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These are articles I wrote some time ago but is still worth reading:
Monaghan General Hospital 004
This past week showed us just how serious the position is regarding getting hospital treatment and getting it in time and in the
proper environment. Of course all finger pointing is directed at the current Minister for Health, Stephen Donnelly and he is
expected to rectify the situation over night and save the lives of those who will pass away before they get proper treatment. I pity
the poor Minister and indeed some of those who have gone before. This entire scenario began back in the 1960’s when certain
people in power decided that all patients should be taken to one hospital and so close the others and redirect the money saved to
some pet project. They soon got support from powerful Medical personnel who saw the benefit to them and year by year this idea
gained strength but was not really workable until the 1990’s when the decision makers were not challenged and by 2005 they had
the power to go ahead with hospital downgrading after a few years of nibbling at the services in the smaller hospitals thereby
making the hospital ‘unsafe’ and a place where doctors and consultants were afraid to work because of the possibility of litigation
and blame. At the same time they removed beds and equipment, failed to fill vacant doctor and nursing posts putting extra
pressure on those who remained. This also reduced the possibility of advancement and development, which made the job
unattractive and uninviting. Minister after Minister did as they were told, tried to make an impossible systems work, and divert
monies from one necessity to another and so for years they moved the chairs around the deck and achieved nothing. The Health
Boards were rolled into one and the number of managers and office staff grew as did the cost of running the HSE itself leaving less
for hospitals and medical staff below Consultant level. Now we may have reached the pinnacle of the damage to patients and their
lives but so far there seems to be just another effort to move the chairs around on the deck - take the money from one area where
the public are not actually complaining and redirect it to where the public are crying out and the TV, radios and Newspapers are
following the poor patient and very soon that same money will be needed elsewhere.
From 2002 until 2009 the Community Alliance was fed up telling the Governments of the day that removing the services from
Monaghan, and similar hospitals in Ireland, would cause major problems for patients and medical staff and that many patients
would die a needless death as a result. We now hear a top consultant telling them the same thing. They did not listen to us but
what we foretold has come to pass and it has all landed on Stephen Donnelly’s shoulders. He is not to blame nor has he the power
or ability to change things for the long term betterment of patients. The head of the HSE has taken on a system in chaos - if he can
dictate a solution to Government and reverse the damage of previous Governments he will be worth every euro he is paid and part
of that solution is the return of services to Monaghan and similar hospitals as well as making the vocation of nursing an attractive
job enticing nurses to want to work in our hospitals.
Monaghan General Hospital 003
This was its name and I still refer to it as such. I do wonder why so many of our hospitals are ‘University’ hospitals – like Kerry
University Hospital, Roscommon University Hospital etc etc while Bantry became Bantry General Hospital, Mallow became Mallow
General and Wexford became Wexford General. Cavan, Monaghan, Dundalk, Navan etc are just hospitals.
At one stage, just prior to the removal of services from Monaghan, it was treated as a top class University as NCHDs all praised the
quality of the teaching and learning available in Monaghan in comparison to all the other teaching hospitals in the country. Anyhow
– what’s in a name?
It is great to read in the Northern Standard re. the renovations and additional spaces in Monaghan and the work outside is also
terrific. All of that we applaud as it should ensure the future use of the hospital. However is does not meet the needs of patients in
emergencies and does little to make our lives more secure. Everyone agrees that early attention and treatment always leads to
better outcomes and that the ‘Golden Hour’ is still the yardstick. During the recent ‘Demonstration to save services in Navan’ it was
stated and endorsed by people who know that taking a patient from Navan to Drogheda decreases the chance of survival and at
very least increases the need for more intensive treatment for a longer period of time with poorer outcomes.
Living in Emyvale I shudder when I hear, on nearly a daily basis, a bluelight/siren ambulance coming from Letterkenny and taking
a very ill patient to a Dublin hospital. I think of the poor patient inside and the poor medical personnel trying to keep him/her alive
and comfortable during the long journey till they get to the Hospital. I have also witnessed a bluelight/siren ambulance coming
through Monaghan town and turning right at the traffic-lights for Cavan and I can imagine how the patient inside must feel as the
ambulance rounds the corner at speed and how the medical presence must try to do whatever is necessary without being bashed
from side to side of the ambulance. None of this is in the best interest of the patient. Indeed the road from Monaghan to Cavan is
frightening for anyone travelling that road even in the best of health.
Hospital Upgrade.
I was delighted to hear and then read about the increase in hours for Monaghan Minor Injuries Unit. At least it is some movement
on the part of Government and HSE. However there is still a need for a further increase in opening hours AND its ability to treat
more than they are allowed or capable of at the moment, plus remove the charge to be paid by those without a referral. Illness and
accidents don’t just happen between 8am and 8pm Monday to Friday and the people of Monaghan are entitled to a 24 hour proper
service instead of being the only MIU in the country with such small opening hours and ability to treat even though the numbers
attending the MIU are greater than most of those open 24/7. It has taken 18 years for us to get these extra hours – will it take
another 18 years to get it open on Saturday and Sunday?
The Government and Department of Health need to sit down and sort out the mess of the Health Services in this country. What
happened in the last two decades has made a complete hash of our health services and the change from local Health Boards to
HSE has been a disaster. When these decisions were being made it is obvious that the authorities did not listen to the
knowledgeable people, who tried to tell them the best way to proceed and plan for the future. It appears that the cities of Dublin,
Cork, Limerick, Galway and Waterford etc had stronger voices than rural Ireland.
In any emergency, be it heart attack, accident, or sudden illness speedy access to hospital care has always been a necessity for
recovery. Access was pushed into second place. Advanced Paramedics, who would be first to the scene, were expected to do, at the
side of the road, what Consultants would do in a hospital situation – impossible. The Helicopter was the answer – patient injured,
someone calls an ambulance (5minutes), it arrives 20 minutes or an hour later (25 minutes +), examine patient and decide
immediate hospitalisation needed and calls helicopter (35 minutes +), Helicopter arrives and finds a landing spot 500 metres away
from patient (55 minutes +), Ambulance takes patient to landing area and transfers to Helicopter (65 minutes +), Helicopter gets
ready for lift-off (75 minutes +). So the patient is still at the scene after 75 minutes + and the ‘Golden Hour’ is well past and the
Golden Hour is still the important time limit. ‘Dead on Arrival’ or ‘death by geography’ outcomes have been numerous and continue
but are seldom made public.
Access to healthcare in Ireland depends on place of residence as well as personal wealth and this begins with primary care. Little
research has been carried out on rural isolation, social deprivation and remoteness and less research has been carried out on the
outcomes as a result of fewer GPs. Rural Ireland in particular is suffering as a result of lack of doctors during the day and especially
during the night hours yet there seems to be little effort to change things. Added to that is the health policy of centralisation, which
also adds to the disadvantages suffered by the populations of rural Ireland.
Centralisation really began back in 1968 when certain consultant groups based in the big cities recommended that all acute surgery
be centralised to 16 major hospitals in the cities mentioned earlier but the geographical and social inequalities in health outcomes,
service provision and access has never been mapped and/or remains hidden from the population and death rates by county are
never available. The Government gave Consultants the power to arrange the provision of services to suit their own interests. A
Comhairle na nOspidéal was set up in 1970 with consultants making the majority of the staff, which gave them the power to
control the provision of services in public hospitals. General and County hospitals like Monaghan were starved of resources and
consultants. The training of doctors became more important than patients and decisions were made with the training uppermost in
the decision making. Specialisation was now the main priority. Doctors would select what specialisation they wanted and their
training in that area followed.
On that note let me recall the position in Monaghan at that time. We had surgical and medical services with consultants and
anaesthetists. We had consultants who covered the Children’s Ward and we had a Cardiac Consultant. We had three anaesthetists
and the hospital ran smoothly even though resources were scarce and funding light. However it was regarded as a training hospital
and every six months junior doctors in training moved to a new location. Monaghan General Hospital was at the top of the list
where the trainees wanted to come. Monaghan had a great reputation for its training and the Consultants were noted for their
terrific training programmes. Junior Doctors were given training in a variety of patient needs and problems. Indeed many of them
requested to do a second 6 month term in Monaghan. When we add to that the inspection and assessment carried out by the Royal
College on Cardiac services in Monaghan during the year 2007 which found that it was excellent and the quality of treatment in
Monaghan matched and in some cases outperformed some of the top Cardiac units in Ireland. Yet all of that was taken from us.
We are all now at risk due to centralisation and unequal distribution of resources. We are also expected to pay the price of having
to travel to a centralised unit, to pay the price for relatives to travel to that unit to visit a loved one, to accept the danger of
travelling difficult roads to and from some of these units, to take days off work to travel the long distances to and from these units
when we want to visit loved ones, and to accept that the Golden Hour will not apply to us if we need urgent assistance and care.
We also must accept that we are not promised proper care as there are not enough nurses or doctors in most hospitals, that we
have to lie on a trolley for hours before we can get a bed, and then have to wait months, or even years, to get called for tests to
establish our condition, hoping that it will not be a late diagnosis. Surely we have intelligent people in the Department of Health
and in the HSE and in Government to solve these problems and provide the people in this country with proper health care. Or is
there a move to force people to pay Health Insurance and get the Private sector to look after our needs and so reduce their
workload.