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Another Monaghan in Portlaoise

In the Sunday Business Post of November 12th 2017 I read an article by journalist, Susan Mitchell, regarding a secret Action Plan to reduce Portlaoise Hospital to one similar to Roscommon - a report that seems to have been kept secret because they were afraid of local objections to the plan. Top medical men, all I'm sure living and working in Dublin were recommending the plan and more and more or less saying that all the acute patients from the catchment area of Portlaoise should be taken to a Dublin hospital in order to get 'better services' -(now where did we hear those two words before??). I wrote a reply and sent it to the SBP but heard nothing. However I never expected it as Monaghan never did count on the richter scale for the Dublin medics or politicians. Much of the reporting on the problem in Monaghan and the protests being held always seemed biased in favour of Dublin. Anyhow I have decided to publish me response here so that some one can read it.

Portlaoise Action Plan
It was with sadness, a heavy heart and a feeling of déjà vu that I read the article by Susan Mitchell entitled ‘The Report the Government doesn’t want you to see’ in relation to Portlaoise Hospital. The people of Monaghan read similar reports and similar reporting regarding services in Monaghan General Hospital when the authorities were in the process of downgrading Monaghan to a similar level as that proposed for Portlaoise and if the people in the catchment area of the Portlaoise Hospital want to know what life will be like when these services are removed from their hospital, all the have to do is ask the people of Monaghan.

Oh yes, the people of Monaghan marched the streets of the capital and marched the streets of Monaghan and the party in power, Fianna Fail, were not for turning. The opposition was on our side and Fine Gael would not do that if they were in power. James Reilly, who was to become the Minister for Health in the Fine Gael Government stood on the Courthouse steps in Monaghan before the election and promised to fight for the services to be retained in Monaghan. You can listen to his words of encouragement to us to ‘fight, fight, fight and Fine Gael will fight with you’ by using this Youtube link - . Then, as Minister, he completed the downgrading begun by Fianna Fail. What a let-down that was.

The Action Plan is proposed and being pushed forward by medics and the reason given is that certain acute and emergency services in Portlaoise are unsafe for patients. So they want these services provided for the people in the catchment area of Portlaoise in some of the four major hospitals within 50 minutes of Portlaoise. So they want a few extra thousand patients taken to hospitals that are already overcrowded, lacking in beds and staff and unable to provide timely services for their existing patients. This overcrowding and delays in treatment has been flagged by senior medics as very dangerous for patients and that it causes needless deaths but yet this is where they want to put the Portlaoise patients. Surgical patients in need of emergency surgery will add to the waiting lists in those hospitals and also add to the numbers languishing on trolleys somewhere in the hospital. We also ask what distance the patients on the other side of Portlaoise will have to travel to get to those hospitals?

It is interesting that €20m is being promised for Portlaoise Hospital and they promise that it will be busier than ever. Monaghan got a similar promise to appease the people into believing that Monaghan Hospital will remain a hospital. It is used from 9am to 5pm Monday to Friday and a small Step-down unit and a similar Rehabilitation Unit but no emergencies are taken there by ambulance and there are no acute surgical or medical services. Some day-surgery, some diagnostics and clinics but no emergencies in Monaghan.

Regarding promises: Monaghan was promised 'better services' but they never materialised. Indeed they have deteriorated. Monaghan was promised an Advanced Paramedic as a First Responder but that lasted a few months. Then we are lucky if there is one on duty at all or we may have to share one with Cavan/Louth/Meath/. We were to get another ambulance but that did not work out either and ambulance times are unacceptable. The nearest A & E is Cavan which is 50 minutes from Monaghan. However for people North of Monaghan Town you can add another 20 minutes. It can take the ambulance 20 minutes to get to the location but sometimes we have to wait for an ambulance from Cavan, Dundalk, Ardee, Longford or even Northern Ireland. They spend 20 minutes stabilising and loading the patient, then 70 minutes to hospital – which is a total of 1 hour 50 minutes before the patient can access Hospital treatment. The Air Ambulance then came on stream. We can give a time line of a call out. A 999 call goes in and an ambulance is dispatched to scene. It takes 20 minutes to get there. 15 minutes after arrival and review of patient they decide to call the Air Ambulance which takes 30 minutes to arrive and find a suitable landing area. The ambulance then takes the patient to that point and transfers the patient to helicopter which takes 15 minutes before the helicopter is ready to depart scene. It takes 10 minutes to reach Cavan landing area and another 10 minutes before patient is handed over to hospital staff.  That is a total of 1 hour 40 minutes – outside the Golden Hour and a big delay in getting hospital treatment. (These times are minimum and in many cases will be exceeded). This type of delay can result in death, not perhaps immediately but later because treatment was not begun in time. When we claim this we are asked to prove that the patient would have survived by reaching hospital sooner, which is impossible to prove but we take the word of certain consultants.

Now also if you have to go to hospital for tests or for treatment you make your own travel arrangements. For cancer patients, e.g., volunteers and voluntary donations provide transport for those who cannot afford it. Indeed so many health services depend solely on the goodwill and generosity of people to fund services in areas around the country. It is once again rural Ireland inhabitants who suffer most as there are no or few public transport systems running in rural areas.

We in Monaghan are convinced that the downgrading of services in Monaghan General Hospital has put more lives at risk than when the hospital was offering full services and that needless deaths have happened. Those services could be provided if the system was properly resourced and managed. But there lies the crux -  the real problem is the lack of investment in beds, nurses and doctors and the inability to manage the system. The Government needs to develop an attractive career path for nurses and doctors and offer them acceptable remuneration so that they will be willing to stay in Ireland and work in our health services. This will also save the huge expenses paid for agency staff and locums which is causing hospitals to cut and/or delay services in order to keep within budget. It might also be a plan to rotate staff between a large and small hospital to maintain skills as it is much safer to make the healthy do the travelling instead of very ill patients and those in need of emergency intervention. We wonder if the numbers are too small for staff in the hospital to maintain skills how do the ambulance personnel maintain their skill attending the same numbers?

If this Action Plan for Portlaoise is proceeded with then it is incumbent on all concerned to ensure that the receiving hospitals will be able to deal with the extra workload and have enough beds and staff. This must be done before any effort is made to remove any service from Portlaoise and the people being served by the receiving hospitals should be shouting loud and clear that their lives will be put in severe danger if this is not done.  The people from the Portlaoise catchment area will not have a hospital when they need it most – in an emergency but the major hospitals will also offer a poorer service through overcrowding.

The question is – have we the people in power to solve this problem properly or will the people of Portlaoise be left with the same unacceptable situation as Monaghan.

Peadar McMahon, Chairman Monaghan Community Alliance.

The Alliance has not gone away and may have to become active again as the situation is totally unacceptable and this Government does not seem to be in a position to change things other than to talk about what they are going to do with their ten year plan. As in the past, only more so, we get spin and more spin which is meant as a Valium tablet for us so that we will be calm and forget about what could happen in an emergency.