Powys and Northern Ireland

A row seems to be developing regarding hospitals in Powys; the largest county in Wales. Powys is a very large rural county; much of its hospital provision is by small community hospitals. A recent report has been quite damning of the quality of care for patients admitted to these hospitals stating that they are inadequately staffed, cannot provide safe care and recommending that acute hospital care be transferred to local District General Hospitals. What on earth has this to do with Northern Ireland?

Actually a surprising amount:
The current model favoured by our Department of Health includes at least two hospitals which although offering slightly more services than the community hospitals and more out of hours consultant and junior doctor cover than the Powys hospitals are actually working to a similar system.

The new “Enhanced Local Hospitals” in Downpatrick and Omagh both have certain similarities to the Powys community hospital model.

Currently to maintain a hospital safely admitting acutely unwell patients it is recommended that one has on site acute medicine, acute surgery and anaesthetic cover as a minimum. As far as I can establish the new Downpatrick hospital only offers acute medicine yet it is proposed that it admit acutely unwell patients. The new Omagh hospital may not end up admitting acutely unwell patients but will have an “Urgent Treatment Centre” again without on site surgery and anaesthetics. Indeed Omagh council seems to be keen on increasing the numbers and complexity of the patients admitted to the new Omagh hospital.

As lamh dearg has noted here the problem is not the staff or the equipment; it is that the staff, no matter how competent, require a certain number of cases in order to keep up their skills and there will simply not be enough patients attending either of these hospitals to allow that to be possible.

In case anyone starts to complain that Downpatrick and Omagh are a long way away from the nearest other hospital: sit down with a map and see just how big Powys is and how far away these communities are from the nearest District General Hospital; yet their health care is best provided by acutely unwell patients travelling to these District General Hospitals.

With tedious predictability one local Assembly Member has already jumped on the save the hospitals bandwagon, much as they did prior to the last Welsh assembly elections; at the time halting Labour’s plans. In our case we could learn from these events and not have these two new hospitals but instead use the money to provide an adequate number of beds in the other hospitals so that these two hospitals can be closed and yet not reduce the total bed numbers. As in Powys I am sure that both the Tyrone County and Downe hospitals have provided excellent care for the last century; however, times have changed and with them health care has changed. Our politicians could show leadership, learn from the likes of Powys and talk seriously to the local populations about what would help to ensure optimal twenty first century health care. Sadly I have very little confidence that McGimpsey or for that matter any other local politicians will do this. As I have before said that is the Real Politick of Health and ironically it is the very people whose health care stands to be improved who will complain the loudest about the closure of these hospitals.

  • aquifer

    Sorry to spoil the party as everyone begins to get up a head of steam.

    The problem is exactly staff. They necessary staff do not want to work in rural hospitals.

    But if a shiny empty white elephant will get you a few votes then why not build one down your way?

  • Slugger O’Toole Admin


  • NDF

    “What on earth has this to do with Northern Ireland?”

    About as much as your posts on Kenya

  • Harry Flashman

    *Our politicians could show leadership, learn from the likes of Powys and talk seriously to the local populations about what would help to ensure optimal twenty first century health care.*

    Or alternatively they could accept that providing people with health care shouldn’t actually be the job of politicians any more than providing them with food, homes, spouses, clothes, information or any other basic necessities of life which people seem to be perfectly capable of getting for themselves without assistance from second rate, provincial political hacks.

    But hey we all love the nanny state and the NHS is the envy of the world isn’t it?

  • Crataegus

    If you have ever sat in an ambulance for 35minutes with someone in need of emergency treatment you soon see the appeal in local hospitals. Nice to have good hospitals at the cutting edge but not much use if you die on route.

  • Turgon

    Yes but the simple fact is that the local hospitals cannot offer an adequate service. As such it is better for the ambulance to go to the larger better equiped hospital adequately staffed with staff who see enough emergencies to keep up their skills.

    Yes it seems nice to have a person in hospital faster but if that care is suboptimal the simple fact is that scary as it might seem the patient is better taken the longer distance to the bigger hospital. The journey time does negatively impact on survival certainly and if the journey time is much more than an hour your argument holds good; not for shorter journey times.

    The idea of stabilising a patient in the small local hospital prior to transfer has also been shown to be ineffective. The assorted ambulance by pass protocols are also frequently ineffective resulting in very sick patients ending up in small community hospitals hoplessly ill-equiped to deal with them.

    It is often difficult for the public to accept but the simple reality of twenty first century health care is that we need smaller numbers of hospitals and these hospitals should each offer more services. Sadly no one: not the really the health care professionals, and certainly not the politicians are willing to tell the public this.

  • gspot

    Can we have a thread on last night’s TV please? Hearts and Minds … Let’s talk … politics … Northern Ireland …. remember??

  • Moochin Photoman

    The welsh mining industry is set for a comeback after some copper was found in Snowdonia

  • Crataegus


    What do you consider an acceptable maximum time to hospital?

    In recent years I have know several instances where swift entry into hospital saved someone’s life. One was related to an acute attack of asthma and that didn’t need intensive care and the other was a heart attack which did need an immediate operation. What saved the person was a doctor with the person when the attack took place and being helicoptered into hospital (it was in another country).

    Not all emergencies need intensive care. If you cut an artery you could easily bleed to death yet if there was local provision you may well live.

    Young mother goes into Labour, perhaps with complications, delay could have major consequences for both the mother and child.

    Experience tells me that it may not be as straight forward as you imply but healthcare is not my field.

  • Turgon

    Instant treatment for a heart attack is drugs to break down the clot. Occassionally an emergency proceedure / operation is required. Such proceedures are currently performed in the Belfast City and Royal and as such there are always going to be transport times outside Belfast; hence, having Omagh rather than Enniskillen is utterly irrelevant.

    You may be referring to the heart stopping in which case one of those defibrillatots is needed. they are carried by all paramedic ambulances and indeed are frequently in shops etc. They do not need a doctor to work them.

    If an acute asthma attack does not need Intensive Care it will very likely not be life threatening during a 30-60 minute ambulance journey. Also ambulances carry nebulisers to give the drugs which are needed.

    The issue of a woman in Labour is valid if there is a sudden complication. My wife has personal experience of this. What is needed is a hospital with an obstetrician, paeditrician, anasthesist and nurses all suitably experienced all present. These conditions apply in larger hospitals. Without these the situtation is highly unsafe in an emergency. It is for precisely these reasons that the South Eastern Trust is likely to close Lagan Valley’s maternity unit.

  • lamh dearg


    One hour.

    And yes that is an issue for some rural areas, so improve the roads, the ambulance service, invest in an air ambulance. These could make a difference. Pouring money into unsustainable hospitals which simply cannot possibly offer an acceptable standard of care (despite everyone’s best intentions and sincerest efforts) will not make a difference.