the end is nigh’ – yes the end is nigh for over 30 small hospitals around this country. All acute services will be removed from Monaghan General Hospital before the end of November and then others will follow in quick succession – Nenagh, Ennis, Roscommon, despite the soundings being made by Junior Minister Michael Finneran, Clonmel, Bantry, etc etc. W
Today we are mourning the deaths of the cancer patients who died needlessly because of misdiagnosis or delayed diagnosis. We in Monaghan are also mourning the needless deaths of those who died in an ambulance on the way to a distant hospital instead of being taken to Monaghan. Let the people of this country be prepared to mourn many others around the country, who will die in ambulances because their nearest A & E has been closed.
Ladies and Gentlemen – The HSE and Government versions of the Hanly reforms and the Teamwork Recommendations are being implemented by stealth but they are doing so without putting in place all the resources, staffing, equipment and facilities, which these reports stated as vital before any downgrading was attempted. Now there is no money to either put in the necessary alternatives or to make safe the existing services. But as we have always claimed – money and the balance sheet is more important than patient care and patient safety.
When the distance to a hospital is too far people will die trying to get there and the remaining hospitals will be overcrowded, with patients on trolleys, long waiting lists, long delays, more mistakes, and more deaths and the poor and the old will suffer most. Now with the recession there will be more unemployed causing the numbers of poor to increase dramatically. There will be more people sick and they will be at a more advanced stage when they decide to go for diagnosis and treatment, making it more expensive to treat them. Fewer will be able to afford the travel costs to the distant hospital, and fewer will be able to afford the Health Insurance premiums, and therefore more and more people will have to rely on the Public Health system, which this Government will have destroyed and decimated.
There are ways of providing safe and efficient services in local hospitals by using innovative methods and modern technology like in other countries.
The survival of Rural Ireland depends on having basic hospital services maintained in the local hospital and the rural organisations like the ICA, IFA, GAA, local development groups, the churches, and Public Representatives must force the Government to stop, re-assess and change the policy, while there is still time. Otherwise Rural Ireland, the rural economy and rural communities will die along with the patients in ambulances along the road to a distant hospital. The fight must go on and the people of Ireland need to wake up to what is being taken from them in order to satisfy the greedy demands of vested interests.
Back to Top | | Dublin issued 15-Oct-2008 | reply to | The National Protest March in Dublin on Saturday last, October 11th, was disappointing from many points of view but also important for us as well. The overall crowd was smaller than last time as was the Monaghan contingent but again we can be accused of poor publicity beforehand. However it was clear that many have decided, without thinking the consequences through, that the services are gone from Monaghan and there is nothing can be done to stop it. Others have still not become interested in the consequences of the removal of services from Monaghan because they have never needed the services in an emergency to realise the importance of having them in Monaghan. There are still others who know and understand but, like in so many other areas of life, are prepared to sit back and let others do the fighting for them as they do not have the time. Boy are they in for a shock. Then there are those who, because of affiliations, must keep quiet and not be seen to be supporting a campaign which will rock the boat. Lastly there are those who agree with the type of reforms being implemented but they do so because they will benefit financially from them, or they believe the constant spin and propaganda being dished out, or they are not willing to think the process through for themselves.
All of these are there at National level too but the big losers will be those same people and those, who have fought the campaign, will be able to sleep with a clear conscience.
The Alliance wishes to thank sincerely all those who made the journey to Dublin last Saturday. Indeed many are heroic as they were prepared to put themselves out in a big way and to accept the hardship, inconvenience and everything else that goes with such a day - especially those who are aged. Well done to them.
The big positive for us was the fact that we supported the other groups taking part and there is a unified approach to our overall aims, which includes standing against the downgrading of small hospitals like Monaghan. Of course time is running out for us but it is a long road with no turning.Back to Top | | Ambulance times. issued 07-Oct-2008 | reply to | An article in the Irish Examiner describes ambulance times in many areas as unacceptable. We are also worried by this problem - one that we have known about but one which is going to become even more relevant in the coming months, if the HSE and Government get their way. If all our emergencies are expected to travel to Cavan or Drogheda, then time will be of the essence. The HSE seems to dismiss the international evidence surrounding the 'Golden Hour'. They more or less say that it is not important, if you have the proper personnel on the ground. WE say - it is not acceptable for the HSE and Government to quote International research to us to try to prove one thing and then ignore it when it suits them in another area. The Golden Hour, within which it is essential to get hospital treatment, is still a vital element in an emergency. Secondly we reject their claim that anyone can do an equal job on the ground. Again international research shows that you have a 50% more chance of death in certain emergencies if treated by an Advanced Paramedic than if treated by an Emergency Medical Technician. The reason given contradicts what the HSE and Government claims - Advanced Paramedics stay at the scene of emergency until they try every procedure they have been taught by which time, in many cases, it is too late to transfer to hospital and the patient is DOA, whereas the EMT will transfer as quickly as possible.
Now with community volunteers and Defibs and First Responders with Thrombolysis the patient can expect to lie along the roadway, or wherever the emergency occurs, for a much longer time reducing the chances of survival and/or recovery.
The second point we must make is that the times given are difficult to agree with. They do not show the full story. For example it gives 45 minutes as the time for an ambulance from Monaghan to Cavan. Even for an emergency in Monaghan town that time would be difficult to achieve, but then what of the people living north of Monaghan town - do they matter to this Government. It seems not. We know that in the past it has taken an ambulance 20 minutes to get to the scene near Emyvale and not just on one occasion. By the time they loaded the patient, stabilised and moved off a further 15 minutes elapsed. It will then take the ambulance 50 minutes to get to Cavan and 65 minutes to get to Drogheda. In all then a time of 85 minutes to Cavan and 100 minutes to Drogheda. That will certainly not give the patient much of a chance but then - well at least they wont need a hospital bed or trolley.
Then we have not factored in the new ambulance - will it go faster? Is it pain free? does it traverse road bumps smoothly like a hovercraft? Forget it - it will make no difference except that the other ambulance can be away for longer. Then we must also add in time for diversions - over the past weekend the Clones/Cavan road has been closed to traffic and detours are through Scotshouse and Redhills - have you ever been on those roads - I ask you!!
We will investigate every case and hold someone responsible for the needless deaths.Back to Top | | Dublin Protest issued 07-Oct-2008 | reply to | On Saturday coming, October 11th, a National Protest will be held in Dublin, starting at 2pm at the Garden of Remembrance. It is organised by Dublin Trades Council, ICTU Youth Committee and Patients Together and supported by many other patient groups and hospital campaign groups like ourselves. We must support them as they support us and there is always strength in numbers.
To date we have two buses going - One leaves Emyvale at 11 am from the Leisure Centre and picks up in Old Cross Square if necessary. The second bus leaves Old Cross Square at 11.15 and picks up in Blayney at 11.40. Anyone wishing to book a seat on these must phone either 047-87239 or 047 -57053 as soon as possible.
Clubs/Organisations are asked to lay on a bus for members and we would appreciate if these were informed to us as soon as possible.Back to Top | | Protest in Dublin. issued 06-Oct-2008 | reply to | On Saturday next, October 11th, a Public Protest will be held in Dublin. It begins at 2pm at the Garden of Remembrance and walks to the Dail, where invted speakers will address the crowd. This is part of a Public Health Service Campaign for a first class Public Health Service and is being organised by the Dublin Council of Trade Unions, ICTU Youth Committee and Patients Together supported by members of the Health Trade Unions, Patients Organisations, medical profession and hospital campaign groups, including Monaghan.
It is very important that Monaghan is represented at this Protest as we are getting support from the other groups in return. No one can claim that changes are not needed in our Public Health Services, as the horror stories continue to surface on a regular basis. The service seems to be drifting in whatever way the wind takes it and crisis management is the norm. Overspends are more important than treating and curing people, who are sick. Services are being cut to save money, without the impact that has on patients being taken into consideration, yet at the same time huge bonuses are being awarded to those in top management in the HSE.
Ther Government must be forced to take another look at its policy and see that it is not providing what it is supposed to provide to the citizens of this country. Things must change and change now so that the patient will be the centre of decision making and that services are in position where and when they are needed. Geography or finance must not be the deciding factor.
Clubs and Organisations in the county ar being asked to organise transport to the Protest for the members of their club/organisation. The Alliance will also run a bus, details of which will be announced later in the week.Back to Top | | Closure.. issued 29-Sep-2008 | reply to | So, we are told that the cut backs will not effect patient care and that patients will not suffer because of any cut backs. That must refer to other parts of the country but not Monaghan, or are they trying to spin the wool over our eyes? Day Services, the Theatre and the Clinics are closing down for two weeks now in October in Monaghan General Hospital. Staff members must take their holidays during that time!! What happens if taking holidays at that time does not suit, what happens if a person has used up all their holiday entitlements, what happens if they just go out on the sick? Interesting questions but it seems that the HSE has that all covered too and it will be 'cost neutral'.
Let's face it - this is to save money, though a small number of things will go ahead because they make money for some, but for them to claim that these closures will not effect patients is unbelievable. Of course patients will have to wait longer for the tests, the diagnosis, the treatment, the appointment and we all know what that can mean.
We would like to know who made this decision - was it a medical person or an administration person? More than likely it was the latter as the books have to be balanced and books are more important than patients.Back to Top | | More comfirmation.. issued 14-Sep-2008 | reply to | During the past week, Caoimhghin O'Caolain released to the public details of information he received from the HSE, per Evelyn Hall, which confirms the determination of the HSE to implement the Transformation Programme before the end of 2008. We were never under any illusion that they had reconsidered that plan and were totally aware of the efforts they were making to put 'some' of the alternatives in place so that they could remove all acute care from Monaghan. This means that the time for protest is getting very short and the time for our public representatives to reverse this decision is also short. Failure to do so will mean a back-lash against them, especially when the first needless death occurs, and it will mean needless deaths for the people of Monaghan and those caught in an emergency as they pass through.
Some parts of the document need further reaction from us:
1. The document claims 'that acute complex surgery, due to safety concerns, has been successfully centralised at Cavan General Hospital'. What safety issues are they referring to? What audit showed lack of safety? Who decided that there were safety issues and on what grounds? Let us know the name of the deciders. The decision must have proof or it is unacceptable as no one or group is expert enough to make such a sweeping statement without the proof. Secondly we would ask how many patients from Monaghan are still being referred, at their own request, to Dublin hospitals?
2. It is also clear from the document that the promise made by so many that a scanner would be installed in Monaghan was pure hogwash and political expediency, used for vote catching. The scanner will be in Cavan and will not be needed in Monaghan as there will be no acute patients there.
3. The document also confirms that 'the draft detailed plan', which the HSE and Government representatives were very anxious to scoff at as it was only a 'plan', is THE PLAN which is being followed to implementation - More attempts to fool the public.
4. More blatant misuse of language tells us that specific measures will be 'in place and bedded down prior to or in parallel with the transfer of acute care to Cavan'. How can something be 'bedded down' and at the same time be done 'in parallel with' the removal of services. Surely their powers do not extend that far , that they can manipulate time, but we were promised that the 'better services' would be shown to be better before the services were removed from Monaghan or was this just another empty promise?
5. Our main problem, which has never been addressed satisfactorily by anyone, is that patients will die while trying to get to Cavan or Drogheda. An extra ambulance, which they have promised, will not make the journey nor the time to get there shorter or faster.
6. The pre-hospital thrombolysis service does not flush us with excitement, when we see how it is done elsewhere, as we have already noted in a previous post.
7. The extra community care packages and the enhancement of Primary Care costs money to get it right and to resource properly but in the current economic climate we are likely to see short cuts and minimum provision which will make the service unsafe.
8. We could go on but will end this post with another example of the type of methods used by the HSE to confuse and distract the public. When surgery was being removed from Monaghan we claimed that it would expose Acute Medicine and could lead to a dangerous situation. They denied that at the time and assured the public that this was not the case. Now they claim that Acute Medicine relies on other specialties to operate safely and effectively and that is why they must move medicine to Cavan. They knew all along what they were intending to do but used smoke-screens to get their way and fool the public. The contents of our past posts shows that we were not fooled but unfortunately the people of the county preferred to believe others, who were in on the act, and provided the smoke machine - but we know and our history will record the truth.Back to Top | | Where does the blame lie? issued 07-Sep-2008 | reply to | | We have directed our anger and our disgust at various people and various organisations at various times over the past years of our existence, we were never real sure just who was to blame. Brendan O'Connor has an article in today's Sunday Independent which has made us think. He seems to say that our civil servants are to blame. He could have a point there. Looking over the history of our campaign we note that we have named a few civil servants who let us down. Indeed they might have done more than let us down - they even misled us. The latest mentions two civil servants from the Department of Health and Children, who were supposed to be dealing with a letter of request which we sent in. We went to the Department first, but were told that we would have to put the request in writing. We did so and both replied that they were looking after it. That is months ago now and there is still no reply. Their involvement in the loss of our services has been duly recorded. Back to Top | | Another Life Saved. issued 04-Sep-2008 | reply to | | During the past months, even though we did not record it here, many have had life-saving experiences in Monaghan General Hospital. People have been rushed in with a heart attack, get the thrombolysis in record time while being constantly monitored by expert staff and make a great recovery. We had one very special one this past week, where time would not have allowed thios patient to get to Cavan alive, nor would the administration of thrombolysis maintained life until the patient arrived in Cavan - it took the expert and timely treatment and care in Monaghan General Hospital to ensure that life continued for this patient and we have been asked to say a big thank you publicly to Monaghan General Hospital by the patient and family.Back to Top | | MEP issued 21-Aug-2008 | reply to | | The editorial in the Northern Standard this week suggests that the Community Alliance might consider running a candidate in the forthcoming European elections. This has been discussed and it is agreed that the base is very good given that the hospitals in the area ( Roscommon, Castlebar, Portiuncla, Sligo, Letterkenny, Ennis, Monaghan and indeed Cavan) are all having problems of one kind or another. It really means that the populations being served by those hospitals may wish to register their disgust by having a specific 'Hospital candidate' to vote for. We have had preliminary discussion with other areas and with some advisors, who can advise us on certain aspects of such a decision. There is quite a bit of work to be done yet before we can say that we are making progress towards naming a candidate. In the meantime we will not be making any further statements until agreement has been reached on these issues.Back to Top | | Signal is Clear. issued 21-Aug-2008 | reply to | One of our Public Representatives has, on a few occasions, poo-hooed our claims that the HSE intended to reduce Monaghan General Hospital to a 'Glorified Nursing Home'. Proof was asked for and when it did not happen at the end of June this was a cause for celebrations almost as it proved that we did not know what we were talking about. However there were other forces at work, like a scarcity of resources, which slowed the process up. There was also a problem in getting other aspects in place before they could remove services. With all this was news, which trickled through to us, that there was a big clamp-down on information with people being told on a 'need to know' basis. This meant that they could work away in the background, implement plans and THEN inform the staff and public. But then maybe the TD did not want to know, or did know but was afraid to face the fact that it was going to happen despite the TD's hopes. The Roscommon debacle is still unexplained but we watch it closely.
So what are the signals? There are two in particular.
1. The recent Innovation Fund money is confusing to say the least. What is meant by improving the communication between nursing services in the community? The main provisions to effect Monaghan are
a. the measures to reduce the length of stay in cavan/Monaghan hospital
b. more home care packages (how is this packaged?) and
c. pre-hospital thrombolysis.
The first two are unclear but basically they are intended to reduce the number of patients, who need or are in hospitals but that will not effect Monaghan since it will be a step-down unit anyhow.
The pre-hospital thrombolysis is a very important one and one that will have far reaching effects on Monaghan patients. This is the administering of the clot-busting drug by paramedics at the scene of a heart attack, or the on-set of an MI. The patient would then be transported to Cavan, as there will be no acute Medicine in Monaghan. Thrombolysis has been shown to improve the chances of recovery from MI, if administered as soon as possible but definitely within the hour. Monaghan General Hospital at the moment prides itself that it is far ahead of other hospitals in the time it takes to get the thrombolysis for patients who arrive with MI. Now it seems patients will get it even sooner.
However we must ask questions about this.
a. why is it a doctor who travels on ambulances in other jurisdictions to give the injection?
b. why, in other jurisdictions, will they not administer the drug to a patient who is further than 10 miles from a hospital, which can deal with the side-effects?
c. who will take responsiblity for the gruesome deaths of those who haemorrhage, as this is one of the major side-effects. Anyone suffering from e.g. peptic ulcer has a major chance of bleeding to death in a short space of time if given the drug. There are many other reasons why certain patients must not be given the drug but who will take responsibility if the wrong person receives it and they die?
d. who and how will the diagnosis of heart attack, or on-set of heart attack be made? The tests will be done in the back of a stationary ambulance or externally at the scene and it has been shown that valuable time is lost by these procedures and that deaths have occurred because of the delay. Again - who will take responsibility for the deaths?
It seems that the medical profession might want to cover themselves from litigation as we are told that, if a patient dies in hospital, questions can be asked and people can be held accountable but if the patient dies in transit then no questions can be asked and if they are asked, there will be no win in litigation. It has happened in other places that services were removed from a hospital and patients from accidents and from heart attacks were DOA (dead on arrival) but no one could be held accountable as it was claimed that 'the patient could not have survived anyhow'. That will not be good enough for or acceptable to the people of Monaghan.
The other signal is the resignation of the consultant as clinical director. She has made scathing accusations against the HSE in that they care not about the patient but about money or words to that effect. Where did we hear that before? We heard it when we heard of other clinical directors resigning from their posts. She is not the first or only one to have made that decision. Why did the others resign? That has never come out but perhaps it should be made public. However the Transformation Plan is going ahead, maybe not at full steam or as fast as the managers would like but it is moving. Meanhwile it would appear that someone somewhere is sitting waiting for something to go wrong in Monaghan so that they can then go public and claim that it is unsafe and has to lose its services. They are helping that situation to come about by starving the hospital of resources and making staff work in unacceptable conditions, with confusing rumours flying about and uncertainty feeding the fears of everyone. How long can Monaghan go without that major adverse event? Back to Top | | What is Public Health Care issued 03-Aug-2008 | reply to | With the Government setting up private companies to provide health services, once provided by the Public System, it is going to be very difficult to see what is 'private' and what is 'public'. Many services for the 'public' patient will be supplied by the 'private provider' and paid for by our taxes. Can we xall this 'piblic service'? The Government seems to be transforming the Public Service from a comprehensive, equitable provider of healthcare into a tax-funded insurer, paying for care provided by others but it is being done on a 'patchwork' manner.
The ‘patchwork privatisation’ of our Health care is deeply worrying because privatised healthcare tends to cost more; accountability suffers; the fog of ‘commercial confidentiality’ makes scrutinising public spending impossible; the profit motive encourages ‘cherry-picking’ of the lucrative work, ultimately leading to the demise of the public service. Then, as has already been flagged, the premia for Health Insurance will rise and rise till a small percentage of the population can afford to buy it and we are left with a similar system to that in the USA.Back to Top | | No Confidence issued 30-Jul-2008 | reply to | With all that is happening in the Hea;th Services it is difficult to have any confidence that those in charge can implement anything, including the status quo. Leaks that there were further misdiagnosis in Drogheda makes for frightening reading and more especially if you or a member of your circle is involved. When is all this going to end and who is going to pay the price, other than the poor patient as usual? In any other situation responsibility would be assigned and heads would roll. When there is no responsibility or accountability we can have no confidence that things will improve.
Lets be clear - there is always the possibility that mistakes will happen because we are all human but we must look at what we do when we find the mistake and the steps we take to avoid similar mistakes again.
Of course we would also claim that the HSE and Government are making the biggest mistake of all - removing services from hospitals where the local population needs the basic care in emergencies. This is putting the lkives of people at risk and is unacceptable. In the future we will have enquiries and reports on why it happened but again no one will be held responsible, and especially not the politicians, who will hide behind the HSE. However our history book will tell it as it happened and name the people involved. Using our history and the files of the Northern Standard future generations will be able to get an accurate picture of what really happened and who to blame.Back to Top | | U-Turn or Not? issued 29-Jul-2008 | reply to | We are listening with great interest to the news from Roscommon that Junior Minister Michael Finneran 'has delivered' and all services will remain in the hospital there. Does this mean that the Government has changed the HSE plans? Does it mean that health decisions ARE political? Does it mean that Prof Drumm has agreed to carry out what Michael Finneran wants? We demand that our Government TDs act on our behalf and this now means that they have to get the same agreement.
It seems that one of the conditions Michael Finneran was given is that the people of the area must use the hospital services or the deal is off. We wonder - how many patients are needed for each service? Who will decide the number required? Will that number apply to all hospitals? Will the number differ for each patient type?
On the same basis we ask for the rationale behind the claim that surgeons must have a certain volume to maintain skills. How many patients must they have annually to maintain skills? Who decided on this number? Does it not vary from surgeon to surgeon? Are all surgeons on a par with skills? Surely all patients are also different. No two patients presenting with the same problem are equal. They will have difference which will require a new apporach and they will respond differently to treatment and care. This means that the numbers claim does not stack up. Could it be that someone is only trying to attract more business to their hospital and to their bank accounts? Could it be that a patient is better to go to someone who will treat the patient as an individual with no preconceived ideas and so get better outcomes.
Perhaps small hospitals like Roscommon would have bigger numbers if the HSE and Government resourced them properly and used innovative methods of delivering hospital care. They could make each hospital a very attractive place to work for consultants and also for trainees and junior doctors but then that would upset little empires that have been established elsewhere.
Oh that the patient was at the centre.Back to Top | | Slow Down issued 22-Jul-2008 | reply to | The pace of implementation of the reconfiguration of services in the North East seems to be on a slow down. Our protest in May set minds thinking but the downturn of the economy is certainly slowing the process even further. There are some who are gloating that the Alliance claimed that the services would be gone from Monaghan by July 12st but have been proven wrong. How narrow minded of them to gloat over such a claim. It does show the lack of information they have or their support for the removal of the services. Either way it is shame on them and our history has recorded this for future generations.
However morale in the hospital is at an all-time low. It is very busy and this is the good season, but staff are demoralised by the manner in which they are being treated by their employers. It is as if the employer is hoping that they will get so fed up that they will resign or look for work elsewhere. With the employment embargo in place, where vacant positions are not being filled, it would be a very short time before they would have to close the hospital altogether. The other scenario, which they might want to see happen, is that something will go wrong and then they will be able to publicly claim that the hospital is unsafe.
The family of the late Roy Coulter, Portinaghy, Glaslough, have asked me to thank the members of the Alliance for their efforts to keep the hospital open for emergencies. The family appreciate the tremendous care, attention and sensitivity they experienced when Roy was brought in as a patient.
Back to Top | | Still Here issued 17-Jul-2008 | reply to | We are still here. Some people have been contacting us to see if we had given up the fight and they were delighted to hear that we are far from finished.
Things changed and we had to adjust to the new scenario - no money in the kitty - not ours but the Government's. This will have a definite impact on the continued implementation of plans for the North East and indeed for other areas round the country. We are trying to assess the changed circumstances and ho we can deal with it to our advantage.
We are also in negotiations with 'people in power' and we are awaiting a response from them. Now we do not intend to wait too long as delaying tactics are not acceptable. However if the outcome from these talks is positive then we will have a good story to tell but if the outcome is negative then we will have a bigger story to tell. We have been very patient and have held fire under severe provocation and a negative response will give us the opportunity to redress that situation. More anon.Back to Top | | Reply to Prof. Drumm issued 17-Jun-2008 | reply to | In reply to Prof. Drumm interview, Sunday Independent, June 15th 2008.
Prof. Drumm claims the NHS has failed because the Gov tried to run it as a business. So why does he favour competition then? Why is he setting out to create a health care market?
Why the dogged imitation of failed policies, such as centralization and privatization? These are policies that ignore the health needs of the less well off, of older people and children, of those living in rural areas. They are not supported by research. The evidence that private for profit health care has failed spectacularly to deliver in other countries, not least in Britain, is overwhelming.
These are policies based on blatant double standards. They involve closing small public hospitals while, at the same time, contracting out services for public patients to small private hospitals.
Monaghan Community Alliance does not accept the claim that Mary Harney is extraordinarily committed to improving the public health service. What we find extraordinary is her commitment to private sector solutions in health care. She pretends that UPMCs link to a private cancer centre in Pittsburgh can make up for its lack of patient numbers, then shortly afterwards terminates cancer services in public hospitals in Sligo and Castlebar on the basis that their populations are inadequate. Enabling these hospitals to link to University College Hospital Galway as part of a cancer network would allow people in the West to continue to receive high quality care closer to home.
But there is another agenda at work here: privatization.
Prof Drumm claims the competition brought by co-located hospitals will be good for the public health service. Consultants are in very short supply and these hospitals do not intent to recruit their own. The co-located private hospital will be legally obliged to accept all private patients, including those presenting as emergencies. But how can a private hospital that is not recognized for training purposes safely provide 24/7 A&E? Given that it will have no hospital trainees on site to provide out-of-hours services, how can this be good for patients?
So why is Prof. Drumm pursuing these policies?
Resources, he says, are not going to be given to those who shout loudest. But HSE is shifting money to precisely those areas that are seen to be in crisis, such as cancer care, and to those hospitals who shout loudest. The national cancer strategy is down to medical and hospital politics and big business.
These are voices that are being listened to, while the voices of communities, such as Monaghans, are ignored.
Prof. Drumm says he wants clinicians making decisions, but it is clear that he is referring only to clinicians in large, urban university hospitals. Other clinicians, working in small, non-urban, non-teaching hospitals like Monaghan General, who have repeatedly tried to influence policy-making, have been ignored, and even marginalized.
His claim to have received amazing political support for the changes in the North-East is puzzling, given his belief that politics needs to be taken out of health. The reality is that he, as HSE CEO, is entirely at the mercy of his political masters.
He implies that major surgery in smaller hospitals in Ireland leads to poor outcomes, but what scientific evidence can he advance in support of this? Can he demonstrate that surgery in smaller hospitals outside Ireland has been shown to be unsafe?
The argument that you will lose your skills unless you do so many procedures is intuitive. But how many is enough? There is no scientific evidence for centralizing all acute hospital services, as HSE is in the process of doing. Research does not support centralization except for a very small number of highly complex procedures, which are not carried out in smaller hospitals. Indeed, some doctors have stated that high volumes leave medics in semi-automatic mode, only partially concentrating on the task in hand, thereby increasing the risk of adverse outcomes.
Prof. Drumm gives the impression of a seamless transition from in-hospital to outpatient and community care. This is very far from being the case. In the north-east, for example, where HSEs so-called reform programme is being piloted, there is a crippling shortage of GPs, Some have been forced to close their lists altogether. Against this background, the development of primary care teams remains a mystery: perhaps Prof. Drumm could indicate how he proposes to deal with the shortage of GPs in the north-east and secondly, just how many primary care teams will be fully operational by 1 November 2008 by which time he proposes to have removed all acute care from Monaghan General Hospital?
If Monaghan General, and others like it, are to do a huge amount of day surgery and diagnostics, where are the resources to come from? Given the shortfall in the budget, can Prof. Drumm assure us there will be safe staffing levels, appropriate equipment, emergency back-up, peer review, and triple assessment?
Prof. Drumm, you can see that we have many questions and we need answers. The Minister is unwilling to meet with us and give us these answers. Will you?
Back to Top | | Post Lisbon. issued 15-Jun-2008 | reply to | We voted and it was decided not to get involved publicly in the Referendum and refrain from trying to influence the outcome.
There was a question as to how the Lisbon Treaty might impact on Health. If, as in the Treaty, the provision of Health services would be regraded as 'economic activity' then it would come under Trade Agreements and would push the privatisation agenda, which of course would suit the present authorities. There was no clear way that the Irish could veto anything in this regard and therefore we should vote against it. We could find no clear explanation of this and no one seemed to have the definitive answer to convince us otherwise.
The big sway came when a member spoke of the feeling of intimidation he was feeling being coerced into agreeing with a Treaty, which could not be explaned to him and which no one seemed to understand, and one that the Taoiseach had not even read in full. The arrogance of being expected to trust someone, who ignored the pleas of the people of Monaghan, and would likely ignore the votes of the nation. Were we now being treated by our own public representatives in the same manner that the European Union was treating us - with confusion and distain?
Some present at the meeting pointed to the good that we had received from Europe but another pointed to the price we had paid for those benefits. They have imposed all these rules and regulations, regulations that might be appropriate in a large country but impractical and appalling for people in a small rural country like Ireland. Conditions are becoming like those in a dictatorship, where everything is imposed by arrogant leaders, without the people having a voice - just as is happening in our health services and especially with the removal of services from Monaghan and the refusal of the Minister to meet with our group. We have been informed by a huge number of people over the past three weeks that they were going to, or had voted 'NO' in protest at what the Government is doing to Monaghan in general and the Hospital in particular. Many have criticised us for not coming out and campaigning for the 'NO' to give the Government a clear message that we will not be bullied into submission. Our answer is that we are a democratic committee and the vote was against that.
However we now say to Government - take note of what has happened with this referendum - people are in a different mood now that the economy is sinking fast. People will not be led blindly but will begin thinking for themselves again. This can be very dangerous for a Government who have a particular mind-set after being comfortable for so long but if they want to turn this around they need to listen carefully to people, and that includes us in relation to Monaghan General Hospital, as might be leading the campaign for the next referendum or election.Back to Top | | More of the same again.. issued 15-Jun-2008 | reply to | Aengus Fanning gave Prof. Drumm more lines this week to issue more spin for the nation. We are not taken in by the bland claims and promises.
We have some questions for the Prof. He states that you cannot have a major operation in a small hospital in Ireland. Can you have it in a small hospital elsewhere? Why can you not have it in Ireland? What statistics and audits has he got to show that it is not safe, if resources and supports are in place?
Another - if small hospitals will be doing huge amount of day surgery and diagnosis - will there be triple assessment there? Will there be emergency back-up? Will there be peer reviews? Will there be the staffing levels to work safely? Will they have the proper and up-to-date equipment?
What does he mean when he asks patients to make up their minds in relation to expensive treatment? What does he mean by asking if it is justified in terms of cost? Is he asking cancer patients to request cheap treatment instead of wasting money on the costly treatment?
So he is in favour of competition in our health services!! Co-Located hospitals are good for us? Public patients will be treated by Public-only contracted consultants to the left and private patients will be treated by private consultants next door? Which consultants will be better? Will both hospitals provide the same services? Will the private hospitals provide A & E? Will the Public-Only consultants treat the private patients in the public A & E? Who will pay for the public patient if they have to be treated in the Private hospital? These are very important questions which need answers but then the HSE are not known for answering questions, at least any way soon.
He floats the old reliable again - you have to be doing so many procedures or you will lose your skills!! This again has no basis in fact and research does not back that except for a small number of specific surgeries. Indeed some in the medical profession have stated that doing too many leaves a medic complacent and lacking in concentration, thereby making mistakes.
So resources are not going to be given to those who shout the loudest!! Oh, we understand alright what you are doing Prof Drumm. You are shifting the money about to the areas that are in crisis in the public view or where there are no loud voices fighting the cause. However to us it seems that there are some voices you listen to but you are deaf to the voices of the people from Monaghan. Why is that? Why are you so dictatorial in relation to Monaghan? Is it that we have little representation at the Cabinet table or is it historical?
You claim that the NHS has failed because they tried to run it as a business. Could you also take another leaf out of the NHS book and stop imitating the systems that have failed for them, like closing down small hospitals and abandoning people in rural areas.
You want clinicians back to the frontline and making the important decisions. Is this the clinicians, who are based in the major cities and working in University and major hospitals or is it the ordinary clinicians working in hospitals like Monaghan, who have continually tried to influence your decisions but have been ignored, nay have been isolated. Why will you not listen to your clinicians on the ground in Monaghan and allow them to make decisions? Whose plan do they not suit?
We cannot agree with Prof Drumm when he says that Mary Harney is extraordinarily committed to improving the public health service. Very few in Monaghan would agree and certainly the 4000 plus who marched through Monaghan on May 10th last would not agree. The privatisation of the service is more in keeping with her actions as we see it.
We would love if the Prof. would elaborate on his statement that he has received amazing political support for the changes in the North East. Surely that is making a political statement, which earlier he was at pains to stress that he avoided. We can take it then that political support and pressure does influence his actions?
In relation to the Primary Care teams we would ask how they are progressing in Monaghan and how many will there be in County Monaghan, fully operational, by November 1st 2008.
Prof. Drumm, you can see that we have many questions and we need answers. The Minister is unwilling to meet with us and give us these answers. Will you?Back to Top | | Statements issued 02-Jun-2008 | reply to | There has been a lot of work going on behind the scenes since the protest rally on May 10th last but little progress can be reported at this stage. Our two TDs, Dr. Rory O'Hanlon and Deputy Margaret Conlon issued Press Statements since then criticising the Alliance and our policies and methods of action. We recorded the following reply in the Northern Standard last week and we publish here without comment as that should not be necessary:
'The Northern Standard last week carried statements from Dr. Rory OHanlon TD and Margaret Conlon TD in relation to Monaghan General Hospital and the Community Alliance. We feel it very necessary to respond to these statements and to put the record straight on a number of issues raised by the Deputies.
Dr. OHanlon states that it is not possible today to provide the level of sophisticated and high tech surgery at every county hospital in the country and gave the impression that the people of Monaghan are demanding that type of surgical service in Monaghan. This is untrue as the Alliance has asked that up to five-day surgical procedures be provided in Monaghan, while the complex surgery be referred to a specialised centre. International research is divided on the benefits of centralising services and countries are very conscious of the knock-on effects of removing routine surgery from hospitals. Indeed the latest report on surgery in Cavan/Monaghan shows that Monaghan can provide an excellent service but we are asking that this be extended to include five-day services. This will make better use of facilities and personnel and improve the quality of services for the people of Cavan and Monaghan.
His praise for the medical services in Monaghan sounds hollow when he states that he wants it to continue until something better was put in place. The problem is that it will be very difficult to establish a better service and how will a new service be audited for quality and by whom? Also, given the evidence that the care provided to cardiac patients in Monaghan, as proven by the audit figures of Coronary Care, which meet and surpass national targets, it is difficult to see how any service can provide a better, safer and more accessible care to the people of Monaghan than that which already exists.
While we acknowledge his intention to work to the best of his ability to ensure that everybody, irrespective of income, has access to the very highest level and quality of healthcare we claim that access is just as important as quality because, if you cannot access the service, its quality is irrelevant.
Regarding the statement from Deputy Conlon we would take issue with a number of points she has raised. Firstly she gave the impression that the Alliance did not convey her apology for non-attendance at the Rally on May 10th. This was done but we never expected her to attend as she had informed us previously that she would not attend any of our public meetings or rallies due to issues relating to her personal health and safety. This remark was found to be very offensive by the members of the Alliance.
Regarding her refusal to accept her statement to Dr. Illona Duffy, prior to the election, that the hospital would be a resignable issue for her, we would like to ask her to consult her notes of that meeting as we accept what we are told by Dr. Illona and her recall of all that was said at that meeting.
Deputy Conlon rejects the megaphone diplomacy employed by the people of Monaghan for the past 25 years but we would claim that we have had little option but to employ this strategy. Since taking office the present Minister has continually refused to meet with us due to a full diary. We have met with the majority of Ministers, who have listened to our arguments but fed us valium in return. Deputy Conlon claims that she prefers to work in a progressive positive and constructive manner through meaningful dialogue with people from the HSE, Department of Health and Children and the Minister Mary Harney TD. Unfortunately we see no progress from this approach as even more services have been lost recently.
Again the Deputys contention that the removal of services without better alternatives in place would be reckless and would compromise patient outcomes ignores the consequences for patients when those better services are so distant that they cannot be accessed in time to save lives in emergencies. To ignore this fact is placing an acceptable mortality rate on the people of Monaghan and this includes all of the county as the south of the county will suffer a similar fate with the removal of services from the Louth Hospital in Dundalk.
Margaret Conlon demands written evidence of the removal of services. Does she really believe that the HSE works that way? A number of Draft documents have been leaked to the public over recent months. We know that these contain the real plans for Monaghan and that the HSE has always moved in a stealth-like manner when removing services. They use confusing tactics including the use of ambiguous language to hoodwink the public but I would ask anyone to check all the statements issued by the Alliance since its formation and they will find that all predictions to date have come to pass and you can believe us when we say that the glorified Nursing Home is soon to become a reality unless these public representatives take a united and firm stand with the people of this county, all of whom they have been elected to represent, to ensure that the basic and necessary services are retained in Monaghan General Hospital.'Back to Top | | Lisbon issued 02-Jun-2008 | reply to | We have been asked to support the 'NO' campaign instigated by Roscommon Action Committee and also by Ennis Action Committee. Other groupos with whom we have had contact recently are also on the 'NO' side and would like us to follow. We will be discussing the matter at our meeting on Tuesday night and taking a vote on what we are to do. It has already been discussed at our last meeting and there was a 50/50 split on what we should do. There were four parts to the argument. Firstly those who were against Lisbon and would want us to vote NO because it is the right thing to do. Secondly those who are against Lisbon but think that we should leave it to each individual to vote whatever way he/she wants. Thirdly those who support Lisbon but want to vote NO as a protest vote. Lastly those who support Lisbon and want us to vote YES. We need to debate the issue again and perhaps some may have been able to get a clearer picture as to the consequences of the Treaty on our future health services. There is certainly a lot of literature out there and it is difficult to make sense of most of it. Whatever the outcome - we will issue a text message to our database asking for a NO vote. If you do not hear from us on this, it means we will not recommend a vote.
One point made by a member: There is really nowhere one can go to get answers to questions on the Treaty. Those who should know are confused or are toeing the party line without personal conviction. Some of the points raised by our members last week clearly identified the conflicting answers and that from people within the same party. It may come down to: 'if in doubt ...... ' Back to Top | | New Junior Minister gives hope issued 14-May-2008 | reply to | Deputy Michael Finneran, Roscommon, has been appointed (I do not like the word 'elevated' as it implies a certain Godliness) one of the new Junior Ministers by Brian Cowen. Joe Finnegan interviewed Michael on radio this am and I did not know whether to cheer or cry.
Cheer firstly - well Michael is against the removal of Consultant Surgeons and Anaethetists from Roscommon and cannot see that this will happen. If that is the case then we have a champion for our cause at the cabinet table. He then went and spoiled it all be saying that one cannot compare Monaghan with Roscommon. We need to know why. What is special about the Roscommon people? Why can Monaghan people be sacrificed but not Roscommon people? The Monaghan Consultants have been as vociferous, if not more so, than his friends in Roscommon hospital but they have not been listened to. Why should the HSE listen to the Roscommon Consultants?
Hwe then gave the impression that the document sent to Roscommon councillors was only a discussion document with various optional proposals and that when it would come before the Minister it would be rejected. Where did we hear that before? - Oh yes - Bertie told us that he would reject any plan that came before him, which would remove services from Monaghan. Yes, he said that to Joe Finnegan on radio just before the last General Election. We said then and we say to Michael Finneran - you will not get another chance to vote on it - you have already voted in favour when you voted for the Hanly Report as Government policy. There is no going back other than to re-visit Hanly and reject it totally, but Michael will not put himself out on a limb to do that - will you Michael?
We were told that they were only discussion documents each time the HSE came forward with proposals. No one ever had to vote, there was no public consultation, they did not listen to Consultants from our hospital, it just happened as per document and we had no power to stop it. Neither will the people of Roscommon on their own and that is why all small hospitals throughout the land need to get together and fight a unified battle. Roscommon has begun the action this time with their call for a NO vote on Lisbon. We will decided at our next meeting whether to do similar or begin a different action but the one certainty is - the war goes on until they sit down and talk. Are the afraid to talk because their arguments will not stand up to debate? Are they afraid to debate because our arguments will win out? Are they afraid that if they are defeated they lose power? Are they afraid that they might have to put the patient first and disappoint their friends? Are they afraid that they will be asked to organise and manage more than they are capable of? Are they afraid that the surplus jobs will be exposed? What is their reason?Back to Top | | March for Hospital issued 12-May-2008 | reply to | A fairly decent crowd turned-out for the Hospital March on Saturday last, which was as many as were expected since there were so many other events on, e.g. Confirmation for a huge number of youngsters in the Cathedral and the Meath Football League final plus weddings and a funeral. Monaghan Brass Band and Clontibret O'Neill Pipe Band prodided a catching start to the parade. The Hearse (thanks to Conor Clerkin, Threemilehouse), led the way, symbolising the need for such transport if they go ahead and remove emergency services from our hospital. If this happens we intend to ensure that those responsible for the deaths by removing the services will be named and shamed and be held accountable, not like last time, when they got away in the smoke.
There are many to be thanked for their assistance in organising the March. Gery Coyle and Ronnie; Murphy Video Services; the two bands; the Gardai; Marie O'Connor; the Marshals; the five members of Monaghan Senior Football team; the members of the Alliance committee; the Court Services for use of Courthouse steps and forecourt; all who helped with publicity and the Northern Standard in particular; the Parish Bulletins; members of the clergy who mentioned it; the speakers; and most of all the general public.
The speakers were: Dr. Illona Duffy; Madeline Speirs, INO; Janette Byrne, Patients Together; Joe Higgins, Socialist Party; James O'Reilly, Fine Gael; Caoimhghin O'Caolain, Sinn Fein.
Apologies were received from Bishop Jackson and Bishop Duffy. Bishop Duffy issued a statement as follows:
Statement from Bishop Joseph Duffy on Monaghan General Hospital and Health Provision into the future for the North East Region.
'I am aware of reports that Navan has been recommended as the preferred site for a New Central Hospital for the North East Region. I am also aware of reports that services continue to be transferred in the interim from Monaghan to Cavan and Drogheda. Decisions such as these are the responsibility of our Political and Civic Leaders and I have to respect that. But as Bishop of the Diocese of Clogher, I have a responsibility to listen to and to respond to the concerns of the people I serve. In matters of local health service provision, these concerns have in recent years been strongly articulated
by consultants and general practitioners working in this area and by groups such as the Hospital Alliance, speaking for individuals and families who have been affected
by changes made and more proposed.
To-day, I publicly request Political Leaders and all those who have responsibility for making decisions on health provision, which will affect generations into the future, to listen carefully to the concems expressed. In planning for the future, it is important that we do not lose the strengths of the past and the present. If centralisation is required for the sake of efficiency, patient safety and necessary economy, it should be able to co-exist with appropriate local provision. It seems to me that consultation with local practitioners and representatives is essential to ensure the devising of health provision which is appropriate to needs and has the confidence of local people.
The people of Monaghan have an appreciative identity with and loyalty to their hospital, solidly based on years of excellent care which they received there. I can personally identify with this and with the concerns and fears for the future which have occasioned to-day's rally. There is still time to acknowledge and address these concerns. If they are taken on board, addressed and sifted with all other points of reference which have to be considered, they can become a positive force in achieving
what everyone hopes for - the best possible affordable healthcare for all the people of the North East Region'.
We too request that Brian Cowan listens to the Bishop and sits down with us to work out a policy for health care in Monaghan that will provide for the needs of the people depending on it. We have requested a meeting with Minister Harney but it will never happen - however more on that anon.Back to Top | | Were we animals issued 11-May-2008 | reply to | We are expected at accept that we will be transported all over the place when we are sick. In our emergencies we are expected to accept that we will be taken over terrible roads to Cavan or Drogheda. When we need specialist treatment we will have to be transported to Dublin or Navan. Daily the fleet of ambulances transport seriously ill patients up and down the N2 from Letterkenny and Monaghan to Dublin hospitals. Frost, snow, fog, sweltering heat - it matters not to bureaucrats sitting in a air-conditioned offices close to a hospital what impact this travel will have on these poor patients as long as the books balance at the end of the year and they have enough money to pay their own expenses and christmas dinner in some top hotel and add the big bonus to their bank accounts.
However we looked at the rules and regulations enforced by the Department of Agriculture for the transport of animals and we were amazed. As a matter of fact we would like to change our notation to 'animal' in order to get better treatment from our Government and bureaucrats.
The rules state that it is illegal for anyone to cause or permit the transport of animals unloess they are fit for the intended journey. They can be unfit if the animal is new-born, aged, diseased, ill, injured or fatigued or has given birth within the preceding 48 hours or likely to give birth during transport. We would be much better off if we were animals.Back to Top | | Desperation issued 09-May-2008 | reply to | Some desperation seems to be setting in among authorities as they fear that they will not close Monaghan. We have gathered some information, which would indicate a push to get the job done prior to the 'Detailed Plan' date of November 2008. We guess there will be nice rewards for those who assist in 'getting Monaghan sorted' and personal conscience will have little to do with it. Wheeling and dealing has no place in the provision of health care but if Monaghan is not sorted then the rest of the country will also be hard to overcome.
With this is mind we can look forward to steps being taken in the very near future to ensure victory. The easiest way to make Monaghan unviable is to remove the permanent Anaesthetic staff. Now that is easy to achieve by not renewing the contracts for those in place and give the jobs to others who will be based in Cavan. But then we do not have to tell them how to do their jobs. They have the experience and we will get no bonuses for our help. The truth will come out eventually and we have recorded the happennings and they will make interesting reading when published. Many will be shocked to hear the truth.Back to Top | | Hospitals on Government hit list named ahead of Monaghan rally issued 08-May-2008 | reply to | Community groups have named hospitals on the Government's hit list ahead of a major rally in Monaghan on Saturday, May 10th. Monaghan
Community Alliance Chairperson Peadar McMahon says if Monaghan loses its hospital, other hospital closures will follow 'as night follows day'. 'As OECD confirmed last week, the North East is the pilot for the Government's National Hospital Planthe elimination of over 40 acute inpatient facilities.
'This is a dummy run for public hospital closures in the rest of the country.' 'If the HSE succeeds in closing Monaghan General Hospital to
in-patients, they will press on, without delay, to terminate over 40 other public inpatient hospitals. Many, like those in Naas, Navan, Nenagh, Croom, Cashel and Clonmel are already marked DNR do not resuscitate.'
Services are being cut in Monaghan General Hospital against the background of appalling shortfalls in primary care in the region and of deepening cuts to hospital services', he continued. 'Despite the dearth of GPs, despite the overcrowding in Cavan and Drogheda Hospitals, the HSE steamrolls on, in the teeth of medical opposition, oblivious to patient safety.'
Marie O'Connor PRO of the Health Services Action Group says these hospital closures will lead to an American-style health system 'where access to medical treatment, including hospital emergency care, depends on ability to pay'. 'Small private hospitals are being given incentives to trade in patients while public hospitals of a similar size are being forced to shut their doors.'
'But replacing publicly-funded services with pay-at-reception private clinics will be a catastrophe', she warned, 'not only for the less well off, but for those who hold private health insurance.'
The Government, she says, seems determined to 'replicate the discredited health policies of the British Labour Party that have destroyed the NHS in England'. 'In both countries, patients are being turned into disease entities so that private firms can turn a profit.'
Confirmed speakers at the Monaghan rally include Joe Higgins of the
Campaign for a Real Public Health Service, former MEP Patricia
McKenna, Fine Gael Health Spokesperson, Dr James O'Reilly, Sinn Fin Health Spokesperson and local TD, Caoimhghn O'Caolin, Cllr Veronica Cawley, representing the Labour Party, and DR. Illona Duffy GP and member of the Monaghan Community Alliance.
An OECD report published last week confirmed Government plans to 'modernise' the health services will be implemented over the next six years. This is a plan that, according to a report on bed capacity done by PA Consulting for the HSE, will take nearly 5 000 public patient beds out of the system. Ireland already has one of the lowest levels of hospital beds per head of population in the European Union.
The following general acute public hospitals are due to close as inpatient facilities, if the Hanly/Teamwork recommendations are implemented in full:
1 Our Lady's, Navan, Co Kildare
2 St Columcille's, Loughlinstown, Co Dublin
3 Naas General, Co Kildare
4 St Michael's, Dun Laoghaire, Co Dublin
5 Mullingar General, Co Offaly
6 Portlaoise General, Co Laois
7 Ennis General, Co Clare
8 Nenagh General, Co Tipperary
9 Our Lady's, Cashel, Co Tippperary
10 St Joseph's, Clonmel, Co Tipperary
11 St John's, Limerick
12 Cavan General
13 Louth General, Dundalk
14 Monaghan General
15 Our Lady of Lourdes, Drogheda
16 Letterkenny General, Co Donegal*
17 St Luke's, Kilkenny
18 Wexford General
19 Bantry General, Co Cork
20 Mallow General, Co Cork
21 Mercy University, Cork
22 Kerry General, Tralee*
23 St. Finbarr's, Cork
24 South Infirmary/Victoria, Cork
25 Merlin Park Galway
26 Mayo General, Castlebar*
27 Portiuncula, Ballinasloe, Co Galway
28 Roscommon General
The following single specialty acute public hospitals are also set to close as inpatient facilities, if the Hanly/Teamwork recommendations are implemented in full:
1 St Luke's, Dublin
2 Coombe Women's, Dublin
3 Clontarf Orthopaedic, Dublin
4 National Maternity, Holles St, Dublin**
5 National Rehabilitation, Dun Laoghaire, Co Dublin
6 Our Lady's Children's, Crumlin, Dublin
7 Peamount, Newcastle, Co Dublin
8 Rotunda, Dublin
9 Royal Victoria Eye and Ear, Dublin
10 St Mary's, Baldoyle Co Dublin
11 St Mary's Orthopaedic, Cappagh Dublin
12 Temple St Children's, Dublin
13 St Nessan's Orthopaedic, Croom, Co Limerick
14 St Munchin's Maternity, Limerick
15 Our Lady's, Manorhamilton, Co Leitrim
16 Orthopaedic, Kilcreene, Co Kilkenny
17 St Mary's Orthopaedic, Gurranebraher, CorkBack to Top | | Another Speaker issued 07-May-2008 | reply to | | All is nowe in place for the March on Saturday but we can just hope that there will be a good turn-out. This will be the first major health protest since Brian Cowen took up office and we hope to impress upon him that he must deal with us and the best way is to sit down and listen. We have one extra speaker for Saturday and she is Veronica Cawley, who is representing the Labour Party. Veronica is involved in the campaign in Sligo to retain Cancer services there and will understand where we are coming from. Back to Top | | 'Go' for Protest.. issued 03-May-2008 | reply to | It is 'Go' for the protest on Saturday, May 10th at 3 pm. Assembly Point is on the Hospital Hill, with the front of the March at the Hospital Gates and then spreading down the Hill towards the Markethouse. A few specific items will lead the March and it will make its way via North Road to the Diamond and then to Church Square for some speeches. Confirmed at this stage are: Dr. James O'Reilly, TD. Fine Gael; Caoimhghin O'Caolain, TD. Sinn Fein; Patricia McKenna, Greens; Joe Higgins, Socialist Party; and Dr. Illona Duffy, Monaghan Alliance. There has been no confirmation from the Labour Party but they were hoping to have a speaker there. Dr. Rory O'Hanlon has other commitments and Deputy Margaret Conlon has a family commitment and neither can attend.
There is still no reply in relation to our request for a meeting with the Minister, but then she is likely waiting to get re-appointed before she calls us in. Well we are prepared to wait another few days but then we go back.Back to Top | | Caoimhghin In The Dail. issued 02-May-2008 | reply to | Caoimhghin O'Caolain keeps Monaghan General Hospital and our health services in general to the fore in the Dail. As spokseperson on health for Sinn Fein he uses every opportunity to raise the issues.
This past week he asked a number of questions regarding the OECD Report and the Transformation Programme document that came to light last week. I would like to take parts of Mary Harney's reply and comment on those, though the entire tone of her replies is one of arrogance and lacking in sensitivity.
The Minister says: 'The first step in the development of a fully integrated regional health service is to ensure that the people of the North East have local access to both routine planned care and immediate life saving emergency care. Over the next few years, in preparation for all acute emergency in-patient care and complex planned care being provided at a regional centre, the existing five hospitals will continue to improve services by further merger of their acute care specialties'. We must have local access to routine planned and immediate life saving emergency care but what she means is that we will get that in the back of an ambulance or in the home because we will not be admitted to hospital, at least our local hospital. Then all acute care will be improved by merger. We know what that means - take it out of Monaghan and cram it into Cavan or Drogheda.
When asked about the Transformation Programme she said: 'The Programme involves widespread and fundamental change and is designed to build a health system that is in line with the model of care emerging internationally' So it is a model of care 'emerging' internationally. We thought it was best practice - that it had been tried and tested elsewhere and would, without doubt, provide a world class service. So it has not really been tested and we are guinea pigs for a programme that may not work - we know it will not work. However it is not the same as that emerging internationally because they all make sure that rural regions have the basic services in their local hospital - they do not abandon large chunks of the population to the risk associated with distance to hospital treatment as she is doing.
Another part of her statement: 'The Teamwork Report, which has helped to inform the approach being taken by the HSE in relation to the Transformation Programme, clearly indicated that the current service configuration in the region is unsustainable'. Why not when it was looking at a hospital in Monaghan that had been ravaged and torn apart by Health Boards and Governments over the previous two decades. Of course Monaghan was not sustainable because it had been starved of resources in order to make it look unworkable and unsafe. Then of course they are coming from an economic viewpoint and not from patient safety and risk.
Looking at this statement: 'In progressing the various elements of the Programme the HSE has repeatedly emphasised its commitment that existing services in the region will remain in place until they are replaced with higher quality, safer or more appropriate services' - how can we believe them. They have removed maternity, pediatrics and surgery but let no one claim that we have a better services in these - certainly not as the reports we get every week tell us. Anyhow we want to know what audit, criteria or assessment will be used to show that we will have better services. Why do they not do that first and then convince us that we will get a better service when we see the results.
'In the case of Monaghan General Hospital the HSE envisages that the future role of the hospital will be to provide a range of acute services within a clinical network' - who is she trying to fool. She should know by now that we are no fools and have intelligence - Monaghan will not, according to the plan, provide any acute services as she says. Monaghan will only be used to provide 26 step down beds for the acute services in Cavan and Drogheda. While there are no basic services in Monaghan we will not accept the plan.
Of course the Minister had to get her little 'rub' in referring to the number of admissions and length of stay for patients in Monaghan. Yes - that was an excellent service and had great outcomes until people like her meddled and caused problems.
Caoimhghin must have great patience to sit opposite and listen to waffle and mis-information and pedantics with a wicked use of the English language.Back to Top | | Protest March issued 30-Apr-2008 | reply to | Plans for the Protest March from the Hospital gates at 3pm to the Courthouse Square are well advanced at this stage. The list of speakers should be finalised in the next couple of days. We expect quite a big crowd as people are becoming aware of the consequences.
Why should you attend?
1. The latest document to come into the public domain is a true record of the HSE intentions for Monaghan. It is a work in progress (it is being implemented as we speak) and this has been notified to members of staff and is confirmed in the OECD Report.
2. Monaghan General Hospital will lose all acute in-patient services and all emergency services before November 2008.
3. What we are being offered is not a better service. We demand that they produce an audit of the new services to show that they are better than the audit carried out in Monaghan in 2006/2007. There is no money at the moment to invest in improved and expanded facilities in Cavan and Drogheda to cater for the extra workload or to put in place the promised Primary Care teams and Community Care packages. The consequences of closing these services in Monaghan are so serious that it is frightening to contemplate the outcomes.
4. People will die on the way to Cavan or Drogheda and the HSE will tell us that the patient would not have survived anyhow or that they cannot comment on individual cases. That is no comfort for families, whose loved one died prematurely in an ambulance on the roadside.
5. The added cost and inconvenience placed on families to access services in a distant hospital will add great hardship to their lives and will impact on the patients. The old, the young and the poor will suffer the most.
6. Everyone has a duty of care to themselves, to their own families and to their childrens children to ensure that they can access health services when and where they need them.
7. Other countries have implemented methods of providing the basic services to the rural populations in a viable and safe manner. All we ask is that we are treated equally.
We would ask you to March with us on May 10th at 3 pm. and to urge your friends to be there. This policy madness must be changed NOW, before it is too late, and YOU can help to achieve that.Back to Top | | Update issued 25-Apr-2008 | reply to | Just a little run down on some of the happenings this past week.
At our meeting on Wednesday night all members reported a very positive response from the public for the Hospital March on May 10th. The truth seems to be more obvious now to more people and they are appalled. Lets hope that translates into attendance at the March.
The two Peadars went to the Department of Health buildings in Dublin on Thursday and demanded a meeting with top authority to discuss the recent 'detailed plan' for Monaghan. Of course the Minister was nowhere to be seen and our representatives were aked to send in an email requesting the meeting. Now we have lost count of the requests already sent in but 'her diary was always too full'. We will wait for a number of days and if the meeting has not been arranged by then the two Peadars will return to Hawkins House and will be more difficult to remove. This time they accepted the word of the Secretary and showed that they were willing to compromise and be reasonable. It is now the turn of the Minister to act likewise.
The committee expressed disappointment that the media seemed to shy away from challenging the evidence for centralisation. Of course there is no evidence as proper research has never been done and many experts have pointed this out but still, not even one journalist will take it on. Are they afraid of the vested interests or what?
Our local representative has really annoyed members of the Alliance with the statement issued in relation to the latest document - 'the Detailed Plan for Monaghan'. We have not seen the text itself but it is reported that she claimed that this was only a discussion document (HSE claimed similar) yet for anyone who is aware of what is happening in the hospital at the moment would know that it is well past a discussion document. Recently she announced that she had a problem with the HSE and now she accepts this at face value. She actually is reported as saying that we are scaremongering - how dare she. There will be another challenge to her in the coming week. As well there is a motion down for next Tuesday night's meeting - 'That the Alliance calls on Margaret Conlon to resign her seat in Dail Eireann due to the further downgrading planned for Monaghan General Hospital'.If the motion is passed she should be willing to do this for those she represents as well as for personal reasons.
We have received advice that if services are removed to Cavan then any person from Monaghan, who has to travel to Cavan for a service that was previously available in Monaghan, can claim costs and expenses from the HSE. These include Travel costs and loss of earnings for the extra time needed away from the job. Members of the family will also be able to do likewise if they have to visit a sick family relative. This could prove very expensive indeed for the HSE, if it were to happen. Of course there will be many other claims against the HSE if services are moved.Back to Top | | Are bigger hospitals better? issued 24-Apr-2008 | reply to | The issue
It is tempting to think that larger hospitals are more cost-effective than smaller ones because of the operation of economies of scale. However, the evidence does not back up this belief. While increasing hospital size can cut costs for some specific procedures, such economics are exhausted at a relatively small size.
Many people also believe that patient outcomes improve with hospital size. Unfortunately, most studies of this relationship are poorly controlled for differences in prognosis, if at all. When such differences are taken into account, the correlation between outcomes and size turns out to be relatively minor or even absent.
Findings
The literature on hospital economies of scale suggests that they are fully realized in facilities of 100 to 200 beds. Yet, in many countries, the concentration of hospital services continues to be a major policy aim, especially through mergers.
However, concentrating hospital services often reduces patient access because it increases social and economic costs for many patients.
Policy considerations
Bigger hospitals are not necessarily better. Research shows that they rarely result in lower costs or better patient outcomes. A good deal still needs to be understood about how to achieve better clinical results, and common size indicators, like hospital activity volume, are too crude to be useful in planning clinical services.
Optimal hospital size depends on local health care needs and the availability of complementary services. The burden of proof for any proposed merger ought to lie with its proponents, who should be able to quantify the expected benefits and costs and explain how the benefits will be realized.
Health Evidence Network (HEN)HEN is an information service primarily for public health and health care policy-makers in the European Region.
Just to keep reminding people of the evidence against the policy being implemented by our Government but evidence that they keep ignoringBack to Top | | Another Document - Same Plan. issued 22-Apr-2008 | reply to | On Friday, April 18th, I was handed a copy of a document which claimed to be a detailed planning of the North East transformation draft Interim report to facilitate input via partnership process and dated April 15th. It also claimed that it was a work in progress only and at the bottom of each page it was written NE Transformation Detailed Plan.
I used sections of that document in my address at the Health Conference in Liberty Hall, Dublin on Saturday, April 19th. An Irish Times journalist asked me more about it and then published a story on Monday in the Irish Times. Some radio stations lifted the story and ran with it and Caoimhghin OCaolain released it to the public at a Press Conference in Monaghan. The HSE then announced that it was only a discussion document and that no decisions have been made. Yeah we heard that one before but how do they explain Detailed Plan?
They can claim all they want but this is THE PLAN and no mistake. Compare it to Hanly, compare it to Teamwork, compare it with Pat Joe Carey Report and you find that it fits in exactly with the recommendations of each of these. It also fits neatly into what we have been consistently told by the HSE and hospital management. It is what we forecast over a year ago, but no one listened. It is also my information that this plan, the exact same details, was given to members of Monaghan Hospital staff at a meeting a few days previously and it was presented as a fait accompli. Is this another ploy by the HSE to get the media to waste itself on this document and then, when the media moves on, they can carry out the plan with no interruption as the media will not revisit the scene? Do they expect us to waste ourselves on this now and then give up so that they can implement it when we have spent our energies? Both of these will not work. We have continued to stay with this for over six years and we are ready for another six if need be, but our attitude will change and methods will change.Back to Top | | Flawed Document issued 22-Apr-2008 | reply to | The document, entitles Detailed Plan is full of contradictions and impossibilities and is flawed from start to finish. It is ludicrous and laughable but it is too serious to laugh as we are aware that there are people out there who would attempt to implement this plan as shown in the document irrespective of the dangers and major risks to the people of the region.
Again we state and continue to state that all this is not about patient safety or better services. They have shown us no evidence that this will be the case. There has been no Patient Impact Statement prepared. International evidence does not support what they are trying to do. International evidence shows that health services will become more expensive and for some too expensive, health services will be of a poorer quality, and that our hospitals and health services will be less efficient, if that is possible.
Forgetting all about a New Regional Hospital, which is decades down the line if at all, it is criminal to consider putting all acute services and A & E into Drogheda and Cavan. They cannot cope at the moment and this document states that they will take the Monaghan patients without any extra beds? How? well they intend to have special ambulances sitting outside Cavan ready to transfer patients back to Monaghan, as soon as possible after their treatment. Who is going to look after them in Monaghan? Could we be looking at another Pat Joe Walsh scenario? And will Cavan patients be happy to come down to Monaghan to recuperate, as they will also have to vacate their beds as soon as possible in order to give the bed to someone lying on one of the 70 trolleys in the corridor.Back to Top | | Warning !!! issued 22-Apr-2008 | reply to | The only thing this document does is give us all a warning. Time is running out and these proposals must be rejected and blocked with all our might. What it contains is not new but that all acute services will be gone from Monaghan by November must be acted on.
Even now, with the end so close, there are those who are blind among us. Those who would still support the decision makers. Those who play political football with our lives and their own. Those who have allowed themselves to be taken in by the spin of the vested interests. Those who will not question the real motives behind the removal of services from Monaghan. Those who do not see the essential need for the services in Monaghan because they never had to call on them. Those who have private insurance and believe that they will never have to go to Monaghan the fools must know they will never have an emergency because in an emergency it matters not whether you have insurance or not you will want to get to the nearest hospital fast and will not be wondering if you have insurance. Those who believe that the Advanced Paramedics will be on the ambulance and will be able to keep them alive until they reach a distant hospital.
Will there be Advanced Paramedics? Are you safer with Paramedics? lets look at some research - Liberman, Mulder and Sampalis took 15 of the better studies comparing ALS (Advanced Life Saving)and BLS (Basic Life Saving)in the pre-hospital setting. They found that the crude odds ratio for dying in those receiving ALS was 2.92, i.e. patients who were victims of severe trauma who received ALS were nearly three times as likely to die than those who received BLS only.
But then again they never listen to clinical evidence or results from research they know it all!! They also know what they were told to implement and it is more than their jobs worth, if they fail to achieve the plan. So blindly they will do whatever is needed to reach the goal and get the bonus, and later the promotion. That is more important than lives and people, even their own people. But they have the Government at their backs a Government made up of Greens who signed a Contract with the people of Monaghan prior to the election but then tossed it into the dustbin when the Merc keys were rattled. More people with no principle. Power is a false God but the real God will avenge.
Back to Top | | No evidence for centralization, conference told issued 22-Apr-2008 | reply to | For further details please phone Marie O'Connor on 086 81 80 254 or
Joe Higgins on 087 29 43 256. Interviews with Prof Pollock and other
speakers may also be arranged.
Speaking at the weekend conference in Dublin organized by the Campaign
For A Real Public Health Service, entitled, 'Building A Public Health
Service - The Alternative to the Government's Agenda', Professor
Allyson Pollock of the University of Edinburgh, said Ireland 'was
modeling itself on England, which is modeling itself on the United
States'. But Scotland and Wales were 'moving rapidly to lock out
private for profit health care'. 'In a market system, such as
England's, she warned, 'around 40 per cent goes on administering the
system'.
The director of the Centre for International Public Health Policy said
there has been a major drive towards centralisation in England,
because the Government was locked into paying the private sector for
buildings built under public-private partnerships for 30-60 years. 'So
much has to be taken out to pay bankers and developers that major
reductions in staff and services are necessary.' There was 'absolutely
no evidence whatsoever' for centralisation, she said. 'It is a
sub-text for something else.'
In England, the marketisation of health care had been accomplished
partly through taking control from clinicians and putting it in the
hands of bankers, industrialists, and others. The administration had
been centralized, and 'new management teams introduced to help bring
in the market'. Public services had been sold to for profit companies,
who then leased them back to the NHS.
Services were privatized from within as well as from without, with
hospitals created as trusts, or even directly privatised through
management contracts, services were contracted out, land and buildings
sold off. There was also 'the privatisation of public administration'.
Lots of entry points were being created into the health services for
for profit companies, including the corporatisation of primary care.
In England the private sector had been invited to design and build
'independent treatment centres' in the NHS. 'This is the parallel
co-location system'. The Government has spent 8 billion in England
on this programme, which Professor Pollock described as 'quite
catastrophic'.
From 1997 2002, more than 10 000 NHS beds in England closed. 'We
have a workforce strategy that anticipates losing 36 000 staff. Staff
have been moved into the private sector, 'where very different terms
and conditions apply'. 'We have brought in 'take or pay contracts.
But the public sector is paid the same regardless of the number of
procedures done. There are no data on clinical services they provide,
no data on value for money. The private sector is treating 50 per cent
fewer patients than they are paid for.'
Another conference speaker, campaign activist and Socialist Party
representative, Joe Higgins, said the problems in the health service
resulted 'from a calculated and ruthless policy of the Government to
undermine public health care to open up the service to for profit
corporations '. When the Government promised 3,000 new acute public
hospital beds in 2002, they were plotting to allow big business
interests into public lands to build private hospitals with huge tax
breaks, through co-location'.
Government propaganda, he said, would have people believe that 'the
health services constitute a black hole into which vast amounts of
money disappear'. 'The lie that the spend on our health service is way
out of line suits the agenda of those who want to destroy the public
system to promote the corporate agenda.'
Our 16 billion spend on health covered a massive range of services,
he pointed out. 'We are still quite a way behind the proportionate
spent on health by the most advanced EU countries.'
Recent increases in the spend, he said, had to be seen against the
very low base of spending in the 1980s, when compared to the European
average. 'The 3,400 beds ruthlessly ripped out of the public system in
the 1980s constituted an incredible 29 per cent of all public beds.'
Despite a population increase of 'nearly a million', these beds had
not been restored.
We need more resources in health, not less, he underlined. 'Public
beds must be restored and adequate step down facilities provided. Co
location must be stopped. We should use every opportunity to frustrate
the speculators who see in the care of our people merely an
opportunity to make profits.'
In his concluding remarks, he said the bureaucracy that is the HSE
must be tackled. 'The men and women who provide the service at the
coalface must be brought into the heart of the management of the
service.'
Health analyst Marie O'Connor said that in recent years, the
Government's privatising agenda had 'moved into top gear, with its
so-called "transformation agenda"'. 'Public patients are now being
treated by a variety of 'providers', including domestic and overseas
companies. These investor-owned corporations mark a sea change, where
the owners are no longer the managers, and patient care may have to
take second place to turning a profit.'
'We now face a future where medical services paid out of the public
purse will increasingly be provided by for profit operators', the
author of 'Emergency: Irish hospitals in chaos', continued. 'In Dublin
and Waterford, for example, public patients are being sent to UPMC for
cancer treatment. Like many American healthcare companies operating
in Ireland, UPMC has a background in fraud in the US.'
'Private for profit hospitals are shooting up all over the country,
uncontrolled, like ragwort. Co-location will add 1 000 beds to the for
profit sector. Adding 13 tax-fuelled investor-owned hospitals to the
mix, the proportion of money-making beds in Ireland excluding
long-stay and psychiatric, is set to rise to 42-45 per cent, at
least.'
She told the audience that 'the current competition for women's smear
tests will lead to the emigration of highly trained and experienced
Irish medical scientists from our hospitals'.
'Private interests are facilitated by the existence of a revolving
door between the public and the private sector.' She criticized the
management contract given to the Health Partnership in relation to the
new public hospital for the north-east. ' Entrusting the location of a
major public hospital to a company with such a strong profile in the
private sector raises issues about possible conflicts of interest.'
'Our public health system is being stripped out by stealth. Over 4 000
public patient beds are slated to close over the next six years under
Government bed cutting programmes dressed up as 'centralisation',
regionalisation', anda particularly successful onethe 'national
cancer strategy'. These stratagems have been carefully designed to
minimise public resistance to the cuts. Commercial organisations will
be the only beneficiaries', she concluded.
Other speakers who addressed the conference included Dr John Barton,
consultant physician, Peadar McMahon, Chair Monaghan Community
Alliance (see script), Michael Murphy (see script), and Des Derwin, of
the Dublin Trades Council.
ENDS
For further details please phone Marie O'Connor on 086 81 80 254 or
Joe Higgins on 087 29 43 256. Interviews with Prof Pollock and other
speakers may also be arranged.
by Marie O'Connor
Back to Top | | Prehospital Interventions issued 22-Apr-2008 | reply to | 22 January 2003
Hans O. Birk, MS;1 Lars O. Henriksen,MD2
Prehospital Interventions: On-scene-Time
and Ambulance-Technicians Experience
This study demonstrates that the Danish ambulance technicians' curriculum includes techniques for which the ambulance-technicians achieve little experience on-scene. This observation is important, because retention of knowledge and skill in prehospital techniques appears to be related
directly to frequency of use.4 The use of prehospital techniques is associated with a prolonged on-scene time, and on-scene time increases with the number of prehospital interventions used. Several studies concerning patients with trauma or medical conditions indicate that ambulance personnel with an extended curriculum spend more time on-scene than do ambulance technicians with a basic curriculum,58 though they do not achieve better outcomes as measured by mortality,5,7,911 return of spontaneous circulation in patients with cardiac arrest,5 time-to-medication,8 admission rate,9 or length of stay in intensive care.7 For most prehospital interventions, there is no or only scanty evidence of a positive effect on outcome,1,2 while shorter prehospital times may represent an important factor in survival for trauma patients.1214 When the scope of the ambulance technicians' curriculum is considered, the limited experience, the lack of evidence of a positive effect on outcome for most prehospital interventions, and the delay of hospital admission, should be borne in mind. This is important because the skills that require the most technical knowledge deteriorate the fastest,15 and because new interventions presumably will be more demanding technically, and their use rarely indicated.Back to Top | | Volume V Outcomes issued 22-Apr-2008 | reply to | All factors affecting the relations between volume and outcome must be identified and quantified to more fully inform policymakers considering issues of access to local (smaller) hospitals and more distant (larger) hospitals in a centralised service.
The institute of Medicine in UK held a workshop on ther relation between volume and outcomes. They discovered that use of more advanced and more effective treatments in a hospital had a major influence on outcomes. Small hospitals very often lagged behind the current methods and this left them open to charge that mortality rates were higher because of lack of volume. This was contradicted by the research and showed that many aspects of care influence the outcomes for patients and not just, if at all, volume.
Back to Top | | Health Conference. issued 20-Apr-2008 | reply to | | A major Health Confer3ence was held in Liberty Hall, Dublin, on Saturday last, April 19th. The conference was addressed by Dr. John Barton, Consultant Cardiologist in Portiuncla Hospital, Ballinsloe; Des Derwin, Dublin Trades Council; Philomena Canning, Mid-wife and member of the National Birth Alliance; Marie OConnor, author of Emergency Irish Hospitals in Chaos and PRO of HSAG; Peadar McMahon, Chairman Monaghan Community Alliance; Joe Higgins, Socialist Party; Professor Allyson Pollack, Centre for Public Health Policy at University of Edinburgh. It was a powerful statement and everyone was very impressed by the sheer mountain of evidence provided by Allyson Pollack against Centralisation and Privatisation of the Irish Public Health system. She certainly gave us all a boost and strengthened our determination and enthusiasm to continue the campaign. The next step will be announced shortly.Back to Top | | More Protest issued 15-Apr-2008 | reply to | The HSE and Government seem determinted to remove all acute care from Monaghan General Hospital as soon as possible and long before all the other services promised are in place. Teamwork has stated that the Primary Care and Community Care must be in place before the services are removed but those in authority are not taking any heed of that. The Consultants in Monaghan General Hospital have stated publicly that the proposed plans for Monaghan is going to cause added suffering and death for patients in the region. GPs have also written in support of the actions being taken by the Consultants. They all did this before and no one listened. Will they listen now? There is a big difference with the current letters. As in other reports recently the HSE and Government were told that things were unsafe and did nothing. As far as Monaghan is concerned - they have been told and we will make sure that, when things go wrong, we will know the person at whom we will point the finger and hold responsible.
The Government representatives from Monaghan have stated that they are against the plans being implemented in Monaghan. Dr. O'Hanlon has always been on our side and Margaret Conlon says she is not in favour until a better service is provided. Who will decide that it is a better service? Can we have proof of that first, before the services are removed, as it will be too late discovering that they are not better when they have already been removed from Monaghan.
At this late stage, it is just not sufficent for our representatives to make statements to the Press expressing their disagreement. They must take sterner action and stand beside us in this campaign. And we offer them the opportunity on Saturday May 10th next at 3pm. We are calling on all, who do not want to take the risks involved in travelling to other hospitals in emergencies, to gather at the Hospital Hill for 3pm and then march with us to the Courthouse for a Protest Rally. This will likely be the final opportunity for all of us to take a stand before the services are removed so we will make it as spectacular as possible. But the fight will only begin if the services are removed because when the deaths happen we will ensure that compensation is received and those responsible are answerable.Back to Top | | The Cancer Scandals issued 10-Apr-2008 | reply to | Part I of a 3-part series
The revelation that five people in the north-east may have died
because a doctor misread chest X-rays indicating lung cancer will
come as a shock to many. It will come as no consolation to their
bereaved families that the radiologist whose work is being
investigated, is said to be in his 70s and recently retired from
practice. That he worked in three hospitals in the north-east,
including Our Lady of Lourdes, Drogheda, suggests that, despite the
propaganda to the contrary, doctor identity, not hospital size, may be
the crucial factor in securing good outcomes.
Landmines in health care are currently exploding on an almost daily
basis. Cancer botches have been identified in a growing number of
hospitals, including large public teaching institutions and small
private for profit clinics. No fewer than three of the eight hospitals
designated as cancer centres are in the frame. Recently, we had the
unedifying spectacle of a small public hospital, Port Laoise Hospital,
being dragged through the mud over cancer care.
Recently it was Barrington's Hospital's turn, after a report found
unnecessary breast operations (numbers unspecified), two cases of
delayed diagnosis, and minor lapses of care in over 100 cases. The
hospital's CEO, incidentally, dismissed the needless surgery as being
of minor importance, but women subjected to unnecessary lumpectomies
are unlikely to agree and will likely sue.
There are many lessons to be learnt from the cancer landmines. They
have been hyped to the hilt. Some of the media coverage, whipped up by
vested interests, has bordered on hysterical. Women need less
hypocrisy, greater honesty, more balance and more information.
The two cases of delayed diagnosis at Barrington's have been the
subject of intense focus, as though delays were not part and parcel of
the patient experience in this country. To judge from the media, the
fact that these particular delayed diagnoses were due to human error
makes them less acceptable, when in fact they should be more so. The
public are being led to believe that, in a properly run system, there
will be no human error. Health authorities and others promote this
dangerous, self-serving myth. The Health Service Executive (HSE), for
example, wants us to believe that better management will eliminate
human error, that improved communications can somehow make up for lack
of resources. This is seriously misleading.
And, like all professions, the medical profession protects itself. It
needs to take greater responsibility for its actions. Nearly 200
unnecessary Caesarean hysterectomies were performed at the Lourdes:
more than one consultant doctor was centrally involved. Yet the Irish
Medical Journal presented these mutilations as a 'systems failure'.
For centuries, doctors led people to believe that they were
all-knowing and all-powerful. But absolute faith in medicine is
misplaced. The view that doctors cannot err is belied by the
experience of the State Claims Agency. Of the 4 000 legal actions the
Agency is currently embroiled in, one third relate to alleged medical
negligence. Having played god for so long, the profession now finds
itself hoist with its own petard. This is especially true today:
modern hospital medicine offers almost infinite possiblities for
mishaps. Many of them are due to under-resourcing or outsourcing,
factors that are completely outside the control of clinical staff.
Punters have been sold a pup, to some degree. The technologies
themselves pose major problems, for example. But journalists are not
asking the right questions, and no one volunteers the information. One
of the cases of delayed diagnosis at Barrington's involved a misread
mammogram, for example. The hospital's CEO said the error rate in
mammogams is around 30 per cent. He had a point. The error rate in
mammography is far higher than most doctors are willing publicly to
admit. Asked by George Hook about the error rate in mammography
several months ago, oncologist John Crown skirted around the question.
Research shows that the error rates in mammography vary from 10 to 50
per cent, according to the medical study quoted. While mammography is
more likely to lead to a finding of cancer when there is none, it can
also fail to diagnose an existing cancer.
Though this will come as small comfort to the thousands of women who
may have concerns about mammograms they have undergone in the past, it
has the merit of putting some of the recent scares into perspective.
Take Port Laoise Hospital, which has been denounced from all sides.
The saga began when a surgeon at the hospital complained about the
number of cases that were being overdiagnosed; and this overdiagnosis
was apparently followed by underdiagnosis as radiologists struggled,
presumably, to take corrective action. (Whether or not the reported
overdiagnosis led to unnecessary surgery is not known.) Nine cases of
cancer were missed in a series of 3 000. While the media focus on the
missed cases was intense, it is absolutely clear that these cases were
well within the accepted margin of error for mammograms. Applying even
a 10 per cent error rate would have yielded 300 cases of under
diagnosis.
So, despite the enormous pressure to roll-out of BreastCheck,
mammography is, at best, a very imperfect tool. But such is the power
of the medical devices industry today that the pros and cons of mass
mammography cannot be debated. And, thanks to professional lobbyists,
BreastCheck has now acquired the status of a civil right in the eyes
of many women.
The cancer landmines highlight the hollowness of the Government's
health policy, which is built on the empty rhetoric of 'centres of
excellence'. The landmines raise serious questions about the national
cancer strategy, which was lambasted last week by Dr Neil Brennan, a
consultant physician in Cork's Mercy Hospital. In the case of Rebecca
O'Malley, for example, two university hospitals, University Hospital
Limerick and University College Hospital Cork, have been fingered. A
HIQA report on the latter hospital, involving a look back at a series
of cases, is due shortly.
One of the two cases of missed diagnoses ar Barrington's also occurred
in a designated cancer centre linked to a medical faculty, University
College Hospital Galway. Speaking on Prime Time, Dr Maccon Keane, an
oncologist at the hospital, lyricised about the value of
multi-disciplinary teams. Asked about the possibility of human error,
he indicated that this casea misdiagnosis by a
pathologistillustrated the value of treating high volumes of
patients in one centre. (HSE could not have put it better.) But
evidently, in this case, as in others, large patient volumes and
multi-disciplinary teams were both insufficient to prevent human
error.
END Part 1
Marie O'Connor
Author: 'EMERGENCY: Irish hospitals in chaos'
Back to Top | | Here goes another issued 10-Apr-2008 | reply to | | The method used by the old Health Boards and the HSE to remove services from a hospital are very similar. The stealth is now so obvious. Find a little problem with that hospital and blow it out of all proportions. This has many effects. It can give the impression to the nation that what they are going to do is for patient safety and better care and so they close that service down. It also frightens the patients who should go there. They begin to believe that that hosopital is unsafe and this will be added to by the professional SPIN from Government, Minister, Department, HSE and of course - the outside independent costly well briefed expert Consultancy agency. Then | | |