The country’s second busiest hospital emergency department will be forced to close at night from July 11, the medical board of the hospital has warned.
The above is the first line of an article in yesterdays edition of the Sunday Business Post. It’s shocking for more reasons than one.
Let me draw you a time-line (and this is done from my personal perspective although it applies to over 300,000 people in total). Until the 6th of April 2009 anyone living in both North & South Tipperary could avail of around the clock A&E services provided in Nenagh Hospital. However that service was withdrawn by the HSE between the hours of 8pm – 8am. Outside of 8am – 8pm people in need of URGENT medical care had to travel to Limerick Regional Hospital. The HSE had promised that the facilities at Limerick Regional would be extended to cope with the extra demand but to date, 2 years on, this has not happened. At the same time similar A&E services in Ennis, Co. Clare were also withdrawn. in simple numbers this mean that the A&E department in Limerick Regional from that day onward had to provide services to 260,194 extra people (according to 2006 CSO figures). Without any significant extra resources or facilities.
Now, just over 2 year later the decision has been made by the HSE to close the A&E facility in Limerick Regional Hospital between the hours of 8pm – 8am. Why one might ask?
Dr Sandy Fraser, chairman of the medical board, said patients would have to be diverted from Limerick to Cork and Galway between 8pm and 8am due to the chronic shortage of non-consultant hospital doctors (NCHD) who are due to take up new contracts in July.
Fraser said it would be impossible to run the emergency department as the HSE had recruited just 40 per cent of NCHD posts required to man the department.
So in the 2 years since the workload on Limericks Regional A&E facility was increased by 50% their manpower has decreased by 40%. Do the maths yourself…
We have repeatedly warned the HSE of the serious problems we face. Large volumes of medical and surgical work are going to have to be curtailed and this will all have a direct impact on patient care and patient safety.
HSE central recruitment imposed this against all expert advice, and the impact of reconfiguration has decimated the numbers of doctors willing and able to work here,” he said. Fraser said it would not be possible to have medical and surgical teams pick up the flak as they were severely understaffed.
As outlined above people living in North Tipperary, South Tipperary, Clare & Limerick will have to travel to either Cork or Galway hospital for A&E care. So what does that mean in real terms? Let’s take the example of myself; say I suffered a heart attack in the comfort of my own home. Up to early April 2009 I could be treated in Nenagh A&E which was a mere 20 minutes away. Since then I had to be transported to Limerick Regional which would take around an hour. When the new closure comes into force I would have to be transported to either Galway University Hospital (1.5 hrs away) or Cork General (2.45 minutes). A rough estimation would lead to conclude that my chances of survival would reduce significantly. The “Golden Hour” standard is widely recognised in emergency medicine; this rule outlines that patient in need of urgent medical care have a substantial higher rate of survival if treated within 60 minutes of “receiving” the injury. Once outside these first 60 minutes the survival rate drops significantly as time goes along. So if I was transported to Galway University hospital it would extend my travel time alone to outside the golden hour. Combine that with the additional waiting time in Galway Hospital where the workload has suddenly increased by roughly 75% and my survival chances are passing slim and coming close to none. I am not even mentioning travelling to Cork General as it would take over 2 hours to get there.
The HSE and the Irish government are fully aware of these statistics. And they don’t care. We live in a country run by bean-counters (also known as accountants) only concerned with the bottom line. This would be fine if that logic was applied in a commercial environment but we’re talking about a healthcare environment here were an acceptable standard of care should have priority over the bottom line. Hospital accountants would have to be subordinate to the medical professionals. The current policies have led to environment where it is cheaper to let people die before they reach a care facility. And that, my friends, is a very worrying development…..
Update 22/06: Now that the news of this closure is leaking out the various politicians are scrambling to release statements denying that it will happen. A spokesperson for Min. Noonan stated that he: “was aware of the speculation relating to the A&E department at the Regional Hospital and the upset it has caused. Before his trip to Luxembourg he got assurances from James Reilly that there will be no evening closures and there is no threat to services in A&E at the hospital”. That doesn’t explain how the A&E services in Limerick Regional Hospital will be able to cope with their workload seeing that they only have 21 of the required 29 junior doctor posts filled amongst others (that’s a 33% understaffing). considering the already excessively long hours that junior doctors work this is creating an timebomb…