Poots gives go ahead to Altnagelvin Cancer Centre

Edwin Poots has announced the go ahead of the Altnagelvin radiotherapy centre. This reverses the decision by Michael McGimpsey to block the centre just before the elections. The new centre is envisaged to open in 2016.

  • Delta Omega

    There goes the Mater A&E to pay for it

  • J Kelly

    Great news for Derry.

    I don’t understand what McGimpsey was at, did he think that his decision would focus minds on the DUP and SF in the Election Campaign, if so he got that wrong when Martin McGuinness stole his thunder and guaranteed to overturn the decision. Was it a blatant political/sectarian act as the UUP have very little support in Derry.

  • Freyanne

    Possibly Delta Omega or has additional budget been found. The Press Release doesn’t make this clear.

    Either additional funding has been provided which begs the question why was this not made available to the previous Minister; or funding has been diverted from elsewhere – where we need to be told about. Of course a 3rd possibility is that McGimpsey and his officials completely got their sums wrong in drawing up the but that’s fairly unlikely.

    Where has the money come from Mr Poots?

  • whizzo

    Jolly good for those who need it. But how will they staff it? With money buildings can be easily delivered, but deilvery of service, without the right people with the appropriate experience, is much more difficult.

  • iluvni

    Is the Republic’s contribution guaranteed?

  • The funding for the capital spend, to 2016 we would presume was always there. The revenue spend was not. From the little on the news it seems there is a lot of projection and presumption that the revenue will be there in an ‘improved’ budgetary environment.

    Which makes McGimpsey’s position odd(er), especially when no-one was going to challenge the decision to proceed with an election on the doorstep. All history now.

  • foyle observer

    Care to explain your comment, Delta Omega?

  • Cynic2

    He has committed to spend money on running it that he doesn’t have and wont be in post when the problem comes home to roost. Still. never mind. Another deal. Another dollar

  • Comrade Stalin

    I don’t see the problem with closing the Mater A&E. There are two other very large A&Es within a couple of miles, or about five minutes in an ambulance.

  • Lionel Hutz

    Yeah, CS.

    There are so many small hospitals close to Belfast. The rural communities have really lost out

  • Stephen Blacker

    Super to hear this news but it is not much of a surprise as OFMDFM had already said this was going ahead before the election. The surprise was when Poots answered a question about where the money for this came from and Poots said he found enough savings that nothing will need to be sacrificed. Well done him.

  • joeCanuck

    Medicine has changed beyond recognition in the past 30 years. Same goes for transport by car or ambulance. Money has to be spent wisely as costs continue to spiral. It makes total sense to concentrate the most important services in a few locations and turn small hospitals into 12 hour clinics.

  • lamhdearg

    “I don’t see the problem with closing the Mater A&E. There are two other very large A&Es within a couple of miles, or about five minutes in an ambulance”
    And whats five minutes when your child is turning blue.

  • Comrade Stalin

    And whats five minutes when your child is turning blue.

    OK then, let’s build a hospital for everyone on their street corner.

  • lamhdearg

    ok then lets close them all and save us all a few quid.

    A&E is the first line in the N.H.S. it should not be comprmised in order to save people time traveling to receive treatment, i would love to see the north west have the best hospitals in the world, but if it means closing an A&E dept, i would say no.

  • lamhdearg

    ps comrade
    the hole Mater and the child turning blue thing is from personal experience so please excuse me if i seemed a little curt.

  • lamhdearg

    whole, not hole, freudian slip.

  • Turgon

    lamhdearg,

    That is fine in theory. However, if your child is turning blue the reality is that a modern fully equiped ambulance may be almost as much use as a small hospital A+E department with very junior doctors and little senior support.

    Then since the ambulance will drive to that small local A+E department as ambulance protocols almost always require them to go to the nearest A+E and even if they do not ambulance staff almost always do that.

    Then if that local A+E is much less well staffed and has people who are more junior or because the A+E is small have much less up to date experience your child will get less good care.

    The so called golden hour is the golden hour to definitive hospital care. Such definitive care is available in the Royal, City, Craigavon, Ulster, Altnagelvin and Antrim and probably Erne and Causeway depending on one’s analysis.

    In all the other places such definitive care is not available and stabilisation pre transfer to definitive care has been shown to increase not decrease mortality.

    Hence, in actual fact if your child is turning blue what you actually need is the ambulance to go directly to the well equiped hospital: not waste time going to the local small A+E.

    You may then say why not have all A+E departments fully able to take everything? That is flawed by the financial argument. However, even if money was infinite think about it. If money were infinite the small A+E would have all the best facilities, all the best trained people. However, since they saw so few emergencies they would gradually deskill, their experience would wane with the months and years between seeing difficult cases. Hence, after a few years the small A+E would be back to square one.

    There is a reason for centralisation of acute hospital services: it is not really about saving money; it is about saving lives.

  • lamhdearg

    turgon
    however small or ill equiped the Mater A&E is/was, the fact that they where there and where/are able to provide life saving care, when an extra 15 to 20 min journey across rush hour belfast may have resulted in death or at best outcome severe brain damage. In my case an ambulance was phoned and in the panic not canceled it arrived 30 mins after the call but importantly after care had been received, so in this case the fact that there was an A&E at the Mater was important. The care of cancer patients and the people who care and love them is also important, as anyone who has seen that b*****d disease at work knows, i hope the money can be found to build and run a cancer care centre in the north west, if it would mean closing an A&E dept at any of our hospitals then i would be against it.

  • Turgon

    If and big if your case is as you say then fair enough. However, it is extremely rare that such a case cannot be sorted by and ambulance. If there were less A+Es then we could have more ambulances. The advice is always to get an ambulance in emergency cases and it is good advice.

    It is highly improbable that the Mater would have saved someone’s life whereas a trip a mile or two further in a 999 ambulance would not. That is not merely my experience of which without being disrespectful I suspect I have a great deal more than you but also the evidence.

    The simple fact is that better outcomes require centralisation of both emergency and complex cases. Having multiple small A+E departments costs lives.

  • nightrider

    we could have more ambulances.

    Presumably proper ambulances. Not those Volvo estates which have no useful emergency purpose. There’s a good start to saving money.

  • Turgon

    nightrider,
    You raise an important point. Of course the Volvo estates are a bit daft. If we had a proper number of proper ambulances they might have some use but of course we do not. Even if we had there is a problem. Many years ago it was established that rushing a person who is ill to definitive care is better than attempting stabilisation at the point when the emergency services meet them. It was called “stay and play” versus “scoop and run”. Scoop and run was shown to be much, much better.

    As such attempts at stabilisation by the Volvo estate and its no doubt well trained driver are doomed to failure as compared to rushing the patient to a proper A+E. If the Volvo estate was purely an addition to the proper ambulance and did not mean that the proper ambulance was not sent out simultaneously then it might have some value. Otherwise it is a dangerous distraction.

    This leads on to the question why the Volvo estates were bought and here is where we get into the law of unintended consequences.

    Practically the only target the Northern Ireland Ambulance Service is required to achieve is reaching 999 calls in 8 minutes (I think 8 minutes is correct – it is a while since I looked at the rules).

    Now this target is practically unachievable due to the rural nature of NI and the inadequate number of ambulances. However, the target is not without merit. Rather than invest in the appropriate number of ambulances, however, the NIAS invested in the Volvo estates. These are fast so being more likely to get to the patient within the 8 minutes – in a way a good thing but see caveats above. In addition they allow less staff to be employed (the Volvo has a crew of one, unlike a real ambulance with 2). This allowed money saving and more ability to reach targets. It lowers quality of care but if one only measures “quality” by targets then officially quality is improved.

    Truly perverse but there you are.

  • lamhdearg

    Turgon
    If and its a big if, you are trying not to be disrespectful, you failed.
    AS for experience of such matters, you are welcome to it, i would be happy never to experience it again.

  • Turgon

    lamhdearg,
    I am not trying to be unpleasant and I say this in all gentleness. A tragic incident thankfully in your case averted is not the basis on which to make health policy decisions. Those decisions, again I suggest with all due respect, are ones which need to be made based on evidence, not anecdote.

  • joeCanuck

    lamhderg,

    I’m pleased that tragedy was averted in your family case but I have to agree with Turgon. It’s unreasonable to expect to get to a fully equipped and trained staff A&E in 5 minutes. If you live in Strabane, for example, you have to go to Altnagelvin which is 16 miles away. What is more important as Turgon points out is swift response by an ambulance staffed by highly trained ER personnel.
    Interestingly, when I had one of my bigger heart attacks in an hotel in Toronto, a 911 call was made and while sitting in the lobby waiting for the ambulance, a huge fire engine pulled in and the firemen rushed in and gave me an aspirin and applied oxygen. That’s the normal response since usually a fire engine can get to the scene minutes ahead of an ambulance.

  • lamhdearg

    Droping the personal.
    So close some A&E dept, to save the money to pay for a fleet of new fully equipped and trained staffed ambulances, and there will be enough left over to pay for the cancer care centre at altnegelvin, ok. ps i have one fish a two slices of bread, could one of you pop round and do the needful, as i would like to feed the world.

  • Turgon

    lamhdearg,
    No close most of the small hospitals to acute admissions. Upgrade the ambulances; upgrade the major hospitals so, just as an example, things like 24 hour modern treatment of heart attacks can be performed.

    Then we will save money and improve health care. This is exactly what has been done in mainland UK and is one of the main reasons why their NHS is years ahead of ours. Undoubtedly lots of money was used in the modernisation of the mainland NHS and some was wasted. Here, however, proportionally at least as much money was invested and most was simply squandered on pointless, useless and downright dangerous small units.

    The consequence is that we are left with a system years behind the rest of the UK which means that, all things being equal, you are more likely to die with many illnesses, or have to make do with substandard treatment in Northern Ireland as compared to mainland UK.

    The small units may have some value as GP centres, out patients centres, maybe minor injuries units but they should not be used for the admission of acutely unwell patients.

  • joeCanuck

    Belfast used to be acclaimed as the safest city in the world to have a heart attack due to the wonderful work done by Dr. Frank Pantridge. From Wiki:
    By 1957 Pantridge and his colleague, Dr John Geddes, had introduced the modern system of cardiopulmonary resuscitation (CPR) for the early treatment of cardiac arrest. Further study led Frank Pantridge to the realization that many deaths resulted from ventricular fibrillation which needed to be treated before the patient was admitted to hospital. This led to his introduction of the mobile coronary care unit (MCCU), an ambulance with specialist equipment and staff to provide pre-hospital care.

    To extend the usefulness of early treatment, Pantridge went on to develop the portable defibrillator, and in 1965 installed his first version in a Belfast ambulance. It weighed 70 kg and operated from car batteries, but by 1968 he had designed an instrument weighing only 3 kg, incorporating a miniature capacitor manufactured for NASA.

    His work was backed up by clinical investigations and epidemiological studies in scientific papers, including an influential 1967 The Lancet article. With these developments, the Belfast treatment system, often known as the “Pantridge Plan”, became adopted throughout the world by emergency medical services. The portable defibrillator became recognised as a key tool in first aid, and Pantridge’s refinement of the automated external defibrillator (AED) allowed it to be used safely by members of the public.

    Although he was known worldwide as the “Father of Emergency Medicine”,[2] Frank Pantridge was less acclaimed in his own country, and was saddened that it took until 1990 for all front-line ambulances in the UK to be fitted with defibrillators. He was awarded the CBE in 1978.

  • Turgon

    Joe,
    Up to a point that is all true. However, Pantridge was an appalling self publicist.

    The current ideal treatment for a heart attack (apart from not having one in the first place) is to receive what is called primary angioplasty also known as primary percutaneous coronary intervention (PPCI) rather than the so called “clot buster” treatment. If the drive time is less than about two to three hours this treatment (PPCI) is superior to clot busters.

    In mainland UK they moved over to PPCI a number of years ago. Currently the Royal in Belfast offer this to the greater Belfast area. However, the rest of NI does not benefit (Craigavon Area offer it about 9-5). Now the drive times may be a bit long for PPCI to be offered from the Royal to the whole of NI. However, if we had say a PPCI centre in Altnagelvin and another one in Craigavon 24 hours a day as well as the Royal then it would work pretty well. Altnagelvin and Craigavon would need to have more doctors, nurses etc etc. However, with three centres each would get enough work to keep the skills up.

    The above would save lives but also after initial investment would save money as PPCI patients not only have less death and complications but also have a shorter hospital stay: a win win. However, this would require acceptance of bypass protocols for the NIAS to bypass small hospitals for say all chest pain patients and all being taken to these three centres. The other hospitals would have to have their cardiology services at least somewhat downgraded as they would get less work.

    That is all a very rough outline but since it can be done in mainland GB with much greater distances and in many areas at least as poor a road network (they do not use air ambulances for such work to any significant extent in GB – they do not need to) it could be done here. What has been lacking is the will and at times I suspect the vested interests of local politicians “standing up for their local hospital” even if that actually means poorer treatment for their constituents.

    Belfast and NI may once have been pretty world leading on heart attacks: on this we are now well behind the cutting edge.

  • joeCanuck

    I’ve had it all. Been defibrillated, luckily laying in a bed in the A&E having arrived there 5 minutes earlier, angioplasty twice, had stents inserted (didn’t work) and been given clot busters twice.
    Anyone having chest pains should get to the A&E as quickly as they can. The staff would much rather you turned up with bad heartburn than you staying at home in denial (very common) and dying.

  • hfmccloy

    The golden hour is a myth, a myth that was accepted to make Developing Better services acceptable on paper. Before Developing Better Services the time from acute hospital should be 45 minutes all of a sudden its a hour, did we evolve to live a extra 15 mins after a acute illness in the space of year, I think not.

    how long does it take someone to bleed to death?, a child to die of meningitis? a stroke victim to be left brain dead? heart attack victim to die? Mid Ulster has already proven an ambulance service cannot replace a local A&E.

    With the added factor of trackers fitted to ambulances, when they do leave areas like Mid Ulster it can be some time till they are back and the tracker kicks into effect. A resident Mid Ulster ambulance leaves a patient to Antrim 17 miles from Belfast, call comes in it is the closest to say a accident in Belfast , it goes to Belfast. But nothing goes to Mid Ulster to plug the gap

    Does lead to the question of ambulance cover, 48% response times on target in Mid Ulster, 41 % for all CATS on target. Everyone else is left to die.

    Although some hope with Poots mentioning the Mid Ulster and Save The Mid in the assembly, 2016 the first cancer beds will be open in Altnagelvin but in the meantime the week before they removed cancer beds from Mid Ulster.

    Whats the Mater, ask Colm Donaghy he is there to shut it down