McGimpsey’s Health Service

When Michael McGimpsey announced that the new radiotherapy centre in Altnagelvin would not be built for the meantime there was the predictable outcry from patients’ groups, the Western Trust etc. Martina Anderson denounced the decision as political: that much is to be expected; Anderson’s role has often seemed to be to play the republican representative for the the hardline Derry segment of Foyle’s republicans. To have the Deputy First minister, Martin McGuinness denounce the decision as sectarian was possibly somewhat more surprising. This has resulted in a robust defence of the decision on the UUP website.

There is already a thread on the Altnagelvin decision and I would be grateful if people commented on that over there.

However, the denunciation of the withdrawal of a service from a hospital (or in this case the decision not to add a new one) is routine: as sadly are allegations of sectarian bias. When deBurn decided the new maternity hospital was to be built on the Royal rather than the City site that was seen as such: some have claimed bias in the decision to have the new Southwest hospital in Enniskillen rather than Omagh; even the decision to have Antrim Area Hospital in Antrim rather than Ballymena was seen as attacking Dr. Paisley when he was far from the government’s favourite unionist.

All closures of hospitals result in equal and on such occasions cross community complaining. When Omagh was closed Pat Doherty (the invisible MP) came out in support of it along with Thomas Buchanan, When it was announced that the Mid Ulster would be closed there was similar cross community complaining.

Despite the complaints, however, the fact remains that the Department of Health’s model calls for 5-6 acute hospitals in Northern Ireland: that has not changed at all from the 1960s. This is simply because increased specialisation means that medicine can achieve vastly more than it ever could in the past: hospital doctors, nurses and professions allied to medicine are now all specialised. The days of the general surgeon who could operate on everything are long gone. Now the surgeon works in a team, does his or her speciality area and achieves much better outcomes restricting themselves to that (by outcomes one often means survival).

In addition Northern Ireland is actually very small. There is nowhere that cannot be accessed in well under three hours from Belfast and nowhere apart maybe from rural Fermanagh and Tyrone which is more than an hour from one of the main hospitals (Royal, City, Ulster, Craigavon, Antrim, Altnagelvin). People often talk about the “golden hour” to get to hospital: very rarely would that be breached if one had only those as acute hospitals (practically never if one kept the Erne). In addition the golden hour is the hour to definitive care. That means in a major centre with all the specialities available. Attempts to go to the smaller hospitals for stabilisation frequently result in greater delays and worse outcomes. In the US patients are moved directly, often vast distances, to huge trauma centres.

Even for patients who survive in the smaller hospitals there is often the seemingly interminable delay whilst they await transfer to the centres which perform the specialist operations or procedures. When people ask why these things cannot be done in the small hospitals the answer is actually very simple: the people doing those procedures in the small hospital would do it so rarely that they would de skill. Would you want your heart operation done by someone who does it once a week or more or someone who does it once every six months?

The real scandal of McGimpsey’s time as health minister (and even more so the preceding direct rule ministers) is that in a time of relative plenty financially the larger hospitals were not increased in capacity; the ambulance service was not improved adequately and the smaller hospitals were not downgraded. This is exactly what has happened in GB. Currently the Scottish government is organising to have two hospitals for the whole of greater Glasgow (a population larger than Northern Ireland). Patients in GB often travel significant distances but access state of the art treatments. That is one of the major reasons why spending in Northern Ireland hospitals is 22% higher than in England.

Whilst McGimpsey is often rightly denounced for his failures as health minister it is often for entirely the wrong reasons. Had he taken the tough decisions to close most or all of the small acute hospitals there is little doubt he would have received even more abuse.