Health Chaos ……………… HERE So The Community Alliance was not wrong. Due to studies carried out in recent times by professional people it has been stated that there are at least 50 needless deaths every week in Ireland due to delays in getting treatment. These delays are caused by the distance the patient has to travel to reach a hospital and the time that a patient has to wait to get treatment when he/she reaches the overcrowded A & E. The Community Alliance claimed, when it came into existence, that patients would die needlessly due to the distance having to travel and the fact that the A & E would not be able to cope safely with the big numbers of patients who would arrive at the A & E door. So the question is – who is to blame? Who Cares about Health? I waited patiently to hear the new Taoiseach and the new Tánaiste describe their plans for the future of our country. I heard them talk about housing and how it is no 1 priority and they went through a list of things that have to be done to make Ireland a better place for its inhabitants but I heard little about our Health Services and what really needs to be done there. When the Community Alliance was formed back in 2002 we told the powers that be that people would die needlessly if the Government and the Health Boards continue with their outlandish plans to remove services from some hospitals and centralise them in one major hospital. We told them that hospitals would not be able to provide the services in a centralised situation, that patients would have to wait too long for diagnosis, then they would have to wait too long for treatment, that patients would postpone going to the doctor out of fear of having to travel to a distant hospital, that there was not enough consultants, doctors, or nurses to deal with the situation as it was, not to mention the extra needed with centralisation. Yes we forecast all that but were ignored but it all came to pass. Patients have died as a result of late diagnosis and treatment. Patients have died because they were taken to a distant hospital and so treatment was delayed and the journey increased the stress on the patient. It is fine for those who live in Dublin or close to one of these Centralised Hospitals but if some of them were living in North Monaghan it would be a different story and Monaghan Hospital would still be an acute centre. We also ask who is actually making the decisions as to what hospital is reduced and what is enlarged. For whose benefit are these decisions being made? It certainly looks like the patient is not considered in all this - Taking them to a distant hospital, bypassing a hospital on the way, and allowing the patient to deteriorate on the journey. It is also a well- known fact that patients recover more quickly when they are visited by family and are in known company instead of being far away from loved ones and in a strange location. It certainly looks like little care for patients when they are allowed to lie on a trolley along a corridor for anything up to 80 hours. Where is the privacy for the patient? where is the comfort of lying on a trolley on a drafty corridor? where is the safety of the patient when they lie on the trolley for 3 to 4 hours before being seen by a doctor? Where is the safety for patients when a proper effort has not been made to employ the required number of nurses and doctors? Why has a real effort not been made to make conditions attractive to nurses and doctors? Why is there a scarcity of ambulances and ambulance personnel which means that here in North Monaghan we have to wait for up to an hour and a half for an ambulance to arrive or worse still when we have to wait for an ambulance to come from Longford, Cavan, Dundalk, Letterkenny or God knows where in Ireland? Why do we have to ask any of these questions? Why did our Taoiseach and/or Tánaiste not tells us what they are going to do to improve our health services? 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 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. Your comments please to peadarmc63@gmail.com