A crunch meeting was held in the Down District Council chamber on Monday evening 23 December between councillors, MLA’s, MP’s, and the Down Community Health Committee, who listened to South Eastern HSC Trust officials explaining the reasons behind the snap announcement of cuts to the Downe and Lagan Valley A&E departments’ hours on the eve of the Christmas festivities.
Following the presentation by the politicians, who were all deeply concerned, Down District Councillors unanimously agreed that the cuts were “unacceptable”, and voted on a varied course of actions.
Firstly, they agreed to hold meetings with the Health Minister, the Health and Social Care Board, and the South Eastern HSC Trust as soon as possible after the festive holidays.
Secondly, they agreed that the Council Health Committee should meet for a full meeting in early January involving all councillors.
Thirdly, the Council is to explore the possibility of running an open day in Down District and the Downe Hospital in conjunction with the Trust to invite QUB University medical under-graduates to visit the area prior to qualifying.
And lastly, it was also agreed to write to the DEL Minister and ask him to consider raising the number of medical graduates at QUB to 350 from its present 250 to allow for a better provision of junior doctors.
Trust Explains Reasons Why Cuts To Hours Are Necessary at the Downe A&E
A Trust spokesperson said: “The GP Out Of Hours system (GPOOH) takes over currently from 10pm and is operated not by locums, but by a team of highly experienced local GP`s, some former GP Principals and some who still have practices locally. They are not locums and are “all Trust employees of the out of hours service”
“There are two distinct groups of GP`s locally – those who work within the out of hours service (ie providers) and those who do not (and tend effectively via their patients to be consumers of the service)
“We will still be providing a GPOOH service from the Downe at the weekend , so will be left with the consequences of the bulk of the populus locally not being aware of the change, and continuing to attend the hospital expecting a functioning A&E dept.
“The model that has existed to date has allowed us to deal with minor injuries after 10pm.
It would appear certainly at present, we will not have the resources to deal with such cases on Saturday and Sunday during the day , so the enhanced GPOOH service will not exist for that period.”
Trust Press Release: Friday 20 December
“The Trust is experiencing a critical shortage of medical staff in both the Downe and Lagan Valley Emergency Departments and it is reviewing a range of options for continued provision of Emergency Care services with the objective of maintaining the Emergency Departments (ED’s at both sites.
“It is anticipated that a decision will be reached in the next few days. This is a regrettable set of circumstances and the Trust is pursuing every opportunity to minimise service disruption to our patients at this time.”
Check out : http://www.setrust.hscni.net/2624.htm (Latest Trust Public Statement).
Speaking the the meeting with Down District Council, Hugh McCaughey, Trust Chief Executive introduced his team assisting in the presentation and explained: “If we did not take action before January on this very pressing issue around the availability of middle grade doctors, then we may have been looking at the closure of the Downe A&E before January. We do not want to see an unplanned closure. The Downe and Lagan Valey A&E’s are the smallest in Northern Ireland but we are committed to their retention as being part of the Level Two grade hospitals that we have. But across the NHS we are looking at 5o% of training posts unfilled. The position has become more acute in recent weeks. We therefore need to take whatever action we can to prevent a total closure.”
Seamus McGoran, South Eastern HSC Trust Director of Hospital Services, explained the background around the current difficulties. He said: “If we looking at the English model at the provision of Emergency Departments (ED’s) in Northern Ireland, we would be looking at a total of four in the Province altogether. There is just no solutions for this at present. By the end of 2011 we all knew that the bigger hospitals may have to close their ED’s. At the moment we have six middle grade doctors between the Downe and Lagan Valley when we really should have 16 to meet needs. We need a minimum of eight to continue operating.
“We have therefore been heavily reliant on middle grade. The shortage is not of GP locums, but A&E middle grade doctor locums. There is a UK wide crisis in the numbers of sufficiently experienced A&E middle grade doctor numbers to cover shifts. When advertising for these vacant junior doctor positions we are just not getting sufficient replies. The couple of suitable doctors who did apply were typically interested in maintaining their skill levels to be maintained.
“We have therefore experienced acute difficulties in staffing since November 2013. It has really unravelled in recent weeks. There are approximately 55 patients presenting at the Downe A&E on Saturday and Sundays both days. As a result of these changes, we expect a third of patients will go to their GP’s, a third will attend the local Downe ED, and a third will go to ED’s elsewhere. That means we expect aroud 30-40 patients to go to the Ulster Hospital. We can increase the number of beds at the Ulster Hospital to accommodate an increase in admissions. The Northern Ireland Ambulance Service will also put on two extra ambulances. We must take corrective action as best we can.
“At one stage I was just two hours away from closing the Downe A&E during one shift when cover could not be provided. Fortunately this has not yet happened and I do not want to be in the position that this happens in an unplanned way.”
Sean McGovern, Clinical Consultant at the Ulster Hospital, said: “This is a most difficult time for the A&E speciality. There is high demand for doctors.At the moment there are abour 55 consultants in hospitals in Northern Ireland and the biggest challenge for them is working beyond 60 years of age. There is a high rate of burnout in this profession.
“We are locum dependent in Downpatrick. On one month we will need to fill 16 shifts. There are two types of locums. Those who work for extra money and do an extra shift and those who are supplied by agencies. In this latter group we may not know much about the doctor supplied and this increases the level of risk. Some doctors also wait until the last minute and may get a better offer leaving difficulties in filling the shift.
“So we can’t go on like this. The difficulties have been there for a while. Many doctors have gone off to places such as Australia where they get twice the pay and have better infrastructure. We understand that this decision to cut the hours will be emotional but we cannot arrive at a stage when people turn up to the Downe A&E and it has closed due to lack of avialability of doctors. Unplanned closure is not acceptable. We have to consider safety issues.”
The Political Reaction… Anger, Frustration and Dismay
South Down SDLP MP Margaret Ritchie has expressed her disappointment at the news that the opening hours of the accident and emergency unit in the Downe Hospital are to be reduced. She said: “The A&E will shut on Saturday and Sunday from the 4 January and the opening hours during the week will now be from 8am to 8pm instead of 10pm.
“The Trust recommends that those requiring emergency services should go to Dundonald or elsewhere. This is simply not feasible.The Trust says that this reduction in hours is as a result of staffing issues which I warned about in recent weeks. The trust is relying on locums which is not sustainable.
“Local access to local services is of paramount importance and it is totally unacceptable for elderly people to have to lie on trollies or languish on waiting lists. As we head into winter time when people are more vulnerable to accident and illness, this news could not have come at a worse time.
“There must now be direct ministerial intervention to ensure the on-going continuation of services at the Downe Hospital. Admissions to the wards of the Downe must be secured and the doors must be kept open. The people of South Downe fought long and hard over a thirty year period for the new hospital and services. We cannot lose out now.
“The Trust must come forward now with a plan on how to restore the seven day service as a matter of urgency.”
Strangford DUP MP Jim Shannon also speaking at the meeting said: “My constiituency covers the areas Ballynahinch, Killyleagh, Crossgar and Saintfield. Part of the real difficulty of this case is hearing at a very late stage about the difficulties. I recall the excitement when the new Downe Hospital opened and we welcomed all of the services available then. At no stage did we question that these services to the A&E would be reduced.
“Did no-one at the Trust see this problem coming a year ago? Were there not any GP’s outside the UK available? The wages doctors are receiving are acceptible – we need to get back to the basic criteria of when and where these doctors are working and change this. We really need to be thinking out of the box on all of this. Downpatrick is just too far away from the other A&E’s and we really have to consider issues of safety for the people of Down District as a whole.
“And what assurances do we have that the Ulster Hospital can in fact cope with the increase in demand?”
DUP South Down MLA Jim Wells added his contribution to the debate and said: “We all remember the hospital campaign years ago for the new Downe Hospital. I was one of the many who fought for the new hospital. Now we are fighting for the retention of services. We are facing a Province-wide difficulty. Around 2005 we set contracts for these doctors and raised their level of pay and now there are problems with this. It was not built into their contracts that they should have to work in hospitals such as the Downe Hospital. Can you imagine what the Chief Constable would do if an officer said he or she did not want to work in a particular town? The tail is now wagging the dog.
“The reality is that there is not much we can do at the moment. When we break this viscious circle of staff problems then we will make progress. But there are huge planning issues especially round the number of female students taking up medicine and how this translates into available doctors.
“I too did not hear about this particular crisis until Margaret Ritchie mentioned it to me and I am the vice chairman of the Assembly Health Committee.
“I do not believe it is unreasonable that health professionals be asked to work one weekend in four. We must crack this problem.”
Sinn Féin MLA Chris Hazzard has called on the Health Minister Edwin Poots to “act swiftly and decisively so that the on-going crisis in our local A&E’s can be resolved.”
Speaking after Downpatrick meeting in the Council chamber, the South Down MLA said: “Undoubtedly, for some time now we have faced a serious problem regarding the sustainable staffing of Emergency Medicine services. This in turn has created undesirable working conditions for many of our junior doctors who have decided to avoid the opportunity to work in our local A&E’s as they instead chose to emigrate or work elsewhere.
“With these dynamics in mind, the South Eastern HSC Trust have taken the decision to simply treat the symptom by cutting the Emergency Service at the Downe instead of finding ways in which the problem can be tackled at the source ie by successfully addressing the issue of sustainable staffing arrangements.
“Our leaders within the Health system must continue to explore ways in which we can secure the long-term viability of our local hospital services. They must look at ways in which employment terms and conditions can be designed so that our local A&E’s become attractive places of work for our medical staff once again.”
The South Down MLA also said that the Minister should engage with the Minister for Employment and Learning to explore ways in which training and recruitment can be enhanced in future. He added: “We know that the cost of Medical School is fairly expensive, perhaps a scheme can be designed whereby the cost of fees is partially covered if graduates work in our local A&E’s on contract for a number of years before moving on elsewhere – something like this would surely help begin to address the staffing issue.”
SDLP South Down MLA Séan Rogers also speaking at the meeting joined the protest against the Trust’s decision and said: “The Lagan Valley Hospital is not Downpatrick. The Lisburn area is only about ten miles from a number of Emergency Departments. Downpatrick is an hour away and many places in this area are possibly ninety minutes away depending on traffic having to run the gauntlet of the Ballynahinch traffic bottleneck.
“Reasonable access to services is just not going to be possible if sick and injured patients have to travel to the Belfast A&E’s. I really would like to understand why the recruitment advertising is just now working.
“Basically, I want to hear solutions to the problems, not news of cuts to services. The question of the strategic deployment of medical staff has to be answered. And this needs to be settled at an early stage. This is simply now an equality issue. The people of Down District must not be seen as less than the people of the rest of the Province.
‘The MP’s, MLA’s and Council are here to help, but we have not been consulted. If there pressure to meet the hours back in June then we should have been properly informed so that we could take appropriate action. This has not happened.”
Councillors United In Their Support For Retention Of Full Services At The Downe A&E
Cllr Patrick Clarke (Alliance) said: “When I heard the news of the cuts to the A&E hours I spoke to local GP’s who knew nothing what was going on. I find this is insulting and disgraceful. The GP’s are the first line and should have been consulted.”
Cllr Billy Walker (DUP) said: “I am very disppointed with the South Eastern HSC Trust. I can remember in our old council offices that they said they would be working closely with us and would consult regularly. We heard at a committee meeting last week for the first time of these cuts to Downe A&E. Even the Health Minister himself did not know what was going on. This is just treating the people of Down District with contempt.
” I just can’t believe that doctors can pick what hospital they want to serve in. I think we have been sold a pup here.”
Cllr Colin McGrath (SDLP): “On some parts of Down District you are talking of traveling 40 miles to the Ulster Hospital to an A&E. This is just unacceptible. You are just Dr Death. There have been no consultations with anyone and this was announced 2-3 days before you decided to implement it.
“The key issue is that midle grade doctors don’t run the Out of Hours Servicee at night – it is GP’s. Middle grade doctors work during the day. We need more transparency. The Ulster Hospital seems to be getting everything. In fact I believe the Ulster Hospital is outside the Trust area!
“This has just been a bolt out of the blue. It is not acceptable to any of the public representatives. A lot of questions need to be answered.”
Cllr Liam Johnston (Sinn Féin) said: “Why are lives in Down District less valuable than those in the Greater Belfast Area? We have witnessed cuts ro services in the Downe Hospital year in year out.
“I personally would not have made it to the Ulster Hospital I was told by a doctor when I took ill when I was saved by the Down A&E staff. There is a growing perception in Down District that we are just not getting fair treatment here.
“I just cannot understand why the Trust allowed job contracts set back in around 2005 to be so restrictive that doctors can opt out of coming to work in Downpatrick. If the Downe and Lagan Valley are the two smallest ED’s in Northern Ireland then that is surely the fault of the Trust.”
Cllr Terry Andrews (Independent) said: “Tonight’s meeting is one of the most important ever in the history of this Council. The Trust are using staffing issues to proceed with a hidden agenda of slicing off another service at the Downe Hospital. Around £235 million has been spent on the Ulster Hospital to date in developments
“The citizens of two constituencies are now frightful and fearful. We as a Council body have lost faith in the Trust Board and officials. We can no longer trust them. I can say that this recent announcemt is just a part of a litany of broken promises and betrayal.”
Cllr Dessie Patterson (UUP) said: “The South Eastern HSC Trust has a responsibility to serve the people of our area. If I took ill I’d be better phoning the Mourne Mountain Rescue Team I could literally get to Dublin quicker than the hospitals in Belfast. We should also be looking at an air ambulance for the whole of Northern Ireland.”
Cllr Cadogan Enright (Independent) said: “There is clear anger in this Chamber. So many people have said that they would not have made it to Belfast when they were seriously ill. Why does the Trust not liaise with Irish health auhorities in its quest for junior doctors and to restore the situation?
“Is it not about time to reconsider the model of the Ulster Hospital – travelling there is unacceptible for the people of Down District, the Lecale and the Mournes. Why should hospitals not be located outside the Greater Belfast Area?
“Why build the Ulster Hospital in the wrong place? This hospital is not accessible to nor servicing the bulk of the Trust area. In any other enterprise this would be see as illogical.”
The above is only a cross-party summary of reactions to the decision by the South Eastern HSC Trust to cut the hours at the Downe and Lagan Valley ED’s.
The Chairman of the Down Community Health Committee, Mr Eamonn McGrady, the community forum that helped to secure the new Downe Hospital with cross-party support, has said that the DCHC seeks to maintain a cross-party consensus in its approach to addressing this vital issue of cuts to A&E hours for the people of Down District. He added that this position is imperative in maintaining effective services for the Downe Hospital and that movement from this political and community consensus would be challenged.
© Jim Masson / Down News 2013.