The Assembly crisis is costing £300 million a year in Health alone

  1. The Belfast Telegraph has an exclusive on the depth of the health crisis. It shows the real world  gap between the obsessive zero sum game that dominates politics and the practical need for regional government  of some sort. If the RHI scandal broke the Executive, will the long-term health scandal remake it?

Northern Ireland’s health service is facing a potential overspend of more than £300m this year – which will worsen already unacceptable hospital waiting lists, a former Northern Ireland health boss has warned.

The massive sum dwarfs the Renewable Heat Incentive that led to the collapse of Stormont, which is predicted to cost more than £400m over 20 years – or £20m a year.

John Compton, ex-chief executive of the Health and Social Care Board, said the health system is in an “unsustainable” financial state and the political stalemate at Stormont is making things worse.

 

Tom Kelly in the Irish News chimes in with a cameo on  the state of Daisy Hill  hospital in Newry

The Sinn Féin statement issued after the visit said: “Minister O’Neill confirmed that Daisy Hill would be part of the acute hospital infrastructure in the future.” which unsurprisingly local Sinn Féin representatives concluded was “great news for the area.”

That was on February 20. Then the board of the Southern Health and Social Care Trust (SHSCT) who are responsible for the operation of Daisy Hill hospital issued a chilling warning on March 30 that ‘ongoing staffing difficulties for the emergency department (at Daisy Hill) could lead to its temporary closure.’

 

 

 

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  • John

    Sinn Fein haven’t thought this whole thing through as usual. Putting selfish sinister party aims above EVERYTHING, and we will all suffer as a consequence.

  • Skibo

    John Compton mentioned a figure of 6% year on year for the NHS to stand still. With the NHS budget currently standing at around 48% of the overall budget, that means in 13 years the NHS budget would require over 100% of the total budget, assuming that the overall budget continues as is. It is common knowledge that the overall budget will be reduced year on year.
    The NHS cannot continue as is. It needs root and branch revision. GP surgeries in particular need change and be made the first line of defence.
    I would also propose drunk tanks for all major towns with a £100 release fee. That would go a long way to reducing the requirement for police standing round A&E and reduce attacks on the doctors and nurses.

  • Skibo

    John what is the point in resurrecting an executive to deal with day to day business when it is completely obvious that it would fall at the first hurdle?
    If the Executive is going to be reformed, it needs to be stable and those who sit in it must be completely signed up to sharing of power and equality.

  • Ray Lawlor

    I know… if only there was some simple solution… like Arlene Foster standing aside…

  • John

    I despise the DUP equally but what is the Nat/republican h@rd on about getting Foster to step aside? Is this the domination to expect in the event of a United Ireland?

  • Ray Lawlor

    Who mentioned a United Ireland…?

    The fact is, Arlene’s department completely botched the RHI scheme and squandered millions… asking her to step aside was both reasonable and necessary.

    Hardly “sinister” party aims.

  • John

    Well it’s all that’s ever talked about on here these days. When the IRA were killing on the streets of Belfast a year ago did the DUP collapse the executive? Did they ask machine-gun Marty to step aside? Nope, they dealt with it. Now Adams says Arlene was probably innocent of any alleged corruption. So WTF was this all about?

  • Skibo

    John, the IRA were not killing anyone on the streets of Belfast if you are talking about PIRA. They are disbanded and decommissioned.
    Now consider how they dealt with a Republican being killed by someone yet to be named, they set about a system of nominating and resigning on and on, keeping the system in constant limbo without bringing it down.
    All the time Arlene Foster was at the helm, ensuring renegade SDLP Ministers and rogue SF ministers did not step out of line.
    Hardly a progressive action.
    Tell me what did they do when the UVF murdered a previous member or when the UDA quite recently did the same. Were their lives worth any less or was it all to do with trying to cope with Mike’s decision to leave the Executive and leave DUP no cover, serving in an executive with SF?

  • Dan

    Maybe someone in authority in the Health service or one of our ever eager for publicity politicians can explain why my local doctor’s surgery refused to ask for a payment for my Canadian relative’s consultation last week, and then the local chemist refused to take any payment for the prescription issued.
    Even when asked to take payment, they refused, but yet, we have the usual suspects crying poverty in the service.
    How many times a day does this happen throughout Northern Ireland?
    How many from the Republic and further abroad are availing of free treatment?

  • Old Mortality

    The principal responsibility of politicians is the immediate welfare of the population they serve. Nobody is going to die from the absence of legislation for the Irish language or homosexual marriage, although hunger strikes on these issues cannot be ruled out. How many rational nationalist voters would give Irish language signposts priority over cutting waiting lists? The longer this goes on, the risk to SF of the SoS calling another election increases. They must be impatient for direct rule to start.

  • Katyusha

    You mean asking ministers who presided over a scheme which lost hundreds of millions of pounds, due to incompetence and possible corruption, to take some gardening leave while their role in the associated scheme is investigated?

    I sure hope so. We’ll be dealing with Fianna Fáil after all.

  • Skibo

    OM the assembly has been in operation for over ten years since the St Andrews agreement where the Irish Language was legislated for. How long should it be put on the long finger?
    The actions of the Unionist parties in relation to the Irish language is symptomatic of their distaste for anything with a tinge of green, further exemplified by the inability of Arlene Foster to attend a ROI match during the Euros.

  • The Merovingian

    First of all, these problems pre-date the current breakdown at Stormont, and there’s no reason why they couldn’t be addressed by civil servants under direct rule. Second, to paraphrase the late Flann O’Brien, it is possible to have both bread and Gaelic, especially when you consider the monies spent by the former communities minister on grants for band instruments.

  • the keep

    communities minister on grants for band instruments

    It had been stripped off them by the previous SF minister.

  • the keep

    Why in heavens name should she go to a ROI she is the first minister of Northern Ireland doesn’t the title give it away.

  • hgreen

    I’ve often attended matches where I support neither of the teams.

  • hgreen

    The management and logistics costs outweigh the revenue raised.

    Next question please.

  • Dan

    Jesus wept.

  • hugh mccloy

    SWAH will cost run £400 million by the time its paid off

  • Fear Éireannach

    Given that the Irish languages proposals are reasonable and an inevitable consequence of the GFA reducing the one sided nature of NI, then those that are delaying things by refusing to have Irish language signposts should just agree to prevent further delay.

  • hugh mccloy

    We need to go back to a system that worked, functional local hospitals that took intermediate care allowing trauma centers to deal with traumas. This will increase capacity for day case and surgery

  • Jollyraj

    “Given that the Irish languages proposals are reasonable”

    Details please. What exactly is proposed? Or don’t you know?

  • hgreen

    I take it you aren’t an accountant.

  • Surveyor

    I thought there was going to be an extra £350 million per week pumped into the NHS post a result in favour of Brexit.

  • Fear Éireannach

    The model used is is similar to Scotland and Wales, which should be reasonable to a British person, the DUP seems to have a lot of these.

  • hugh mccloy

    Compton is not the person to be going on about this, rolling cost cutting savings introduced by him to trusts, they let the debt roll. Of the £300 million overspend how much is it on services or how much is it on rolling cost cutting targets ?

    The reality is before Compton came about we had a fully functional health system, we didnt have A&E crisis every month, or huge waiting lists.

    Bengoa wont bring massive change it will bring massive cuts and bluff everyone that its done in the name of patient safety.

  • Old Mortality

    If we have apparently an emerging financial crisis in the NHS, it’s hardly a propitious moment to introduce new spending commitments which are of far less importance to the most people. Even more so, if RHI turns out to be as expensive as predicted. Of course, an Irish language act with no financial commitment should not be an obstacle to progress.

  • Old Mortality

    That may well be. However, if there is such an acute crisis in health, money already spent on frivolities is no justification for spending more.

  • Old Mortality

    That’s probably because you’re a genuine fan of the sport. I strongly suspect Mrs Foster is not.

  • Brian O’Neill

    So basically all the failings in the health service are down to John Compton?

  • Old Mortality

    That’s outrageous but not surprising. Saving money is not a priority among NHS ‘professionals’. I would hope that the proposed curbs in England and Wales on prescribing drugs that are available over the counter is rapidly applied here as well.

  • Old Mortality

    What are the logistic costs of a doctor charging for a private consultation? Could it just be that both GPs and pharmacist have no idea of the real cost of anything anymore. They just dole it out.

  • Jollyraj

    Well, no, I think I’d like to hear the details please since you’re convinced we need it and the expense will be worthwile. It’s not good enough to say it’s a must and then when pressed for details shrug and say “er…I dunno..something like Scotland has”.

    What exactly would it involve?

  • Dan

    Wouldn’t want you to be mine, thats for sure.

  • Jollyraj

    Indeed…. but that is no longer the complaint. It’s the lack of an I&USLA that’s riling SF today. So much so that they are willing to sacrifice the health of patients with these costs to the health system while Gerry gazes lovingly in the mirror.

  • Ray Lawlor

    “risk to SF of the SoS calling another election increases.”

    No risk there…

    http://www.irishnews.com/opinion/cartoons/2017/03/10/news/another-election-warning-960322/

  • hugh mccloy

    Quite a few of them are, and that was before he got nominated for TYC. Prior to this he was tasked with implementing CSR 2008 while continuing alongside the Developing Better Services Strategy. Funny his was not on about this when he was in office, but now is the expert ? Guys like him and Dr ONeill pop up every now and again, the yes men.

    Ask the question, is the £300 mil over spend on services or is it on rolling cost saving targets. Who introduced these ?

    HSCB is an arms length body and the Trusts were arms length to it.

  • Fraser Holmes

    One key aspect of Liam Donaldson’s report was the provision of A&E services . His recommendation was a cut in the number of hospitals providing this care. At the time of his report there were 11 hospitals with full time A&E, if English practice were to be followed this would reduce to 4. This may be too drastic given the geography and politics of N.Ireland but a significant reduction is required. The problems are neatly illustrated by Daisy Hill.

    Much of what is needed to modernise the NHS is uncontentious and can be handled by the reforms in the Bengoa report, but it requires leadership from Stormont to force through the closure of A&E units. So the likely outcome is drift and fudge.

  • Fear Éireannach

    Dundalk and Newry are both in the top 20 towns by size in Ireland and have a substantial population around them, they are 10 minutes drive apart. Yet sectarian partitionist policies have ensured that there isn’t a proper large hospital serving this area and no doubt many people here will be proposing that this continues with its consequent adverse effect on the health of the population.

  • Nevin

    Hugh, there seem to be many levels of administration. There are also local commissioning bodies. Presumably a lot of money must be soaked up in administration, including harmonisation across this multiplicity of administrations.

  • George

    That’s the problem right there: you consider spending money on the Irish language is frivolous, but the problem is that others do not.

    Part of living in a cohesive and healthy society is supporting things of high value to others even if you consider them frivolous. I note you don’t consider the Irish language threatening to you in any way merely consider it to have no value to you.

    And seeing as you’re looking at the bottom dollar on this, it can be argued that living in a cohesive society increases health and well-being and therefore reduces the cost of healthcare. It’s no surprise that people living in Northern Ireland, the least cohesive and functional part of the UK, have the lowest life expectancy in the UK. Ireland to your south has a higher life expectancy too.

  • Skibo

    Hugh that is the system we have and we cannot afford. We have to accept that having numerous hospitals all over the country all specialising does not work. Daisy Hill cannot even work A&E any more as they cannot find enough highly qualified senior doctors to staff the place 24/7.
    We have to realise that we do not have an ever increasing pot of money and design a health service that works to the best that we can afford.

  • Skibo

    And there you have an answer to a different thread. What do you call a decent Unionist, one who recognises that the rights of the rest of the community are as important as your own. MMcG had no love of a NI team but he went to their match.
    Arlene has alot to learn about being a politician for the whole community.
    The whole idea of the GFA was not one First Minister to represent one side and one First Minister to represent the other side. It was for two First Ministers to represent all of the community without fear or favour.

  • hugh mccloy

    The only thing measurable that TYC done was create another layer of admin. Management costs have been staying static over the past few years though they are very high.

    I think I reported that Mr Compton walked away with a CETV pension pot of around £1.5 million

    But the admin is only a small part of the problem, trusts are told each year to make saving, they cant make these savings so they get allowances form HSCB, this £300 statement is fake accounting for the lack of a better word. I would want to know exactly where the overspend is if Compton has went this far he can go a little further

  • hugh mccloy

    What can we not afford ? lets make that list and see what is what. its not that long ago that we had a functional system.

    Daisy Hill is another “crisis closure” easiest way to wipe out a service, make sure it fails and close it. If we applied Bengoas model for judging services now more than Daisy Hill will close, but the demand will stay the same and the health service will crumble more with less capacity available.

    I am only guessing here but no doubt in the future it will come out that Daisy Hill could get staff but the trust needed to shore up craigavon to keep it open. Just like Mid Ulster and Antrim

    Criagavon was badly hit when Mid Ulster lost acute services, it wont be able to take on any more. Just like Antrim it is constantly escalated.

  • lizmcneill

    Where would you put 4 units in NI that everyone can get to in a reasonable time? What’s the English standard for time to get there?

  • Old Mortality

    Is there any evidence that Irish speakers suffer poorer health, mental as well as physical, than the population at large?

  • Nevin

    PFI appears to have been a serious misjudgement – unless you’re a beneficiary:

    A new report from the audit office has alleged that the South West Acute Hospital will cost the public purse a colossal £712m, £488m more than the initial project cost.

    The extra money will go towards payments to the private sector for their funding of the hospital.

    In the same figures a Western Trust services centre with an initial project cost of £15m will cost the public purse £56m.

    The figures released last week reveal that the Enniskillen hospital, Northern Ireland’s first Private Finance Initiative (PFI) hospital will cost more than three times more (£224m) due to payments made over a 30 year period. .. Fermanagh Herald, April 5, 2014.

  • Skibo

    Hugh I look back to when I was a young lad and if you were ill, you went to the Doctor. If he thought you were ill enough you went on to the hospital. This does not happen now. A&E is full of people who went to A&E first and tie up a system that was not designed for them to attend.
    Many a Gandmother or Grandfather was nursed at home with the Doctor regularly attending. You knew your doctor on first terms.
    Now most of that is moved into hospitals. We are turning into a society that thinks the state owes us and should look after us.
    That is why the NHS is at breaking point.
    The A&Es are blocked up with people who should be at the doctors along with drunks who should be locked up.
    Beds are being blocked because people no longer believe it is their duty to look after sick relatives. The state can only do so much and as society continues to put more and more pressure on the NHS it will creak, bend and break.
    We as a people are living longer. Cures for diseases are being discovered all the time at an expense as the Pharmaceutical industriy try to make greater profits.
    To say that the NHS were better before is not to accept that society has changed. As society changes, the rules for the NHS have to change also, otherwise all our budget will end up being required to keep the NHS ticking over.

  • Skibo

    PFI is a Tory wet dream and should never have been pushed by a socialist government. It is a sop to Big Business. Unfortunately when you are trying to supply a present day system with an out of date estate system something had to be done. We were not in control of raising finances and that was the only option open to be able to supply a estate fit for the future.
    I note you are only comparing the original build costs against the lifetime cost of the building. Have you included running costs and interest costs and inflation if the initial building costs had been borrowed?

  • Dan

    i’d say we need a strong direct rule minister for that, because the local morons in charge here haven’t had the courage to take any difficult decisions.

  • hugh mccloy

    swah was a purly NI project, can’t blame tories they were not in power in getting this.

    This was a sf project rubber stamped by the uup

  • Nevin

    This from an NIAO report in 2014:

    The Report records that the current 39 operational PFI contracts have built up an estimated £7 billion of commitments against future years’ departmental resource budgets, costing an average of £245 million each year until 2030. However, there is currently no central collection of PFI costs and commitments or dissemination directly to the Assembly or its Committees.

    https://www.niauditoffice.gov.uk/publication/future-impact-borrowing-private-finance-commitments

  • Korhomme

    Many here, I’m quite sure, have been at meetings where some pretty trivial item has dominated the proceedings, where all those present think they know something about and insisting on putting their point forward. Meanwhile, a large complex issue gets waved through with barely any discussion, usually because people don’t want to let their ignorance be aired publicly.

    We now have politicians debating whether to form an Executive, with these discussions, as the media report, including an Irish Language Act and Legacy issues. Now, an ILA and the Legacy issues are certainly desirable, but they aren’t quite in the same league as maintaining essential services, such as the provision of health care.

    Why is it that our politicians cannot or will not see the difference?

  • Korhomme

    The English model of NHS care used to be for one unit per 250,000 population; this has now changed to 500,000 population.

    Around half of the population of NI lives in the greater Belfast/Lagan valley area. You might use this as a model for the distribution of A&E units.

    However, if you go to England you’ll see that around 80% of the population live in large urban centres, and this model works well enough there.

    Go, however, to the Western Isles of Scotland, or to the Orkneys or Shetland. These places have populations far below what is required for an A&E unit. Does this mean that people in these places shouldn’t have any emergency medical provision? Well, the Scottish government doesn’t think so.

    In NI, we are in a rather intermediate position; there is a large scattered population outside the single major conurbation; scattered, not just in significant-sized towns, but throughout the countryside. (It’s a reflection of the differences in farming in the two countries.)

    The implication is that, to allow reasonable access for the rural population, rather more A&E Depts are needed than simple mathematics would suggest. And that means more doctors, nurses etc.

    Yet, the UK doesn’t produce enough doctors or nurses; and nursing bursaries have been abolished by George Orborne. Just where can we expect to get these people from today? After all, Brexit is all about limiting immigration isn’t it? (Anyway, why should the UK expect other countries to help with our staffing problems?) And today’s problem reflects bad decisions taken years ago.

  • Korhomme
  • Korhomme

    I would also propose drunk tanks for all major towns

    That used to happen. Back then the cops would round up the drunks and let them sleep it off in the cells.

    Unhappily, and with depressing regularity, some of the drunks were found dead the next morning. They might well have been drunk, but they had died from complications relating to head injuries.

    Which is why, today, drunks are brought to A&E depts for observation; and a hospital is, legally, a ‘place of safety’ and also has a ‘duty of care’.

  • Fraser Holmes

    I can’t see how four A&Es would work either but the essential point is that resources are being spread too thinly and rationalisation is needed.

    I couldn’t agree more about the state of the NHS. The UK spends less than most advanced countries on health. This amounts to roughly 2% of GDP. So if we want a health service fit for purpose we need to spend more.

  • murdockp

    This is where the misinformation is at its best.

    Are people protesting about services being run down because they are concerned about loosing their jobs or their service provision. I would moot job security is a more likely reason.

    In the case of Newry a Massive £50m community treatment and care centre which is designed to merge GP and minor procedures in a new state of the art facility is in limbo with a preferred bidder in place but with no planning permission, or any likely hood of planning permission.

    But the locals know bugger all about it or what it will do. Daisy hill is time expired with a spawlling concrete frame and is ready for demolition, but still they spend money on it due to politics rather that healthcare need.

    Politicians need to listen to experts and deliver the efficiencies that are known to work. Exemplar hospitals such as Birmingham need to be studied and copied and the time expired inefficient hospitals closed no matter the fall out.

    It seems to me the NHS is not very good and communication and liaison with the public. If the public understood the long term vision for the service that would not get so worked up.

    Having taken my son and father to Daisy Hill A&E only to watch them being taken by Ambulance to the Royal Victoria Hospital which has all the consultants in place a hospital needs and were they were dealt with promptly and efficiently, did I finally understand that Daisy Hill A&E is only being kept open to satisfy politicians and keep people in jobs and not for medical reasons as it is just not possible to provide the level of consultant support to offer the full service to serve lets face it, a small community.

  • murdockp

    But you are assuming an A&E is the answer. Community Treatment Centres which are not full blown A&E hospitals and not suitable for say a serious industrial accident or say a road traffic accident but are effective for a broken ankle, or a serious cut would fill in the gaps of downsizing an A&E department numbers.

    Or put simply. If you are seriously injured, would you rather be taken to the likes of daisy hill with very few consultants and which provides an ‘adequate’ service or to a centre of excellence such as royal Victoria which has a full troop of consultants available to give you the best service that can be provided.

    I know what I would rather have.

  • Korhomme

    There are already Minor Injury Units to deal with ‘minor’ problems; and they can be paired with an out-of-hours GP surgery. Even so, such units may be constrained by difficulties with medical and nursing staffing.

    The RVH is the Regional Trauma Centre for NI. Such a major centre should have all surgical specialties on site. Consider if you had your serious injury in Castlederg or Belcoo. Firstly, how is it decided whether your injury is serious enough to go to the RVH, and secondly, how do you get there? Ambulance crews have trained paramedics who can assess and initiate treatment; but getting to remote locations takes time. The roads in such places are often poor, and although there is to be a Helicopter Service, this functions only during daylight hours. If in Belcoo, perhaps you should go to Sligo — but the road’s awful. I know these are extreme examples, but the do illustrate the problem.

    If you’re injured in the Greater Belfast area, fine, you can be taken to the RVH reasonably quickly. Of course, you might well not need all the facilities that the centre can offer.

    And this is one of the significant problems with such care provision in NI; how do you maintain reasonably equity of provision? It can’t be good enough for there to be one standard around Belfast, and another for those out in the sticks.

  • Korhomme

    It’s more than 2%, around 8.5%. But you are quite right, it’s still less than many other countries. Tony Blair did promise a greater spend — as an impromptu comment on a TV show — but the current ‘austerity’ agenda continues to erode this. You don’t need to be paranoid to think that the Tories are attempting ‘death by a thousand cuts’ with a view to privatisation and charging for services.

    The King’s Fund has more on spending here:

    https://www.kingsfund.org.uk/blog/2016/01/how-does-nhs-spending-compare-health-spending-internationally

  • The article just illustrates how the tail has been wagging the dog in Stormont for too long.
    John Compton (who I had many debates with re: health provision in Down) has for many years taken advantage of competing political priorities of different Health Ministers to implement his plans for health service delivery.
    This plan is based on private sector dominance/dependence not affordability, accessibility or delivery, and he didn’t step away until it was complete.
    The health deficit can be attributed to the architect so wether the Executive was up and running or not the bill will continue to increase, as will the dependence on the Private Sector.
    The South Eastern Health & Social Care Trust ( formerly SET & Down,Lisburn Trust), under the stewardship of John Compton, gradually redirected all key services from Downpatrick to the Ulster Hospital in Dundonald and Lagan Valley in Lisburn. The SEH&SCT became a back up service for the Belfast Trust leaving the large rural areas as far south as Newcastle, Castlewellan, Kilcoo, Ardglass and Downpatrick itself where a new hospital had been built, with an inadequate, limited service.
    The new build in Downpatrick was to have an A&E and a range of other services as laid out in B de Bruns Developing Better Services. By the time of the official opening ( it had been opened over a year) Edwin Poots was Health Minister and while unveiling the plaque to open it, I as Council Chair asked if he was there to announce the closure. By then most of the services committed too had either been removed or never been put in place at all.
    A&E had already become an Out of Hours Service, the state of the art Consultant led Midwifery Unit had no consultant and GPs had been instructed by the Trust to refer patients to Dundonald. Ambulances drove past the Downe hospital with critical patients, on a back road journey to Dundonald. They were also instructed to bring patients from Newcastle to Belfast (Dundonald, RVH, City) & we were assured a blue light ambulance could make this journey in 25 minutes. The Minister who hadn’t a notion believed the info provided by “health experts” but even in the worst cases of the tail wagging the dog, his acceptance of this info is beyond ridiculous. A blue light ambulance might make it to Belfast in 35 mins from Newcastle at 4am but it would take a minimum 45 mins during the day, and Newcastle is not the furthest point within the Trust area.
    This all coincided with the forced privatisation of respite and Domicilery Care, with the closure of Trust run facilities.
    It’s difficult to decide which measure had the most impact or which was the most illogical, but the removal of mental health services from Downpatrick was really the nail in the coffin. This process is yet to be completed but it is almost there and again it appears to confirm that the South Eastern was all just part of Comptons plan to provide a cover service for Belfast.
    To those unfamiliar with the geography or who are unsure of the evidence. All services moved to Lagan Valley which is within a 10 minute drive of both the RVH and the Belfast City Hospital, and remaining services to Dundonald which is again on the edge of East Belfast and 10 minutes from Belfast City Hospital.
    John Comptons expertise is not in question, his expertise in health service delivery is.

  • Fraser Holmes

    Sorry for the lack of clarity, I meant 2% less than other advanced countries. The King’s Fund link confirms this.

    As for privatisation – well the unelected minister for education and Tory donor Lord Nash has form on this

    http://powerbase.info/index.php/John_Nash_(private_equity)

    But then the NHS is safe in their hands isn’t it?

  • Korhomme

    The Tories’ manifesto for the 2010 election included a ‘promise’ of no top-down reform of the NHS. What did they do? a top-down ‘reform’ of the NHS in England.

  • lizmcneill

    A friend of mine had a chest infection with pain and crackling noises when breathing. Couldn’t go to the out of hours GP because apparently it’s only for children, the elderly and the terminally ill. So is the only option for adults A&E?

  • Skibo

    Hugh you cannot deflect blame from Westminster so easily. They control the purse strings.
    Would you prefer the Enniskillen Hospital was not built?

  • Skibo

    If you visit the A&E while drunks are there, you will find a police presence tied up “keeping them safe”. It doesn’t stop A&E staff getting attacked or threatened. I still thing the drunk tank would be a great idea as long as it is properly staffed and had access to medical assistance.

  • Korhomme

    The problem of assaults on staff in A&E is certainly a major one, not just in NI but throughout the UK.

    Many assailants may well be drunk, but perhaps it doesn’t help when waiting times are so long. (And do these people need to be there anyway?)

    Drunk tanks sound more like ‘vengeance’. It’s not good enough to make a one-off assessment of a drunk to determine if there is also a head injury. This can only be realistically done by repeated observation and recording of vital signs, often this means 15 or 30 minute reassessments. I don’t see how this is feasible in a ‘drunk tank’.

    In terms of prevention; well, there was a time when such drunks were videoed, and the tape played back the next morning when they were sober. That’s only suitable for the individual.

    At a societal level, we’re really talking of a culture change. This is usually something that happens very slowly. Think how long it took before seat belts were acceptable, or if a group went to the pub, how long it was before one member had to stay sober — or they all called a taxi.

    One suggestion has been pricing alcohol by units, making it more expensive. I understand this is introduced in Scotland; elsewhere it isn’t popular. Popular or not, it might be worth a trial.

  • Skibo

    I believe in Australia they make the pub that serves drink to someone who is obviously drunk responsible. This may be the solution. If a landlord knew he would be up in court or have his license in danger if drunks were exiting his establishment, they may be a bit more responsible in allowing people to get so intoxicated.

  • john millar

    I have personal experience of the French system They have no problem in organising the “system” for collection Simple and effective

  • john millar

    “Which is why, today, drunks are brought to A&E depts for observation; and a hospital is, legally, a ‘place of safety’ and also has a ‘duty of care’.”

    And charge them an appropriate fee when then they are found to have been simply “drunk”

  • hugh mccloy

    I am not deflecting, we have devolved institutions that can make decisions, the decision was to let health crumble. Look at the reality the initial shut down of Mid Ulster A&E cost £40 million and the reason to shut it was because antrim was collapsing and it needed mid ulster staff. Look at the last period of direct rule Westminister had ample opportunity to close down hospitals as per developing better services, it did not, it carried out risk assessments and made the decision based on them to keep services open.

    Time to take some responsibility for our actions and inactions as a country.

  • Skibo

    Hugh you are being disingenuous. Could the MU A&E continue to give the service and the cover that a full service would require?
    MU A&E as far as I am aware is still open for selective injuries. All serious conditions are directed elsewhere.
    Ask yourself is it possible for each and every hospital to supply the full A&E service.
    Westminster make decisions in the interest of the community, I don’t think so!
    Carrying our risk assessments is a short term solution showing that Westminster had no interest in actually updating the system, merely treading time.
    Did you see the changes Westminster is forcing through on child tax credits and single parent allowance this week?

  • hugh mccloy

    The simple answer is yes, it could have sustained services. MU A&E was closed, a minor injury unit was opened which is great but limited by opening hours.

    The question is not can every hospital sustain one, not every hospital was sustaining a fully loaded A&E. What we had was a critical care network that had capacity. Removing the type 2 A&E at Mid Ulster led to the loss of acute inpatients and high dependency, this in turn left a critical care bed shortage. The critical care bed shortage has led to the collapse of the A&E services across the country, led to longer waiting lists as wards are full and has led to deaths. The very thing that the Westminister assessment warned of, but dont let facts get in the way.

    You can try and change the subject, Westminister had 5 years to shut the mid after the consultation carried out by Sinn Fein that agreed to shut it. Westminister kept it open, less than 1 year into Stormont getting back up and running they put the wheels in motion to shut it down,