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Thursday, July 30, 2009

Wexford General Hospital, Monaghan for the next decade

Following the decision to take Monaghan off call and complete the downgrading process, HSE network management probably feels that at last the monkey is off their back and if they can pull off the retreat from Monaghan then anywhere; Ennis, Nenagh, Mallow, Bantry or Wexford is on for downgrading. Somehow I don’t think so. The people of Monaghan have been successfully ignored by the HSE. The connection between the community and care is gone, if you’re sick in Monaghan the reality is that you should go to either Cavan or Drogheda and join the queues in those counties. Now that might please many people if they knew that there were no queues and no trolleys there but the reality is different.
The old health boards were lambasted because of political representations interfering with clinical decisions and best practise but now it seems they were only interfering with economies of scale. In time communities will reflect benevolently on the days when the local councillor could raise the local issue of health care in a local forum. Now it’s no more. When I have a question about health I usually pass it on to Brendan Howlin who’ll then ask a question to Minister Mary Harney who’ll refer it on to the HSE political section responding that the question is not longer a matter for the Dept of Health and Children but the HSE. The HSE will parrot back to confirm the personal details and then set out the theoretical path along which the patient should follow and state that global position of the HSE in relation to the medical problem and in the end the patient is no closer to being dealt with. So after all the paper moving from councillor to deputy to Minister to Agency nothing is achieved and no one is treated.

Wexford General Hospital was officially opened 17 years ago, by Albert Reynolds, during a General Election. It is a modern 2 storey building that replaced a 19th century county hospital. Opening it during a campaign was an overt sign that FF accepted the political importance of medicine a few years after their then leader Charlie Haughey said he couldn’t know how much health cuts had hit despite being elected of the back of a campaign saying health cuts hit the old the sick and the handicapped. Everything that has happened at the hospital has to be seen in a political context. Be it cancer care or a CAT scanner, the money was raised in the county and the HSE was reluctant to put up their own cash.

The campaign for 19 beds was conceded in the run in to the 2007 General Election, the failure of the manager to meet with Wexford Borough Councillors before the Local Elections amid an application to build an extension to triple Waterford’s A&E capacity as well as the decision to set up a consultative group to evaluate the proposal to consolidate health care in the south east around a centre of excellence which is HSE speak for Waterford.
I’ve always seen the hospital as a general hospital, ie they don’t specialise but refer you on to a specialist team who’ll deal directly with the problem. So if you have a serious head injury they bring you on to Beaumont. If you need serious surgery then expect it to be done in Dublin or Cork where teams specialise and recuperate in Wexford. That’s the way it’s been but now with A&E to close, the hospital will become a centre for minor elective surgery, maternity, paediatrics while the future of acute wards will certainly hang in the balance. Coronary care and intensive care generally rely on A & E for a throughput. So what will happen there?
Wexford A&E has each year about 30,000 cases many of whom are admitted. It’s a very busy department taking admissions from throughout the county. What the move to Waterford will mean is an increase in spending on new ambulances and EMT personnel. I’ve been told by a senior member of staff in WGH that a medic there has evaluated death rate against distance based on Australian figures he can source and he forecasts an increase of 8% in deaths. Clonmel, Kilkenny and Wexford will all lose their A&E’s if the HSE get their way and it’s a case of driving across Waterford presumably on the new by-pass when it opens next year and join Mary Harney’s queue there. The network management plan will be wheeled out later this year by an anonymous group who won’t consult with local political reps. In the background is the spectre of Swine Flu and what happens now in a hospital with low staff morale where swine flu coincides with winter vomitting bug? Expect the worse and stay healthy.

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