HEALTH campaigners in Down District continue to exert pressure on the South Eastern HSC Trust’s management to reverse the recent decision to close the Downe A&E at weekends and evening after 8pm, the campaign shifted to the Trust’s monthly public board meeting help in Bangor on Wednesday 29 January.
The meeting reached a high point when the Trust announced that it could access doctors to service the Downe A&E but only during the day shift during week days. There was an immediate reaction form the local politicians and campaigners who then walked out of the meeting in protest claiming that the people of the Downe Hospital catchement area were being treated as second class citizens.
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The Downe A&E department … at the centre of a political storm.[/caption]
Health Committee Chairman Appeals To The Trust
Eamonn McGrady, Chairman of the Down Community Health Committee said: “The entire community in South and East Down was shocked by the announcement in the very “mouth” of Christmas, of the intention of the Trust to curtail Accident and Emergency Services at the Downe, the People’s Hospital, on a temporary basis.
“The anger expressed by our public representatives in the Down District Council Chamber on 23 December and subsequently by our MLA’s in the recent adjournment debate in Stormont fairly reflected the views of the people or South and East Down. I would urge you all to read the Hansard Report of that Stormont debate and the minister’s comments.
“The temporary reduction in services which you announced provoked an unprecedented cross-community reaction with a cross party political consensus rarely seen in this jurisdiction.
Our concerns include the following:
* the decision taken was not on the basis of clinical need, nor on the basis of patient outcomes, but rather on the basis of a resource allocation that favoured the Ulster Hospital over the Downe and Lagan Valley hospitals. Doctors are there, who, quite simply, should be in the Downe. I would, at this point, wish to express my support for the people of the Lisburn area in their fight to retain their local services too.
* the decision taken is described as “temporary”. There is a widespread belief that “temporary” will become “permanent.”
* the concentration of acute hospital services in Belfast does not serve our community well. With 41% of A & E attendances at the Ulster Hospital being from residents of the Belfast Trust Area, it is clear that the Ulster Hospital A & E is just another addition to the range of A & E Services for the people of Belfast.
* the future for the Downe Hospital as an enhanced local hospital as promised to and built for our community looks distinctly shaky to many of us. The polyclinic proposed and rejected for the Down area some 15 years ago now seems to be taking shape. This will not meet the needs of our community. When does a hospital cease to be a hospital? When beds are lost? When services are withdrawn? When a hospital becomes a gp health centre? Are we going down that road? Is it when it loses a designated coronary care unit?
“Our community response has been one of outrage. Over 7,000 likes (62% from people aged from 25 to 44) on a Facebook page are testament to that. The thousands of signatures collected already by our Petition Sub Committee are further testament.
“This issue will not go away. The community and political campaign will continue and intensify until our seven days a week, 24 hour service is restored. Bumps and grazes minor Injuries units, sometimes of questionable sustainability themselves, as the people of Bangor recently learned to their cost, are no substitute for 24 hour A and E, even in a Type 2 unit.
“We require proper sustainable accident and emergency services at our hospital. We were forced to accept, two years ago, a reduced service that was “sustainable”, the “envy” of other areas. Our community will not accept such assurances again.
“We will support all efforts to restore a 24-hour accident and emergency services at the Downe Hospital. Minister Poots has made his support for our 24-hour service abundantly clear. We hope that the Minister’s wish will become a reality. Our hospital meets the needs of our community in our unique circumstances. The nature and geography of our area and our infrastructural inadequacies in terms of transport are such that our fight must go on.
“Our hospital is still open for business. It enjoys massive support within our community. We as a proud local community, will not let the Downe, the People’s Hospital, down.”
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Ritchie Blasts Trust At Meeting
South Down MP Margaret Ritchie has blasted South Eastern HSC Trust officials for ‘temporarily’ closing weekend A&E services at Downe Hospital, which she says must be fully restored urgently to ensure patient safety is not compromised.
Speaking at the monthly meeting of the South Eastern Health and Social Services Trust on A&E Services at the Downe Hospital, Ms Ritchie said the people of Down and Mourne had “waged a long, arduous campaign spanning four decades to get the Downe Hospital and would not stand by and allow hard fought for, and much needed local health services to be eroded.
Ms Ritchie accused the Trust of making the decision regarding A&E services at Downe Hospital at weekends, and throughout the week, without proper consultation, or regard for the impact on the wider community and the rural population. She added she thought the reason put forward by the Trust for the cuts was a shortage of middle grade A&E doctors, but she said officials, including the Health Minister Edwin Poots and the Department of Health, had taken no action to address the issue effectively.
“The South Eastern Trust and the Department of Health have caved into pressure from centralist government medical philosophy emanating from Whitehall, and embodied in the Royal Colleges and the British Medical Association, that senior doctors can select where they want to work and not go where they are sent within a Health Trust.”
“This is a failure to implement appropriate workforce planning procedures” she added, and further called on them to put in place adequate arrangements for the recruitment of A&E doctors to assist in the sustainability of services at the Downe Hospital. She also accused the Trust of failing to act with any kind of urgency to recruit doctors for A&E, even when they knew vacancies would arise.
Ms Ritchie asked: “The Trust has nine vacancies to fill, but only received three applications. Therefore, we seem to need four more doctors to cover a rota arrangement. Can these not be found through rotation arrangement of doctors in the Belfast and South Eastern Trusts?”
Ms Ritchie said even though extra ambulance crews had been in place at weekends, there were reports of people in Ardglass and Castlewellan waiting significant times for an ambulance to arrive at Belfast hospital A&E departments which were already over loaded with patients.
“The Trust must acquire the power and authority to ensure that A&E doctors are told to go to hospitals such as the Downe Hospital where they are needed; that a determined and robust recruitment procedures are put in place to address the deficit in middle doctor positions and that all stops are pulled out to find the four middle grade doctors to staff the unit.
“The Health Minister states he wants the weekend A&E provision to be restored. The Minister must ensure that happens as a matter of priority, and must also visit the hospital to see the work that is being done and what are the opportunities for the future provision of medical and health services. All of that most happen as a matter of priority.”
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Unison Disappointed At Trust Announcement
Marion Ritchie, Downpatrick Unison Branch Secretary, said she was “disapponted” at the Trust’s proposal of running a 5-day a week A&E at the Downe Hospital. Speaking after the meeting, she said: “We are disppointed but it was not to be unexpected.
“Down District deserves to have its A&E running24/7 on the same basis that other area in Northern Ireland are entitled. The people in Belfast have a choice of up to five A&E’s to attend whereas the people of Down District don’t have one full-time now.
“Given that 41% of the patients in the South Eastern Trust A&E’s are from the Belfast area, it does raise a question of whether the Trust boundaries need to be re-drawn. These patients who talke up a sizeable part of the Southeasrtn Trust budget from outside their area are chosing to use these A&E services at the expense of people in Down District.
“It just seems that the Trust are trying to balance the books first and worry about patient outcomes second. Unison will continue to fight side by side with the hospital campaign for full 24-hour cover in the Downe A&E. “
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Trust Must Clarify Position Says Hazzard
McGrath Says He Will Report Issue To The Equality Commission
Cllr Colin McGrath address the Trust Board and directors and explained that the peopel of Down District were strongly opposed to the ‘inequality’ of the decision to cut the opening hours at the Downe A&E.
Speaking following the heated meeting, Cllr McGrath said: “That 41% of attendances at the A&E at the Ulster are from the Belfast Trust area raises a serious question. Why is this the case when they have the same population size as the South East but have two fully fledged a and e units – one at the royal and one at the Mater.”
“Why are 41% of the resources allocated to the South East Trust area being gobbled up by the Belfast Trust residents. We will need a full investigation into the ‘reciprocal’ arrangements for South East Trust patients into the Belfast Trust – I will be calling for that at the Council delegation visit to Health Commissioning Board Chief at our next council meeting.
“Also, the decision to close the Downe A&E at the times suggested was never scrutinised by an Equality impact Assessment… we are a rural and nationalist community – are we underserved in terms of health? Look at the Western trust – they put one acute hospital in Derry and one in Enniskillen. Enniskillen isn’t the biggest population (Fermanagh county has the same population as Down District), but the Trust assumed accessibility is important and placed the hospital there.
“I think the services at the Lagan Vally A&E should be moved to the Downe Hospital and have a full unit at the Downe and Ulster and then all services could move around. Should we be looking at boundary changes? Is it sensible for the people of Lisburn to travel down the M1, West Link and Newtownards Road to get to the Ulster – passing as they do the Royal, Mater and City to get to their Trust hispotal?
“There are many moves that could be done that are not being done – and that was the thrust of my challenge to the Trust.”
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Johnston Queries The Role Of The Trust Boards
Councillor Liam Johnston who did not have speaking rights at the Trust Board meeting made his opinion clear to the Trust Board Directs that their proposal of falling short of full 24/7 cover for the Downe A&E was “simply disgraceful”.
He added: “It is about time we looked at the role of the paid non-ececutive Trust board. They have pre-meeting before their monthly meeting, and I would have thought that the main role of the Board was to advice support and wher enecessary provide an intervention by way of checks and balances. If the Board was more active in representing the needs of the the people of Down District then maybe we would not have a situation where Trust policy has led to a situation wher ewe are being trated as second class citizens. This is simply just unacceptible.
Councillor Terry Andrews said: “I also was present at the meeting along with unison representatives and residents of our towns and villages. The speakers Eamon Mc Grady, Margaret Ritchie MP and Cllr Colin McGrath all spoke passionately and challenged the Trust over A&E provision and putting in place a wide range of services and treatments across all Departments in the Downe Hospital giving the hospital a much needed boost.
The Trust announced that they preferred a Minor Injuries Unit as a prime option. This is simply not acceptible. In the same breathe they said they might get interest in filling the doctor vacancies in the Downe A&E if they were allowed the weekend off. There is no reason why they could not work staggered shifts to allow the A&R to be open 24.7.
“I got to my feet to protest and as soon as they had pronounced sentence ,Cllr Liam Johnston protested loudly about the weekend option announcement to which they the Trust didn’t answer.
“To cap it all I stood there and told the Trust members to their face that it was not emotion that the people of our district are feeling… it is rather expectation of a fully operational Downe Hopsital delivering services to all the people from all arts and parts, and no matter how they glossed it all up , the Trust had lost all credibility in the eyes of the people and they should do the decent thing and resign!
“I staged a walkout along with all the elected representatives that were present. This was a day of infamy. What we all learnt and heard was this is what the Trust has in store for the Downe Hospital.
“Our Message is a simple one we are all united in thos to teh very end. HANDS OFF OUR DOWNE HOSPITAL!
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Councillor Patrick Clarke Writes To Health Minister
Councillor Clarke, who could not attend the Biard meeting, supported teh health campaigners and said: “I wrote to Minister Edin Poots in late december and his reply to me indicated that he is supportive. It begs the question of whether the Trust will take head of the Minister’s recommendations and actions.
Mr Poots wrote (a section of the letter):
“I want to make it very clear that I am profoundly disappointed that the South Eastern HSC Trust found it necessary to temporarily reduce the opening hours at the Downe and Lagan Valley Emergency departments. I recognise that in the circumstances, where sufficient doctors are not available to find all the necessary shifts at both sites, the change was unavoidable. However, I have challenged the Trust, the HSC Board and the Department as to why this has proved necessary, particularly during the winter period. Consequently, I have asked for several key actions to be taken.
Firstly, that all appropriate and feasible steps are taken to ensure that the consequences of these changes are managed in a way that minimises the risk of unmanageable pressures on the emergency departments at the Ulster, Royal Victoria and other affected hospitals… so that patient safety and the quality of the patient experience is not compromised. The Trust and the HSC Board have assured me that the numbers of attendances and admissions likely to arise at other sites will be manageable.
Secondly, that the HSC Board and the Ttust accelerates the work to develop and implement the new model of care at the Lagan Valley Hospital which will enable many of those affected by these changes in the short term to resume receiving services locally. Alongside this, the work to sustain the model of care in place at the Downe will be no less important.
Thirdly, that fresh efforts are made to secure medical staffing for both sides.
Fourthly, I am requiring the HSC Board and the Trust to bring forward a detailed plan for the future of the Downe and the Lagan Valley Hospitals with an implementation plan to secure confidence in the community that the best possible steps are being taken.”
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