Our Health Services 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 there are people who have 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 as highlighted above. Where are the people who devised the removal of services from certain hospitals and expected the remaining hospitals to cope with the huge increase of patients arriving at their doors. They are certainly not lying on trolleys on a hospital corridor. The remaining hospitals are not able to cope and the consultants tell us that there are many deaths due to delays in getting to a hospital and further delays in getting treatment. Who should be held responsible? The HSE has not been a success and is overloaded with managers and top earning structures. They don’t have sufficient money to pay staff is seems but the question is - do they need so many on staff? Where is the money going to at the moment? We need doctors and nurses but so many of them are not willing to work in Ireland - why? - find out and change the system if necessary. Consultants of course rule the health services in that every patient with a problem is directed to a Consultant and they are not cheap and anyone who can afford it is paying Health Insurance and that’s not cheap either. We need a Government who will take control and put the patient needs first.