Health reforms slowly being revealed

Slowly, almost painfully so, the health reforms are beginning to be revealed. The Compton Review stated that each of the Health and Social Care Trusts was to bring forward proposals for hospital services by June 2012. It is slightly unclear if that was to be the start or the end of this month: however, rumours of proposals have been circulating for some time with Marie Louise Connolly of the BBC providing most of the information:

The Royal Victoria Hospital is to become the main base for all emergency surgery within the Belfast Health Trust from 2012/13 with elective surgery remaining at the Belfast City and Mater Hospitals.

The Southern Trust plans a series of “treatment hubs” with GPs moving to larger centres and having additional resources in these centres. According to the BBC these changes might well result in services being moved out of Daisy Hill in Newry.

The most prominent recent issues have, however, been with the Northern Trust. Two reports into Antrim Area Hospital recently have been highly critical especially of the A+E department and subsequently reports of bullying have surfaced. Added to this is the suggestion that Causeway in Coleraine might lose 24 hour a day A+E. Indeed there have even been claims that the Northern Trust is even considering, in the longer term, abandoning Antrim and Causeway and building a single new facility in Ballymena.

Through these leaks and suggestions Edwin Poots and the Department of Health have remained fairly tight lipped. Poots did specifically say after Compton that each trust should draw up its own plans and present them. He did recently say that he would not make the same mistakes as were made in the past and allow the precipitate closure of hospitals resulting in A+E departments having to cope with much larger numbers than there were designed for – at its root the main cause for Antrim Area’s problems.

Poots also, however, reminded people that the longer term plan is for one acute hospital for 250,000 people. That practically inevitably comes back to the “gold five” of Royal/ City/ Mater; Ulster; Craigavon; Altnagelvin and Antrim (or its replacement).

The need to reduce the number of acute hospitals in order to optimise outcomes (ie minimise death and disability) is one which has been reiterated time and again: and all too often has been opposed by the very communities which would benefit most from such changes (aided and abetted by bandwagon jumping if not creating politicians).

Edwin Poots has tried to avoid being too prescriptive regarding the way forward in each Trust. However, changing services and closing hospitals even for completely appropriate reasons is always a deeply political decision. Trusts tend to be good at implementing changes but less good at long term strategic thinking. They also tend to be very adverse to the negative local headlines which service changes so often bring. Hence, it is probably necessary for Poots to give a pretty clear steer in public as well as privately that these changes are what is required (and what Compton proposed).

In turn then Poots needs to be given the political support of politicians who apparently all too often agree in private that changes to local services are necessary yet then denounce those self same changes publicly. Furthermore Poots should set out the longer term vision pretty clearly. The problems of Antrim for example (leaving aside the massive issue of its location) would have been nothing like as severe if previous health ministers had admitted that the Mid Ulster and Whiteabbey were going to close and had enlarged Antrim to cope. As it was by refusing to say that this would happen and refusing to enlarge Antrim, lest it become clear that the smaller hospitals were going: when the Mid Ulster and Whiteabbey closed, chaos ensued. That chaos has demolished public confidence in Antrim to the extent where it will be difficult to recover.

If indeed (and it is a big if) there is a plan to go for a single new hospital in Ballymena (Waveney mk2) then that plan should be stated publicly and a long term time frame, along with interim plans, should be made clear at the outset. In addition at the outset there should be a clear indication of the political will to drive such a plan through to conclusion. Short termism has always been one of the NHS in Northern Ireland’s greatest problems.

Poots has thus far done a genuinely good job with the very poor situation he inherited: certainly colossally better than the débâcles which were the tenures of his Stormont predecessors DeBrún and McGimpsey. As such Poots should receive the unequivocal backing of his party and leader. In a time of change the suggested handover of health to Jim Wells should be postponed indefinitely. Barring any unforeseen issues Poots should remain health minister until the end of this Stormont term of office and maybe even beyond: after one term, however, he might well want rid of the poisoned chalice he thus far has transformed, if not into wine, then at least into something less toxic than he first received.

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  • I’m broadly supportive of the direction Edwin Poots is travelling in, but as you describe the Antrim/Ballymena/Coleraine situation it sounds like hospitals being sited and catchment areas determined to bit the convenience of Trust boundaries, which is not the right way to do these things. Antrim Hospital is still pretty new; seems a major waste of money to decommission it.

    If Daisy Hill closes, much of its catchment population is much closer to Dundalk than Craigavon. The difference in travel times from places like Crossmaglen are significant. Will a DUP minister bite the bullet on an issue where North-South would actually make by far the most sense?

  • Turgon

    Gerry Lynch,
    Dundalk hospital has been massively downgraded. Our Lady of Lourdes in Drogheda is the relevant hospital nearest the border in the RoI: much further than Craigavon from Newry and no closer to Crossmaglen than Craigavon. Hence, the cross border idea on that score makes little sense even before any issues regarding politics let alone the different nature of the RoI’s health care system are factored into the debate.

    In terms of trusts you may have a point. Certainly less Trusts would probably be better. Three might be optimal: Belfast; Northern and Southern to reflect the largely east west nature of our infrastructure. Just one trust for NI would risk ending up being too Belfast-centric. Three would allow the other two to be an adequately sized counterbalance.

    On the specific issue of the current Northern Trust hospital, however, it may be reasonable to have a hospital in the north of NI between Londonderry and Belfast. The best place for such is probably Ballymena sort of area: I guess, hence, the suggestion. Such a hospital would be adequately sized to have a wide range of specialities and a sustainable long term future. It would also allow a break from the percieved failures of Antrim. In actual fact Antrim’s problems could not doubt be fixed but it is a little far from the north coast and a bit too close to Belfast to make sense. That and the poor publicity it has had for a number of years may make the idea of a clean break attractive.

  • Mister Joe

    Poots did specifically say after Compton that each trust should draw up its own plans and present them.

    The population of N.I. is less than many cities worldwide. Do we really need more than one Trust? It could be argued that Poots is abandoning his responsibility so as not to be blamed for upsetting the natives.

  • Turgon

    Mister Joe,
    As I said above there is a potential problem with one Trust regarding excess Belfast-centricity. It would also be larger than almost any UK Trust (remember ours do social care as well as health). However, a smaller number of Trusts (probably three) would be best.

    As to Poots: he has done a reasonable job and I suspect he does not want to be too prescriptive. However, on things like number of Trusts or the closure / downgrading of a hospital: that is a political decision. the Dept of Health and the assorted professionals can advise him but he should make the final decision and should announce his decision publicly.

  • Pete Baker

    To paraphrase;

    Well, I wouldn’t start from here…

    But, Turgon, I have to take issue with this

    The problems of Antrim for example (leaving aside the massive issue of its location) would have been nothing like as severe if previous health ministers had admitted that the Mid Ulster and Whiteabbey were going to close and had enlarged Antrim to cope. As it was by refusing to say that this would happen and refusing to enlarge Antrim, lest it become clear that the smaller hospitals were going: when the Mid Ulster and Whiteabbey closed, chaos ensued. That chaos has demolished public confidence in Antrim to the extent where it will be difficult to recover.

    That’s not what happened. What happened was that assurances were given that Mid Ulster and Whiteabbey would not be closed before sufficient investment and preparation was made at Antrim to ensure it could cope with the added pressure.

    And then Mid Ulster and Whiteabbey were closed without that investment and preparation being made.

    That’s what has “demolished public confidence” in both the Trusts and the politicians dealing with this issue.

  • Turgon

    A fair point. The problem was that everyone in health and many outside knew the Mid Ulster and Whiteabbey were unsustainable. However, people were told exactly as you stated that they would not close until adequate measures had been put in place in Antrim. Those measures were never put in place and indeed it looked very like attempts at any such measures (to facilitate closure) were being blocked lest it become clear that the small hospitals were closing.

    Then eventually the hospitals fell apart for a number of reasons but centrally to do with junior doctor staffing and the impossibility of sustaining rotas, training etc. Those issues themselves being driven not solely by the European working time directive but also by the fact that modern healthcare requires so much greater specialisation and technologies that the smaller hospitals simply could not offer adequate services in a sustainable fashion.

    The way forward is to be honest with the public about what is going to happen. Poots has been better than the previous ministers regarding the need for changes but he should come out and say what most already know: namely that a number of the small hospitals are going to be downgraded / lose services or close completely.

  • Drumlins Rock

    Turgon, if you consider moving Antrim & Causeway as a viable option surely that also means Craigavon, a much older building, could be relocated further west? Say south of Dungannon on the M1.

  • Pete Baker

    “Those measures were never put in place and indeed it looked very like attempts at any such measures (to facilitate closure) were being blocked lest it become clear that the small hospitals were closing.”

    I’d like to see some evidence of this allegation, Turgon. Because it looks more like although the assurances were given, the investment was never made available. The reasons why are not apparent.

  • An interesting game of Fantasy Health Trust Manager going on in this thread. A new hospital in Ballymena and another new one in Dungannon! Where exactly is the money for all this coming from?

  • Turgon

    Gerry is correct re people suggesting fansasy solutions. That said his was the silliest: sending the people of South Armagh and Newry across the border to an almost closed down Dundalk hospital would be truly idiotic. It would be expensive and impossible: moving them to Drogheda would merely be mildly idiotic, further for most of them and expensive.

    You are correct that one could hypothetically move a number of hospitals. In an ideal world that would probably be the best option. However, it would be very expensive (though it could be a stimulus to the building industry – very Keynesian). Furthermore to put a hospital in Dungannon to serve the catchment of Craigavon, Daisy Hill and Erne one would really need a single trust covering that area. It would probably be the best long term idea and then have one or two hospitals in Belfast, one about Ballymena, one in Dungannon and Altnagelvin.

    However, the above is overwhlemingly unlikely to happen. It is just possible, though unlikely, that a new Ballymena hospital would be considered: a new South Tyrone almost impossible. More likely are bypass protocols to bring many patients past Causeway to either Antrim or Altnagelvin and under certain circumstances directly to the Royal. The same is likely to happen with the shiny new Erne with certain patients being taken straight to Altnagelvin or Craigavon.

  • hfmccloy

    I think your overlooking the lies that shut Mid Ulster Hospital, in the drive for fact based evidence form Poots and Compton they both were shown in face to face meetings with myself and Save The Mid that the Mid Ulster Hospital was shut for no reason. Everyone from personal meetings with the first and deputy first ministers through to the health committee and MLA’s and Poots knows and recognises that Mid Ulster should never have been shut down but they shut it down and allowed it to be shut down.

    The reasons as cited in the CSR 2008, by former health minister Michael McGimpsey and the same from Poots were already proved to be lies according to a Mid Ulster Hospital Consultant.

    They said they could not get doctors, they lied they never tried to hire them, that’s proven fact.

    The same reasons were proved lies by a risk assessment issued by the DHSSPS in 2006, it stated the most high risk move not just for Mid Ulster patients but patients across the Northern Board area was to shut the Mid.

    Lets face the facts of what have happened with Poots and the NHSCT within the past year, he admits the Mistake of closing the Mid but does not fix it. He visited Antrim Hospital and knew that patients were diverted and hidden by a senior A&E consultant in Antrim, who is also part of the bullying scandal and does nothing about it.

    1- a new A&E unit at Antrim that is the same size as that currently in operation
    2- a new ward at holleywell which is too small for projected attendances
    3- a new neonatal ward that is still to small by RQIA standards and 6 years to late since shutting the services at Mid Ulster, and this is days before Poots stated the 32 recommendations will be fully implemented post pseudonymous outbreak.
    4- lack of capacity in out patients and inpatients left 10,000’s waiting for treatment and appointments, this has led to out sourcing to private hospitals and the introduction of backstops to take patients of the radar. Thus outsourcing takes place at the end of the financial year no surprise there.
    5- Antrim hospital A&E waiting times do no include time spent in clinical decision, short stay wards, or the new corridor ward that is shuttered by curtains. These places are part of the emergency care pathway.
    6- the introduction of new pathways, it does not matter how many doors are made the building is still the same size and still has the same capacity.
    7- did not develop maternity afeter shutting mid
    8- did not develop a&e afther shutting mid ulster
    9- did not develop inpatients after shutting mid ulster
    10- did not develpo surgery after shutting mid ulster
    11- did not develop out of hours cover after shutting mid ulster
    12 – did not develop ambulance over after shutting mid ulster

    this is just a quick fraction of the carry on in the NHSCT, its all in the name Antrim Area Hospital, I wonder who that was built to serve Turgon ??

    Why is this all going to go down at the end of June, becuase the MLA’s involved will have plausible deny ability, as they will be on holidays for the summer, any one who is supportive of the Health Ministers decisions that are back by the cross party executive who in turn are told what to do by Compton who is the CEO of the HSCB who has overseen the worst health crisis in Northern Ireland needs there head examined.

    Poots may not of been the boos of this purely political sag of health when this all started with developing better services but he is the boss now and instead of fixing the mistakes he is no better than the rest who now is building upon the broken foundations of the past.

  • hfmccloy

    But whats worse the bloggers will blog while they do the same to the Causeway, or maybe they have missed they already have

  • hfmccloy

    Gerry, many years ago before Poots pays outside consultants to do a population survey one was already done, and stated

    Ballymena to have a large acute facility serving coleraine, antrim and surrounding areas

    Cookstown to have a large acute facility to serve Dungannon Cookstown, Magherafelt, Omagh and surrounding rural areas, imagine a hospital with radius like that in central N Ireland

    this is nothing to do with money, it never has or never will

  • hfmccloy

    Is there any reason why the western trust have been ommited

  • hfmccloy

    A removed comment me thinks?

    s a native of Western Trust i think that it has been show time and time again that Mr Poots is sadly unaware, almost disinterested in regional equity!. All Trusts making own decisions, making quarterly self-audits. If required in come PHA/HSC or even RQIA – yet they are all at HSCT email contacts.
    Reactive corrections are too late! Wonder is he aware of what services are to be offered in the new state of the art hospital in Enniskillen? which unfortunately may have every room and ensuite (hotel style) YET all Ennislillen hopital patients – beraing in mind the geographical area this covers, will still have to travel to Derry, Craigavon or Belfast for everyday heart procedures.
    Has been referred to by a doctor as a state of the art nursing home…NOT forward thinking – only too typical of Western Trust.

    Notably the article ignores #westoftheBann our fate and our provision becomes worse rather than better!. Any mention by mr Poots on south Fermanagh for instance? in his LONG TERM STRATEGY??
    to be perfectly honest, i find it hard to have any belif that he has one! or certainly one that includes us all!

  • quality

    The thought of Jim Wells potentially being health minister is genuinely terrifying.

  • I agree , particularity when he warned in a meeting with the first minister and save the mid “there will be an Armageddon in health”