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.

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  • Cynic2

    Having McGuinness denounce anyone as ‘sectarian’ is a bit rich given his track record in the PIRA Pogroms

  • 241934 john brennan

    Cynic 2 is right. It is a bit rich for the DFM to use the word “sectarian”, in relation to the location of cancer treatment centre – or even to comment on current hospital budgets/priorities. This was never a priority when his associates were filling hospitals and morgues, giving endless and costly employment to medics, undertakers and monumental sculptors, by their 30-year campaign of bombings, shootings and punishment beatings.

    The ongoing cost of all that is still eating into Health and Social Services budgets as well as Police and Justice – not forgetting the millions now spent on free legal aid, H.E.T etc.

    Of course, neither is FM absolved from any of this. His and the DUP track record are not free from the stain and cost of sectarianism, with its ongoing effects on public expenditure.

    One wee example – The Office of FMDFM has ring fenced an £80m ‘slush fund’ for the ambiguous and mostly unaccountable purposes of ‘conflict resolution’. Was this or EU money recently used by The Ti Chulain Centre to kit out children posing with replica machine guns and AK47 rifles, while wearing paramilitary gear and balaclavas? The public has a right to know.
    In this time of financial austerity could that £80m not be better spent on the necessary Cancer Centre?

    Turgon mentions hospital downsizing in Glasgow. But Scotland also has a ‘rural health care’ scheme, which involves speedy delivery health care specialists to patients living in very remote areas. How much does it cost to fly a ‘hospital crash team,’ to a heart attack patient on one the Western Isles?

    Here, the costs and concerns of some former paramilitaries seem to have been ‘ring fenced’- and put beyond use and scrutiny. Is that not the big public scandal, worthy of public and open debate?

  • Exactly how can one access Belfast in 3 hours from Dunfanaghy or the west of Co. Donegal? The point of having services in Altnagelvin is to help people in the NW of the whole island, rather than forcing services to stop at a internal EU boundary. Because administrations focus on just their own areas, people living near borders suffer, rather than, e.g., setting up A&E units between Newry and Dundalk to serve both places.

    In WW2 and during the early years of the NHS, many London hospitals were moved out of London, rather than forcing everyone to come for treatment to the capital. It is time one of the Belfast Hospitals was closed down and moved out of Belfast.

  • Turgon

    241934 john brennan,
    A person with a heart attack on the Western Isles will most likely be treated in Stornoway Hospital. However, the Western Isles are an excellent and illustrative example due to their complete lack of relationship to the Northern Ireland situation (except Rathlin). Nowhere in Northern Ireland (except Rathlin) is an inhibited island without road links to a hospital.

    davenewman,
    Yes it is more than three hours to Belfast from west Donegal. However, had you read the blog I pointed out that the plans have consistently been for five or six acute hospitals. The one in Londonderry would seem adequate for the north west. In the RoI there is Letterkenny General, and Sligo General.

    The specific issue of radiotherapy services is being dealt with on the other blog and I would refer you to my comments there. However, just to explain briefly here: radiotherapy is not something one needs within any “golden hour” and a three hour drive if it is to a better equipped unit would be an investment of time.

    The problem is having small hospitals with inadequate services which are fairly close to big hospitals with adequate services. Examples would be the Mid Ulster, Downpatrick, Newry (best example of all probably Lagan Valley) all of which are reasonably close to fully equipped hospitals. The people who suffer from these small hospitals existence are in part all of NI (due to their inefficiency) but mainly the local population of the area who cannot get rapid specialised treatment because they are taken by ambulance to the local hospital for “stabilisation” rather than to the larger hospital for definitive treatment. Sadly no one puts this to the local population properly and every time there are proposals to rationalise services we have shroud waving protests and politicians jumping on band wagons.

    In the second world war I think the reason for moving hospitals out of London was German bombers: again a completely irrelevant situation to the current one here.

  • 241934 john brennan

    Below is an extract from ‘Remote and Rural Health care in Scotland.’ Are no areas in NI classified as remote from Belfast? Where is our government commitment to Community Hospitals? Why do we wastefully keep ‘Bed Blockers’ in major Belfast hospitals? Is because Local Health Trusts don’t have the delegated authority or funding to care for them in local hospitals and nursing homes? Unlike Scotland, why do we not have devolved government, able to prioritize bread and butter issues – instead of prioritizing, pampering and pandering to former paramilitaries? Are we really going into another election fixated on sectarianism – as exemplified by the number one big issue – which foot will the First Minister kick with?

    “Improve access to care for remote and rural areas
    Around 20% of Scotland’s population lives in areas that have been classified as remote and rural. Delivering high quality care in these areas is challenging and without careful planning and management could potentially lead to inequalities in access. Within the remote and rural communities of Scotland, the skills and expertise of health and social care professionals will need to be effectively deployed if communities are to have local access to the widest possible spectrum of care.

    “What could success look like? There will be more consistent high quality care available across Scotland. In particular, the development of Extended Community Care Teams will ensure that a robust system of local services is both available and sustainable. All remote and rural areas will also have access to intermediate care services, some within a Community Hospital (CH) and others delivered through augmented care within a patient’s home.”

  • Turgon

    241934 john brennan,
    You are completely missing the point. Look carefully at the article you are referencing: the bit you quoted.

    intermediate care services
    Those are out of hospital services: not acute hospital ones.

    Then look at the mention of hospitals in the article “community hospitals”

    These are not acute hospitals: they are usually GP run. It is not a model of health care which has been much used in Northern Ireland. It might well be useful to us but has nothing much to do with acute hospitals.

    The point is that all these are excellent services and we should indeed promote them just as the Scottish have. We should centralise the acute inpatient services in a much smaller number of acute hospitals. This would give us more money for better acute in patient care. It would also leave us with money to finance intermediate care and community hospitals. The bit which does not fit is the bit the Scottish (and Welsh and English) have largely closed: the very small acute general hospital. That is a major drain on resources and provides not only less efficient care but also poorer outcomes (survival etc.).

    I do not know if you meant it but the article you quote is actually not arguing for small acute hospitals: quite the reverse.

  • Pigeon Toes

    Turgon,
    Should such services not be centered in Mid-Ulster?

    Damned if I knew when living there on how to get to RVH in an hour or anything like it…

    Altnagelvin isn’t much bloody easier.

  • Turgon

    Pigeon Toes,
    Firstly you are ignoring Antrim Area.
    Secondly there is little or no advantage getting to the Mid Ulster. if you are sick enough to need care within the so called golden hour then you need definitive care: that was not able to be provided in the mid Ulster. Hence, the time wasted driving you to the Mid Ulster and attempting to stabilise your condition whilst there would have been much better spent getting you to the Royal, Antrim or Altnagelvin.

    There are two major acute hospitals in the Mid Ulster area (depending on how one defines Mid Ulster) they are Craigavon Area and Antrim Area.

    There will always be the odd person for whom the small acute hospital would prove life saving but the drive to the larger hospital even in a paramedic equipped ambulance would be un-survivable. However, that small number is greatly outweighed by the number of people who would have survived had they been taken directly to definitive care rather than time wasted driving them to the small acute hospital and attempts made at stabilisation there.

  • Barry the Blender

    It can never be right to close a hospital

  • son of sam

    If there is a Sinn Fein Health Minister after the election will he / she consider redirecting the ” slush fund” monies to the maintenance of the Altnagelvin cancer centre ?Given the typical desire of Sinn Fein to try and monopolise local opposition to Mc Gimpseys announcement,it would surely be a logical step.But then that would divert money from all their power bases and that would never do! By the way,could someone list Bairbre de Brun s achievements when she was Minister for Health?

  • 241934 john brennan

    SOS

    “By the way,could someone list Bairbre de Brun s achievements when she was Minister for Health?”

    Paralysis by analysis.

  • Crubeen

    The Minister has recently been pontificating about the impending Chapter 11 hanging over health and Social Care. One wonders why he did not foresee this in time and do something to avert it. There is no bottomless pit of money for his Department or any other. The time is long overdue that Health and Social Care be delivered on a Value for Money basis. For too long the cry has been for more and more money on a false premise that money thrown at a problem will solve it.
    Healthcare has been subject to “mission creep” since the NHS was founded. It has also been mismanaged – it has lost a sense of priority and, rather than concentrating on the reasonable care of all, has been focused on the practice of medicine on the frontiers of knowledge and social care on a perceived need to socially engineer the population.
    Many years ago the doctors in Israel went on strike. The death rate declined.
    http://www.thetruthseeker.co.uk/oldsite/article.asp?ID=7012
    The moral of the story is that dependence on medical care is not necessarily conducive to life or good health. Indeed a significant number of hospital admissions and deaths can be directly attributed to disease and disorder produced by medication and/or other treatment properly prescribed by doctors.
    http://www.docstoc.com/docs/18728984/iatrogenic-death-and-disease
    For those not yet convinced then recall that C Diff is a product of, among other things, the overuse of antibiotics. Many treatments are ineffective if not contraindicated. They could be done away with without harm to patients or budgets.
    As for hospitals – I broadly agree with the concept of 5-6 major hospitals across N Ireland. Each one should have a major trauma centre for stabilising patients with acute life-threatening injuries before that patient is transferred to the appropriate regional centre for recuperation/rehabilitation. Most patients who report to A&E departments however, do not have life-threatening injuries. They are just as important as those with life threatening injuries or disease. They could easily be seen and treated at community hospitals or other facilities which could and should include palliative/rehabilitation care. There is no need for all patients to attend major trauma centres and policy should reflect that. It would be more economical if localised care units were manned 24/7 by local GPs with backup from hospital doctors seconded to them for experience.
    Social Care is probably the most wasteful aspect of care. I note two examples that can be vouched: –
    “A Trust took over a residential respite unit from a well-known children’s charity. The cost of running it escalated by well over £100k per annum because the Trust employed Social Workers as a ‘safeguarding’ measure. It also, I understand employed nurses because disabled children often have complex medical needs. Quite why the nurses could not have safeguarded the children eludes me.”
    But the Minister’s real failure, and that of his predecessors, is to listen too much to his officials and to buy into the mutual care society that protects staff whist persuading the public that it is looking after their interests … when it patently isn’t! If he had set up an independent commission for complaints from or about the health service – it clearly being the case that the commission was not and would not be staffed by former health service employees or others with vested interests – I somehow doubt he would be in the pickle of presiding over an organisation filing for Chapter 11 or its equivalent in Northern Irish law.
    It is not just the Minister’s failure – it is also the failure of public and politicians to rein in the monster .

  • dwatch

    Surely if my memory is correct, did the ‘Deputy First minister’ Martin McGuinness not pull the plug on the 11 plus the last day of a previous parliament when he was ‘Education minister’? Could his action in 2007 not be called sectarian knowing rightly Unionists (mostly Protestants) were pro the 11 plus and couldn’t challenge it.

    The scrapping of the 11 plus cannot be reversed but the halting of new radiotherapy centre in Altnagelvin can be reversed once money has been found in a next parlaiment.

  • tinman

    “…the Department of Health’s model calls for 5-6 acute hospitals in Northern Ireland”

    Isn’t department policy still governed by Developing Better Services, which called for 10 acute hospitals (Royal, City, Altnagelvin, Antrim, Causeway, Craigavon, Daisy Hill, Mater, Ulster)? I don’t think there’s been an official departure from that position.

  • Comrade Stalin

    The Minister has recently been pontificating about the impending Chapter 11 hanging over health and Social Care.

    Chapter 11 ?

  • Comrade Stalin

    By the way,could someone list Bairbre de Brun s achievements when she was Minister for Health?

    I seem to recall De Bruin announcing a consultation over a proposal to close the Mater Hospital in North Belfast. The Assembly was suspended before the debate got “interesting” especially as Gerry Kelly was vocally opposing the closure.

  • Turgon

    tin man,
    A fair point from page 41 of the recommendations. It proposes ten acute hospitals. It is, however, somewhat misleading. The Mater seems to be going as an acute site offering all services; Daisy Hill does not offer a full range of services (it has no ICU), There are strong suggestions to remove certain things from BCH such as cardiac services and possibly A+E (though McGimpsey will not allow that – his constituency – but he will not be health minister for much longer).

    The long term direction of travel is downwards in numbers. Sadly our politicians are not willing to take these difficult decisions. As such they fail to close the smaller hospitals. Ironically it is the people who demand them most (those served by the small hospitals) who suffer most due to their existence.

  • Barry the Blender

    Ironically it is the people who demand them most (those served by the small hospitals) who suffer most due to their existence.

    Just get bupa

  • 241934 john brennan

    “Bairbre de Brun’s achievements when she was Minister for Health?”

    Paralysis by analysis. Reviews, then reviews of the reviews – and so on ad nauseum.

    What about achievements?

  • Old Mortality

    Crubeen

    ‘But the Minister’s real failure, and that of his predecessors, is to listen too much to his officials and to buy into the mutual care society that protects staff whist persuading the public that it is looking after their interests … when it patently isn’t!’

    How true. Only a fool believes that ‘public services’ do not operate principally for the benefit of those who work in them.
    Sadly, there were quite a few impressionable fools on the march in London yesterday, apparently.

  • Crubeen

    Comrade Stalin,
    I do recall that the Minister used the American expression “Chapter11” in an interiew on the parlous state of the finances. We know it here as “receivership” or “administration” – a process whereby a failing corporate body is taken in hand by utterly ruthless professionals and either rescued or throttled.

    Come to think of it …. that’s not a bad idea! Can you imagine the apoplexies of public servants having to justify their existence to some hard-nosed git whose claim to fame is his MBA from Harvard or worse … and who doesn’t buy into the public service ethos? Just suppose all sectors had to justify their activities on a strict accounting basis – the cost versus the benefits achieved. My bet would be that there would be a awful lot of healthcare managers and social workers seeking JSA.

    And there’s the total ineptitude of Department and Minister … massive outcry over cancelled cancer unit but if he had sacked a load of social workers (and gone ahead with the cancer unit) nobody (apart from the Ritchie and the Ford) would have complained.

  • If you want to see what Chapter 11 is really like, take a look at the long-running SCO saga on Groklaw.net . It is the lawyers (and some accountants) who benefit, no-one else.

  • Cynic2

    “5-6 major hospitals across N Ireland”

    Try 3 to 4 and you’d be nearer the mark

  • Mac

    Peter Robinson (through Martin McGuinness) arranged to meet the north west Pink Ladies group today (breast cancer survivours). Lots of ladies from the bogside,creggan and brandywell singing his praises and feeling upbeat about the assurances Peter gave them.

  • joeCanuck

    Does N.I. not have an air ambulance service to helicopter critically injured patients directly from an accident site, for example, to a critical care facility?

  • Turgon

    joe,
    No it does not. There was an attempt to create one but it was a “charity” which spent almost all the money it collected on paying its directors.

    The reality is that NI is so geographically small that an air ambulance is unnecessary. Air ambulances are useful in Canada I have absolutely no doubt: they are no doubt useful in Scotland but in Northern Ireland there is little need for them.

    In addition the Irish air force and HM coastguard / RAF have more than enough helicopters for any such needs.

  • joeCanuck

    True, Turgon. Sometimes I forget about the huge differences in distances. My small town needs a community hospital which is staffed by our local GPs. It’s necessary since on a number of occasions each winter our roads are all closed for up to 3 days.

  • Droagh

    The tragedy of McGimpsey’s period as Minister is that he used it purely for his own electoral advantage. He wanted to protect jobs – I wonder why when he has RVH and BCH in his constituency. He took all the easy and popular decisions and photo opportunities. He opened a hospital in Downpatrick that has no long term future, a maternity unit delivering less than 50 babies per year and while he couldn’t put money into the radiotherapy unit in Derry, he had a maternity unit in Lagan Valley with birthing pools.

    McGimpsey was advised by PR people who knew nothing about health and tried to promote him as the saviour of the health service. He claims not to be able to save money from his £4billion+ budget while anyone who has visited or been a patient in a hospital can see huge inefficiencies. Paul Goggins and Shaun Woodward were the 2 best health ministers we had in 30 years. McGimpsey could have built on their work – instead he wasted the opportunity.

    We need honest politicians – not those who vote for a policy and then join a picket line to protest about the decision. We need someone with courage to design a modern integrated service for NI. Every town can’t have their hospital. Times and technology are changing. Aneurin Bevan said “I would rather be cared for in the cold clinical atmosphere of a large hospital and survive than be lovingly looked after in a small hospital and die”. (or words to that effect). We must design a service that is fit for purpose. Making short term and local decisions only makes things worse. We need a health minister that will have good hospitals with good access even if less local. Otherwise we are left with the Antrims and Coleraines that are too small and try to do what they are not capable of.

    Wishful thinking – yes but I can hope that a man or woman with courage and vision will opt for health in may.

  • hfmccloy

    The point about Mid Ulster has been critically missed, when some people speak of Antrim Area, you must have in your mind that Antrim Area is a fully built, an all serving hospital or to use the Health Chiefs words a “Golden Hospital”

    Fact is Antrim is only half built, will never be completed, cannot meet the demand that it is placed under, has waiting times in A&E, Out Patients, In Patient surgery the like that this country have never seen before.

    Has ever increasing rates of infection in patients nearing that which sparked off the last C DIFF enquiry.

    Antrim Area is 17 miles from Belfast and locationally speaking as no bearing on serving remote Mid Ulster, the NHSCT has the largest and most disperse population of any health trust and has 2 and a half hospitals left to serve that population.

    It has to come to a head, do we keep building on the mistakes of the past, or do we build for the future?

  • Turgon

    hfmccloy,
    That is actually a very salient point. Antrim Area is undoubtedly in the wrong place. Much wiser even now would be to build a big hospital in Ballymena and close both Antrim and Coleraine (and obviously the Mid Ulster). The same argument could be made re Craigavon: it is not as bad but really would be better in Dungannon and not have Craigavon, Daisy Hill or the Erne. Ideally we would maybe have 1 or 2 hospitals in Belfast, 1 say in Ballymena, 1 say in Dungannon and 1 in Altnagelvin. That is the sort of thing that has happened elsewhere in the UK and it would improve not only efficiency of care but also outcomes.

    Droagh’s quote of Bevin is extremely appropriate: “I would rather be cared for in the cold clinical atmosphere of a large hospital and survive than be lovingly looked after in a small hospital and die.” Assuredly that is what people are calling for when they demand keeping their small local hospital open: increasing their own chance of dying.

  • hfmccloy

    Developing Better Services, stated that the Ballymena Hospital would of best served residents, fact was when Hayes came in he was told this is the 6 hospitals we want and you write a report to support it. All off a sudden over here we should of lived 45 minutes from an acute A&E, after the very subjective report it became 60 minutes, there may be changes in survival rates when we arrive at hospitals but as people we still bleed the same after a accident.

    The Royal Colleges also put forward suggestions that a green field site Hospital in Cookstown to serve that area.

    To sort out health is a big ask but someone has to do it next term, I like the quote but I don’t think the mortality figures would support it, the still birth and infant deaths rates most certainly do not in the NHSCT