When is a joke not a joke and when A&E is sidelined

This week’s Wexford People leads with a comment that John Browne TD made at the Rally in support of Wexford General Hospital last Sunday night. As part of his address to 1,000 people, including myself who had gathered in Whites Hotel, Deputy Browne told us that his daughter who’s in a wheelchair and is 23 asked him to oppose cutting back opening hours at Wexford’s A&E because he claimed she needed it when drunk and that she didn’t want to stop drinking.
It’s a shame that the meeting’s purpose has been diverted by such a remark because people turned out on an autumn evening to listen to politicians, a consultant, nurses, EMT’s and staff set out their concerns about the future of Accident and Emergency at Wexford General Hospital. Our deputy, Brendan Howlin had worked hard to promote the meeting for some time and has tenaciously highlighted how the hospital is being run primarily by accountants rather than doctors. His website contains a petition and if you follow the supplied link you can sign the petition and add your name to the list of those opposed to any downgrading of our generla hospital.

Lets get to the point of the meeting, Dr Colm Quigley succinctly set out what the HSE network group are looking at in terms of re-configuration of services. He set out which services had been transferred to ensure a better service to the county and what he felt he needed to ensure acute services and A&E could continue to be delivered better at Wexford General. Nobody demurred from the theme of the meeting. If anything the meeting could have gone on for longer as the chairman brought down the curtain with a motion committing to re-meet when the network report is published. I had the chance at the end of the meeting to talk with Dr Quigley and ask if the ambulance service was capable of delivering a service to Co Wexford in the context of A&E moving to Waterford and as to whether the EMT’s were available to crew ambulances. His reply was one that gave me a sense of both the betrayal and frustration that is obvious in some consultants at middle size hospitals such as Sligo or Wexford at present.
I don’t accept John Browne’s explanation of the comments as joke, no more than I think Tommy Tiernan’s Anti-Jewish remarks at Electric Picnic were funny. Both Tiernan and Browne have effectively highjacked a serious issue for the purpose of self promotion. Families of politicians are effectively off limits in the context of political attacks, but how does one respond when a politician humiliates a member of his family as a means of self-promotion. As I listened to John speak, I could barely believe what I was hearing. What John said was gormless, crass and in bad taste. It is telling that he believes most 23 year olds interaction with A&E is to deal with excessive alcohol consumption. Last year I attended a conference where Senator Phil Prendergast set out how medical staff in A&E’s feel threatened by violence from people with excessive alcohol. It’s no laughing matter, I can tell you. He doesn’t need to explain himself to the people of Wexford however and most of important of all, he needs to apologise to his daughter

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.

The dreaded E Word, Is Election ‘08 likely?

Given the convulsion sweeping through the government after their decision to withdraw the medical cards for over 70’s, is it possible that we could be sleepwalking towards another General Election? It is unbelievable that broken promises form Election 02 are still tripping up this government.

I wonder about the possibility because with one seat vacant due to the death of Seamus Brennan, now a resignation by first time TD, Joe Behan, the incorporation of the PD’s into the FF fold now numerically brings Fianna Fail back to where they originally were numberswise. The reality that Finian McGrath and Michael Lowry are now semi-detached on the issue too leaves the Green Party playing the role which Michael McDowell played in Election ’07, will they jump won’t they jump and if so who cares? Under our law if a government falls on a budgetary measure it must resign. True Jackie Healy Rae remains on board but if the combined opposition were to vote in favour of the Fine Gael motion on medical cards there would surely follow a confidence motion. What then? A rearrangement or election? In the 80's Garret Fitzgerald fell from office when Jim Kemmy refused to back a budget plan to put VAT on shoes. This lead to the disastrous GUBU government

The Green Party’s credibility on this issue has been damaged because they are seen responding to FF back bencher pressure rather than concerns that they raised themselves in the run up to the budget. In every coalition there arrives a crunch issue for the smaller party when they stare into the abyss, For Dick Spring it was food subsidies and Reynolds passport’s for sale, for O’Malley being called a liar, for McDowell it was Ahern’s finances and for the Greens it’s the grey’s. How you handle this in the eyes of the electorate dictates your standing for the rest of that Dail.

The recent past showed how McDowell’s party imploded when he wanted to pull out during the campaign. This is surely weighing heavily on the minds of the greens as they appeal very much to middle class voters slightly younger than those who followed McDowell. As Labour found out in 1997 the middle class can be very unforgiving when it comes to crucial issues. I don’t think they’ve changed and indeed if anything the rapid changes in society show there are now many more out there in the long grass waiting as the middle class is significantly bigger than in the 90’s.

As Jackie Healy Rae once said when he threatened to walk out on FF, it may be time soon to get the bicycle clips! One way or another we're facing a fascinating week, if the government gets through it intact some one will have to back down. I'll cast my eye over the budget next week but in the meantime discuss and vote above!