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More Hospitals to Be Downgraded.

The Hanly Report which recommends the downgrading of most of our acute hospitals was the bible by which the Health Services were going to be reformed and Fianna Fail when in power, decided to implement the proposals contained in Hanly. In 2002 the County Monaghan Community Alliance was formed at a public meeting and began to lead the opposition to these proposals. The Alliance was instrumental in setting up a National Alliance, known as the Health services Action Group (HSAG) which represented 16 of the acute hospitals in Ireland.  Studies were carried out and opinion sought from leading experts in Ireland and abroad and we were convinced that the Hanly Reforms would not provide the people of rural Ireland in particular with a workable, adequate and satisfactory health service. It would also cause major problems for the Urban hospitals to which so many extra patients would be directed to inadequate and poorly resourced facilities.

During that time Peadar McMahon, Chairman of the Community Alliance and vice-chairman of the HSAG, addressed public meetings and Protests in Roscommon, Nenagh, Ennis, Clonmel, Portlaoise, Portiuncula, and others. Some very important people were on our side.  Alan Kelly, Kathleen O'Meara, James Reilly, Liam Twomey, the late Joe Sherlock, Jerry Cowley, among others. The people of Cavan were invited to join forces with Monaghan in order to maintain the services of both hospitals. TD’s and Senators from opposition parties supported the Alliance and the HSAG but those in power persuaded their people that they would never allow the downgrading of their local hospitals and assured the public that the Alliance and HSAG were scare mongering. When the opposition got into power they changed ship and proceeded to implement further cuts to rural hospitals ability to provide emergency care.

That ‘scare mongering became a reality for Roscommon, Nenagh, Ennis, Mallow, Bantry, Loughlinstown, and Monaghan and is planned to become a reality in Cavan, Portiuncula, Mullingar, Wexford, Kilkenny, Cork University Hospital, Clonmel, Portlaoise, Naas and Navan, as reported in the Sunday Paper. Of course they would need to develop, enlarge and resource the new Centres for A & E but that will not happen as was the case with Monaghan and all the others, which is why the ‘big’ A & E’s are overcrowded and dangerous. Once the A & E is taken away other services will follow as will in-patient Medical and Surgical services. The hospital will become a ‘Day Hospital’ and Nursing Home. We told the people of Ireland this in 2002 and they did not believe us but we are there now.

At the moment A & E’s are struggling to meet demands and we are being constantly told by the medical profession that patients are put at serious risk when in these overcrowded A & E;s and have put the figure at 300 needless deaths each year as a result of these dangers. Then they tell us that we are at serious risk if we go to our local hospital for treatment in emergencies as the services to do so are not there. So it is like going from the frying pan into the fire for rural patients.

Here we republish a Press Release issued in May 2005 as a result of the death of the late Philip Courtney, Blackhill, Monaghan:

Replacing local A&E units with paramedic ambulances will lead to more unnecessary deaths, coroner’s inquest shows

Health lobby groups say that replacing local A&E units with paramedic ambulances will lead to more unnecessary deaths. Health Services Action Group Chairman Peadar McMahon says: “We now have a coroner calling for the restoration of emergency services in a local hospital, yet the Government seems determined to plough on with its plans to shut local hospital emergency units all over the country.

Last week’s response to a Dail question from Monaghan TD Seymour Crawford confirmed that the National Hospitals’ Office is still on track to implement the Hanly plan to replace local hospital A&E units with paramedic ambulance services. “Research shows that patients taken to hospital by paramedics tend to die more often, compared with patients transported by ambulance drivers. We are being asked to accept a high-risk model of hospital care”.

Hanly will create another two-tier health system, he warns, a system of inequality based on where people live. “There will be one hospital healthcare system for urban areas and another - second-class - system in place for the rest of the country.

“As Mr Courtney’s untimely death shows, Hanly is a model that denies people living outside urban areas access to safe, hospital healthcare. It is nonsense to suggest that being looked after by paramedics in the back of a speeding ambulance is as good as being cared for by doctors in hospital”.

Immediate resuscitation is vital for heart attack patients, the inquest into Philip Courtney’s death was told. A Louth physician, Dr Olwen Lynch, underlined the importance of immediate intubation as a life-saving procedure. This, she said, could have been done at Monaghan Hospital’s coronary care unit. The unit is less than two miles from where Mr Courtney had his fatal heart attack. Paramedics in Ireland do not intubate patients.

Philip Courtney died following a heart attack after being taken from his place of work in Monaghan Town to Dundalk Hospital. The ambulance transfer, from initial call-out to arrival in hospital, took almost an hour. Mr Courtney was aged 48.

Health board protocols prevented him from accessing the local coronary care unit at Monaghan General Hospital. Following last week’s inquest, Louth Coroner Ronan Maguire called for acute services to be restored to Monaghan General Hospital.

If Hanly is implemented as planned, Mr McMahon predicts, that in addition to Monaghan General Hospital, both Dundalk and Cavan Hospitals will be downgraded to nurse-led minor injury centres: “The North-East will then be left with just one A&E unit in Drogheda, purporting to serve a population of almost 400, 000. This dangerous scenario will be replicated all over the country”.

“Hanly is not about ‘regional self-sufficiency”, the HSAG Chair concluded: “To shut the doors of casualty units in non-urban areas across Ireland is to deny thousands of people access to hospital emergency care. Children, young people and older people will all be at increased risk of dying. For them, Hanly amounts to a potential death warrant.”


For further details, please contact Peadar McMahon, Chairman, Health Services Action Group.

Lots of people are screaming loudly that this loss of services cannot happen and the answer they are getting is 'that there are no plans to remove services from A & E and that it is only serious and moderate trauma that is talked about, which is only about 1% of emergencies'. Our answer - so for the benefit of 1% of emergencies the other 99% are being deprived of timely and easy access to emergency care. They tell us that only Trauma will go to the centralised centre but then why should heart attacks not go to a centre where there are cardiologists, strokes should go where there is a proper stroke unit, surgical patients should be taken to a hospital where there are at least three specialist consultants in that particular field, e.g. urology, etc etc. When any services is withdrawn from a hospital all services within that hospital are effected in that it reduces the workload and consultants will not want to stay in a sinking ship. If the work for the anaesthetists decreases then they will wait till there is only one left in that hospital and then remove the services as it is too dangerous with only one anaesthetist.
How many times were the people of Monaghan told 'that there are no plans to downgrade Monaghan General Hospital' while at the same time they were putting things in place to close it down. This is the old trick - leak a report regarding loss of a service, which does not tell the full story, and let the local people rant and rave for a few days and let the media have a field day but will go on to a new story after a few days and then the Department of Health and the HSE can carry on with their planning and implementation. That is what they did with all the hospitals which they have downgraded so far. It is also worth noting that the new Centres of Excellence were never properly resourced or developed to be able to cope with the added workload. However the basic premise still holds - the golden hour still rules and paramedics on the side of the road or in a speeding ambulance cannot replace a doctor and nurses in a hospital situation with the equipment to diagnose. The air-ambulance is not the answer either as in most cases the patient has to be transferred to a pick-up point to avail of the helicopter. The ambulance service cannot get to the patient fast enough to allow for the extra time needed to get to the Centre of Excellence. Modern technology can make it possible for a local hospital to offer safe, timely and efficient emergency treatment to 90% of all emergencies. The other 10% may have to be transferred to a specialist unit but they can be stabilised first of all to help them survive until they get to the Centre of Excellence. Centres of Excellence lose their value if the patient is dead on arrival there or so far gone that recovery is impossible. The threat to Cavan is real and fits in with all the other plans for our health services being hatched by economists and vested interests. When the present outbursts die down the work will continue and the downgrading will come down the line. Believe it because this is the way it happened in Monaghan, Roscommon, Nenagh, Ennis, etc.