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Where We Stand …. 18/11/03. We all agree that major Health Reforms are long overdue and Government has commissioned numerous reports on what Reforms are necessary. The EU directive on the 58-hour working week for NCHDs has accelerated the need for change, though we would have thought that the interests of the patients should have done so long ago. The latest Report, the Hanly Report, has caused major concerns among many groups of interested people. There are recommendations in that report, which are welcome, but those dealing with the reconfiguration of hospital services are flawed. Evidence-based research, which has been carried out in many countries ( these include UK; Canada; USA; Australia; Portugal; Spain; Sweden; France and Germany) does not support the hospital reforms as detailed in the Hanly Report. In-depth analysis has been carried out by leading researchers in Health Policy for the WHO and the EU and their conclusions show the lack of expected results of similar reforms when implemented in other countries. We cannot assume that they will work in Ireland. It is as a result of this evidence that we oppose the Hanly Report and condemn what has and is happening in Monaghan General Hospital. There are many vested interests fighting both for and against these reforms in Ireland. We, as a non-political group, have only one interest - the lives, the health and the welfare of our families. At the moment our lives are at serious risk. Monaghan has lost its Maternity Services, its inpatient paediatric services, its Post Mortem services and has been 'OFF CALL' for emergencies since July 2nd. 2002. A further reduction in services is planned and a Project Team has been set up to implement this further downgrading. It is planned that: 1. We will lose all acute and emergency surgical services. 2. We will lose all acute and emergency medicine e.g. Heart attacks, Asthmatic attacks, strokes, etc. 3. We will never have the hospital 'ON CALL' for emergencies. 4. All ambulance cases will be brought to Drogheda. 5. We will lose our Treatment Room between 8.00pm. and 9.00am and also at weekends. 6. We will never have any form of Maternity Service. 7. There will be a further reduction in Laboratory Services. 8. Post Mortems will never be restored. 9. Capital spending on Monaghan will be reduced or eliminated because of lack of activity; the 'Big Centres' will demand and receive the majority of capital funding. The question is - what will we be left with? The answer is simple - a nursing home for senior citizens, who are not sick, and a minor day surgery unit working from 9 to 5 five days per week. Monaghan is the 'blueprint' for the rest of the country. If they are successful in removing these services from Monaghan, they will use the same format to accomplish a similar situation in many other hospitals throughout the country. The outcome will have disastrous effects on all these communities and will not give us a better Health Service. Many areas are convinced that their Hospital will not be downgraded and is 'Safe'. We thought that too some years ago; the people of Ennis thought that; the people of Nenagh thought that, but we have been forced to change our minds. For some the realisation may come too late. What is good about the Hanly Report? 1. A big increase in Consultant numbers and an effort to have a Consultant-provided service as opposed to Consultant-led. 2. Safer work practices for NCHDs who will have a shorter working week. 3. Better investment in local hospitals to provide more services. 4. Retention and development of services in local hospitals for patients with minor injuries and illnesses. What is bad about the Hanly Report? 1. The removal of A & E from local communities. 2. The inaccurate assumption that so many other reforms will go in tandem with these recommendations. 3. Flawed conclusions from world research and evidence-based figures from other countries. 4. The inaccurate conclusion that training for NCHDs can only be carried out in major centres. 5. The false assumption that these recommendations will have better patient outcomes. 6. The false assumption that new contracts can be agreed with Consultants and GPs. Etc. 7. The false assumption that there is sufficient capital available to build, staff and equip these Major Centres. 8. The false assumption that patients will be alive when they reach the Major Centres. 9. The acceptance that there can be 'an acceptable mortality rate' for the good of the minority. 10. The false assumption that more patients will be treated, thereby reducing waiting lists and waiting times. 11. The false assumption that there is no other way of reducing the working times of NCHDs other than by cutting services in local hospitals. If these reforms are implemented as planned - what will be the outcome? We in Monaghan do not have to guess at the results - we are already experiencing them: 1. Needless deaths in ambulances on the way to a major centre. 2. Diagnosis by ambulance personnel in very difficult circumstances with very limited resources. 3. Long waits in waiting rooms to get treatment. 4. Long waits on trolleys hoping for a bed in a major centre. 5. Long waits for appointments and longer waits for treatment for serious illnesses. 6. A different doctor for every visit, therefore, no continuity of treatment. 7. Shorter consultation times with consultants. 8. Loss of days from work, when an hour or two sufficed when attending your local hospital. 9. Poor and disadvantaged will be unable to afford the cost of travel to distant hospitals, thereby removing equal access. 10. Treatment will not be sought in time due to problems of travel, thereby increasing the number of serious illnesses. 11. Increase in number of clinical mistakes and missed diagnosis. 12. Increase in litigation numbers. 13. Loss of employment in local hospital. 14. Loss of employment in community due to withdrawal of local suppliers. 15. Loss of inward investment as industries site premises close to A & E services. 16. An evacuation of Rural Ireland as young people move towards the urban areas with full Health Service facilities. 17. Loss of community identity. 18. Loss of confidence in area and communities. 19. More stealth taxes to pay for these privileges and again it is the poor, who will suffer most because they cannot afford the insurance cover and are over the limit for Medical Cards. What is the solution? The Government must first of all accept authority and responsibility for the provision of services and dictate to other bodies, rather than have a host of regulatory bodies set the agenda. We do not have the resources nor the funding to work out the details of an overall plan but from delving into research, which has been carried out for the World Health Organisation and the EU, we are in no doubt as to the uselessness of the plans being currently proposed. We are wearied listening to Ministers informing the public of the amount of finances being poured into the Health Services over the past few years. One would think that it was their own personal money they were talking about. It is tax payers money and we, as tax payers, are far from happy with the way our money is being spent. Then when one adds in the amount of voluntary time and voluntary fund-raising, which is done to bolster the ailing health system, one has to ask - Who is making a fool of us? Now we are being told that we will have to pay more in order to implement a plan which we are convinced will give us a poorer Health System. The first major step must be consultation with the suppliers of services (Consultants, Doctors, GPs, Nurses etc) and the receivers (the patients). In keeping with their Health Strategy they must take local needs and difficulties into consideration in providing equal access to all citizens. In order to achieve this there has to be a major overhaul of how the Health Services are funded and how they are managed. There must be responsibility and accountability. Streamlining management and administration will reduce expenditure and facilitate the proper functioning of existing services. The concept of Centres of Excellence is very good for the minority of patients who require that level of treatment but is a waste of resources for the majority. High tech equipment and staffing will be needed for these Centres and this will soak up funding, which is necessary for the provision of Health Services for the majority. To provide these Centres for the treatment of larger numbers of patients, most of whom do not require that level of Treatment, is not sound economics nor will it lead to better patient outcomes. An investment in modern technology for databases, diagnosis and treatment would be of much greater benefit to patients and to doctors in training and should be given serious consideration. Some of our hospitals in Ireland, e.g Temple Street and Our Lady's Hospital, are already using this and the benefits are enormous. More widespread development and use would enhance our health services at a more local level. We have had three major reports presented to Government in the past year or so and proposals from all three need to be taken together in order to produce a National Plan, which is workable, sustainable and meets the needs of the people equally. At the moment the Government seems to be implementing small sections of a report, which, because the other necessary actions are not in place, will bring about an even worse health service. Before any steps are taken to put some of the Hanly Recommendations in place there needs to be an overall plan developed for all aspects of the Health Service, including administration and management and all levels of health care. Then everyone will see the direction we are being driven and be more able to assess the outcome. The Reforms cannot be done piecemeal. In agricultural terms, it would be like a farmer erecting a brand new gate on a field to keep the cattle in but not doing anything about the massive holes in the hedges running around the same field. Conclusion. As far as Hanly is concerned we must continue to highlight, at every opportunity, the foolishness of proceeding with these reforms. Every avenue must be used to break down this move towards an elite service in a few hospitals and lack of service for the general public. We are supported in our stand by leading medical people and International research. In this we must strive to get involved in the national debate and protestations because in numbers there is strength. As for Monaghan itself, we have a greater task and that is to ensure that desired and necessary services are restored and put on a sound footing. We must attract support from every quarter and begin to plan proper strategies, which will make our voices heard. 03/012/2020 The Alliance tried to stop the implementation but needed more support to succeed. Now we see that what we forecast has happened and people have paid a high physical, mental and economic price and, seventeen years later, we still do not have a satisfactory and capable health service.
All Content Copyright emyvale.net
Where We Stand …. 18/11/03. We all agree that major Health Reforms are long overdue and Government has commissioned numerous reports on what Reforms are necessary. The EU directive on the 58-hour working week for NCHDs has accelerated the need for change, though we would have thought that the interests of the patients should have done so long ago. The latest Report, the Hanly Report, has caused major concerns among many groups of interested people. There are recommendations in that report, which are welcome, but those dealing with the reconfiguration of hospital services are flawed. Evidence-based research, which has been carried out in many countries ( these include UK; Canada; USA; Australia; Portugal; Spain; Sweden; France and Germany) does not support the hospital reforms as detailed in the Hanly Report. In-depth analysis has been carried out by leading researchers in Health Policy for the WHO and the EU and their conclusions show the lack of expected results of similar reforms when implemented in other countries. We cannot assume that they will work in Ireland. It is as a result of this evidence that we oppose the Hanly Report and condemn what has and is happening in Monaghan General Hospital. There are many vested interests fighting both for and against these reforms in Ireland. We, as a non-political group, have only one interest - the lives, the health and the welfare of our families. At the moment our lives are at serious risk. Monaghan has lost its Maternity Services, its inpatient paediatric services, its Post Mortem services and has been 'OFF CALL' for emergencies since July 2nd. 2002. A further reduction in services is planned and a Project Team has been set up to implement this further downgrading. It is planned that: 1. We will lose all acute and emergency surgical services. 2. We will lose all acute and emergency medicine e.g. Heart attacks, Asthmatic attacks, strokes, etc. 3. We will never have the hospital 'ON CALL' for emergencies. 4. All ambulance cases will be brought to Drogheda. 5. We will lose our Treatment Room between 8.00pm. and 9.00am and also at weekends. 6. We will never have any form of Maternity Service. 7. There will be a further reduction in Laboratory Services. 8. Post Mortems will never be restored. 9. Capital spending on Monaghan will be reduced or eliminated because of lack of activity; the 'Big Centres' will demand and receive the majority of capital funding. The question is - what will we be left with? The answer is simple - a nursing home for senior citizens, who are not sick, and a minor day surgery unit working from 9 to 5 five days per week. Monaghan is the 'blueprint' for the rest of the country. If they are successful in removing these services from Monaghan, they will use the same format to accomplish a similar situation in many other hospitals throughout the country. The outcome will have disastrous effects on all these communities and will not give us a better Health Service. Many areas are convinced that their Hospital will not be downgraded and is 'Safe'. We thought that too some years ago; the people of Ennis thought that; the people of Nenagh thought that, but we have been forced to change our minds. For some the realisation may come too late. What is good about the Hanly Report? 1. A big increase in Consultant numbers and an effort to have a Consultant-provided service as opposed to Consultant-led. 2. Safer work practices for NCHDs who will have a shorter working week. 3. Better investment in local hospitals to provide more services. 4. Retention and development of services in local hospitals for patients with minor injuries and illnesses. What is bad about the Hanly Report? 1. The removal of A & E from local communities. 2. The inaccurate assumption that so many other reforms will go in tandem with these recommendations. 3. Flawed conclusions from world research and evidence-based figures from other countries. 4. The inaccurate conclusion that training for NCHDs can only be carried out in major centres. 5. The false assumption that these recommendations will have better patient outcomes. 6. The false assumption that new contracts can be agreed with Consultants and GPs. Etc. 7. The false assumption that there is sufficient capital available to build, staff and equip these Major Centres. 8. The false assumption that patients will be alive when they reach the Major Centres. 9. The acceptance that there can be 'an acceptable mortality rate' for the good of the minority. 10. The false assumption that more patients will be treated, thereby reducing waiting lists and waiting times. 11. The false assumption that there is no other way of reducing the working times of NCHDs other than by cutting services in local hospitals. If these reforms are implemented as planned - what will be the outcome? We in Monaghan do not have to guess at the results - we are already experiencing them: 1. Needless deaths in ambulances on the way to a major centre. 2. Diagnosis by ambulance personnel in very difficult circumstances with very limited resources. 3. Long waits in waiting rooms to get treatment. 4. Long waits on trolleys hoping for a bed in a major centre. 5. Long waits for appointments and longer waits for treatment for serious illnesses. 6. A different doctor for every visit, therefore, no continuity of treatment. 7. Shorter consultation times with consultants. 8. Loss of days from work, when an hour or two sufficed when attending your local hospital. 9. Poor and disadvantaged will be unable to afford the cost of travel to distant hospitals, thereby removing equal access. 10. Treatment will not be sought in time due to problems of travel, thereby increasing the number of serious illnesses. 11. Increase in number of clinical mistakes and missed diagnosis. 12. Increase in litigation numbers. 13. Loss of employment in local hospital. 14. Loss of employment in community due to withdrawal of local suppliers. 15. Loss of inward investment as industries site premises close to A & E services. 16. An evacuation of Rural Ireland as young people move towards the urban areas with full Health Service facilities. 17. Loss of community identity. 18. Loss of confidence in area and communities. 19. More stealth taxes to pay for these privileges and again it is the poor, who will suffer most because they cannot afford the insurance cover and are over the limit for Medical Cards. What is the solution? The Government must first of all accept authority and responsibility for the provision of services and dictate to other bodies, rather than have a host of regulatory bodies set the agenda. We do not have the resources nor the funding to work out the details of an overall plan but from delving into research, which has been carried out for the World Health Organisation and the EU, we are in no doubt as to the uselessness of the plans being currently proposed. We are wearied listening to Ministers informing the public of the amount of finances being poured into the Health Services over the past few years. One would think that it was their own personal money they were talking about. It is tax payers money and we, as tax payers, are far from happy with the way our money is being spent. Then when one adds in the amount of voluntary time and voluntary fund-raising, which is done to bolster the ailing health system, one has to ask - Who is making a fool of us? Now we are being told that we will have to pay more in order to implement a plan which we are convinced will give us a poorer Health System. The first major step must be consultation with the suppliers of services (Consultants, Doctors, GPs, Nurses etc) and the receivers (the patients). In keeping with their Health Strategy they must take local needs and difficulties into consideration in providing equal access to all citizens. In order to achieve this there has to be a major overhaul of how the Health Services are funded and how they are managed. There must be responsibility and accountability. Streamlining management and administration will reduce expenditure and facilitate the proper functioning of existing services. The concept of Centres of Excellence is very good for the minority of patients who require that level of treatment but is a waste of resources for the majority. High tech equipment and staffing will be needed for these Centres and this will soak up funding, which is necessary for the provision of Health Services for the majority. To provide these Centres for the treatment of larger numbers of patients, most of whom do not require that level of Treatment, is not sound economics nor will it lead to better patient outcomes. An investment in modern technology for databases, diagnosis and treatment would be of much greater benefit to patients and to doctors in training and should be given serious consideration. Some of our hospitals in Ireland, e.g Temple Street and Our Lady's Hospital, are already using this and the benefits are enormous. More widespread development and use would enhance our health services at a more local level. We have had three major reports presented to Government in the past year or so and proposals from all three need to be taken together in order to produce a National Plan, which is workable, sustainable and meets the needs of the people equally. At the moment the Government seems to be implementing small sections of a report, which, because the other necessary actions are not in place, will bring about an even worse health service. Before any steps are taken to put some of the Hanly Recommendations in place there needs to be an overall plan developed for all aspects of the Health Service, including administration and management and all levels of health care. Then everyone will see the direction we are being driven and be more able to assess the outcome. The Reforms cannot be done piecemeal. In agricultural terms, it would be like a farmer erecting a brand new gate on a field to keep the cattle in but not doing anything about the massive holes in the hedges running around the same field. Conclusion. As far as Hanly is concerned we must continue to highlight, at every opportunity, the foolishness of proceeding with these reforms. Every avenue must be used to break down this move towards an elite service in a few hospitals and lack of service for the general public. We are supported in our stand by leading medical people and International research. In this we must strive to get involved in the national debate and protestations because in numbers there is strength. As for Monaghan itself, we have a greater task and that is to ensure that desired and necessary services are restored and put on a sound footing. We must attract support from every quarter and begin to plan proper strategies, which will make our voices heard. 03/012/2020 The Alliance tried to stop the implementation but needed more support to succeed. Now we see that what we forecast has happened and people have paid a high physical, mental and economic price and, seventeen years later, we still do not have a satisfactory and capable health service.