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No End In Sight.

There does not seem to be an end in sight to the problems that face the Health Services or rather the problems that face the patients who require the Health Services of this country. The media splashed the problem of trolley figures all over papers and radio for a week and local representatives came out with their demands, which seemed to come after another journalist reprinted articles from in the Northern Standard. However the 8th Amendment and Brexit soon pushed the Health Services and its needs into the background again. A Minister of State is supposed to be coming on a visit and Minister Harris is looking into the possibility of using ‘small hospitals’ to relieve the pressure on larger units and we remember the promises made to the people of Monaghan by various Ministers for Health and other TD’s.

The latest problem to be highlighted is the care given to major trauma patients. This service must be ‘centralised’ so that doctors/consultants/nurses will have an adequate number of patients to maintain their skills. Have they not already learned that the way we centralise services in this country does not work and causes more problems and does not solve the one it was meant to eliminate?

Things have changed but the management of the services has not changed accordingly. In the ‘old days’ many will recall that when the cow got sick you called the vet and out he came and tended to the animal and most times solved the problem. In the ‘old days’ when a person in the house got sick during the  evening or night you called the doctor and out he came and most times solved the problem. Today some things have changed -  the Vet will come out to the animal but most times you have to take the sick person to the Doc-on-call or he may direct you to go directly to the nearest A & E, which is not as simple as it sounds when you live in rural Ireland and almost over 50 mile from the nearest hospital. During the day you took the sick person to the doctor or he/she came out on call after he/she finished surgery hours and most times that was sufficient to deal with the problem. Nowadays there are more patients and there appears to be more sicknesses. We are living longer and the population is increasing. Modern technology is being used to cure ailments that are possibly being caused by modern technology. But modern medicine and modern methods has changed the way illnesses are treated and by whom. The work of the GP has changed and the way they work has changed but the management of all of this has not changed and has been overcome with problems as a result.

While all this was happening it was decided that we needed to cut down on the amount of money we were spending on Health. Let’s close a few beds, sorry a few thousand beds, let’s close a few hospitals, let’s not give pay rises to doctors or nurses, let’s stop spending money on equipment, let’s stop maintaining hospital buildings, let’s build a few more office blocks for the growing number of managers, let’s break the whole health system into workable sections and appoint new managers and staff to control that, let’s cut the allocation of money to hospitals and make them only do what they can afford to do, let’s make sure that if anything goes wrong that we have someone down there we can blame, - all this seems to have happened whether by accident or design and there was no one to shout stop, and there was no one to listen to community groups around the country, who begged them to stop. Now the chickens are coming home to roost.

Some group or other gets the brainwave that if we direct everyone to the one spot, there it will be better for everyone. Great idea but then it did not achieve the expected results – rather it caused more chaos. Let’s set up ‘Centres of Excellence’ as these small hospitals are not safe and lo and behold we see where that got us! Packed A & E’s, patients on trolleys, surgery cancelled, mistakes, missed diagnoses, long wait for appointment, long wait for treatment and for many – too long, overstressed nurses and doctors, fewer doctors and nurses, more needless deaths and a fear of getting sick among the older generation.

Now the A & E’s are under attack again. This time there is a big push to get special Trauma Centres.  They tell us that of the 4,426 major trauma cases in 2016 only 8% were received by a Trauma Team. They want all major trauma patients to be brought to specialised centres for trauma and that a couple serving the country would be sufficient. This would improve the chances of survival and better projected outcomes for the patients. I wonder are there figures for the number out of the 4,426 who died as a result of poor care in the units to which they were taken and treated.

The problem with all this will be similar to what happened in Monaghan. All trauma and basically all emergencies of that nature will bypass hospitals to get to the Big Centre which will soon become overloaded with people who should not be there, just as there are huge numbers of patients forced to go to Cavan and Drogheda where they could be adequately and safely treated in Monaghan. The trouble with at centralised services is that the hospital which lost the service will lose other services because of a lack of resources. When they took maternity from Monaghan it reduced the work load of surgeons, anaesthetists, doctors and nurses and so weakened other services and made them unsafe and so gave them the excuse to remove those also. So it will be with Trauma Centres – taking the trauma service from a hospital will weaken the service for even minor trauma there and they will then reduce the A & E to a minor injury unit.

As always they are going to put the cart before the horse – removing the service before the new receiving unit is built up, staffed and resourced to be able to cope with the extra workload. We are still waiting for the ‘Better Service’ that they promised us when reducing Monaghan to a nursing home. We are still waiting on the enhanced ambulance service, we are still waiting on proof that the golden hour does not matter. Indeed one of the consultants advising the major trauma units is saying that major trauma patients should be in the Major Centre within the hour to gain any benefit. For many living in Monaghan it will be almost an hour before the ambulance gets to the patient never mind transporting him/her to the Major Centre in Dublin within the hour. Surely that is where they should begin – build a proper, workable and efficient ambulance service. I also pose the question – who will make the decision that the patient needs to go to the Major Trauma Centre? Who will have the substantial responsibility of making the decision? Will that person not err on the side of caution and bring everyone to the major centre? Now longer ambulance journeys will result in fewer ambulances on the ground to answer other calls that come while they are away.

However there were 1.25 million attendances at A & E’s in 2016 and we are talking here about 4,426 of them getting to the right hospital for the right treatment within the right time and I wonder how many of the remaining 1,245,574 patients received the right treatment within the right time. Of course set up major centres to treat major trauma but if it is so far from Monaghan that the patient dies on the way or suffers more trauma because of the travel and the delay in getting there then questions must be asked – what benefit does it bring to the people of Monaghan. Dublin they say ‘is at a disadvantage because there are a couple of trauma centres’ which should be merged into one. No word of the disadvantage of the people of Monaghan. It appears that some people with a voice want hospitals only in Dublin, Cork and Galway. Even the people of Waterford are being directed to Cork I am told. What IS going on?