Nenagh & Ennis 24 Hour A&E Services End Tonight

Sierra Oscar

The cutback half of the HSE's reconfiguration plan comes into action tonight, with the closure of 24 hour A&E services in Nenagh & Ennis in favor of centralization to Limerick Regional Hospital.

The HSE's reconfiguration favored a "center of excellence" approach to healthcare in the region, and suggested that a new center of excellence hospital should be built and A&E services should be centralized to this location.

The HSE have decided to just go ahead and close the Ennis & Nenagh A&E services without implementing the full resources that the reconfiguration plan suggested should be implemented.

Expect plenty of controversy surrounding this decision in the coming months.

Ennis and Nenagh to lose 24-hour A&E services

The 24-hour A&E services at Ennis and Nenagh hospitals in Co Clare and Co Tipperary will be withdrawn from tomorrow.

It follows talks at the Labour Relations Commission in Limerick between the HSE and health service unions.

In a joint statement this morning, both sides say the reconfiguration of the Departments of Emergency Medicine in the Mid-West will proceed as planned.

Emergency services will now be centralised at Limerick General Hospital.

cson

Madness, the regional is swamped as it is. I had almost a 10hr wait on a pretty innocuous Tuesday night a few weeks ago.

Sierra Oscar

cson wrote: »

Madness, the regional is swamped as it is. I had almost a 10hr wait on a pretty innocuous Tuesday night a few weeks ago.

I had someone in last weekend went in on Saturday around 6PM and waited till 1AM until a consultant saw him and told him return the following morning.

He returned at 10AM Sunday morning, and was not out until 6PM. Disgraceful, to be honest.

Also, its not very appealing when you have the following stories coming from nurses working in the hospital:

Nurses forced to re-use dirty linen, claims top doctor

NURSES at the Mid- Western Regional Hospital in Limerick frequently have to re-use dirty and stained sheets on hospital beds, it was claimed at a public meeting over the weekend.

shaqmac

I was chatting to a paramedic lately. they are completely unprepared for this.

Bang Bang

And yet again all the promise's made from that useless lump of lard we call our Minister for Health have not been carried through.
How can she show her face in public again after yet another blatant lie. She spoke on TV a short while ago and promised that the Ambulance Service would be equiped and ready with additional crews and vehicles for this, yet we all knew she was just filling the public with pure governmental bullsh1t...

Run_to_da_hills

Bang Bang wrote: »

And yet again all the promise's made from that useless lump of lard we call our Minister for Health ...

ROFL

Bang Bang wrote: »

How can she show her face in public again after yet another blatant lie. She spoke on TV a short while ago and promised that the Ambulance Service would be equipped and ready with additional crews and vehicles for this, yet we all knew she was just filling the public with pure governmental bullsh1t...

I was led to believe that she was to provide a helicopter on stand by to deal with these emergencies?

Sierra Oscar

Run_to_da_hills wrote: »

ROFL
I was led to believe that she was to provide a helicopter on stand by to deal with these emergencies?

Heh, that was rumored and then denied - the only air ambulance in the Munster region is voluntary run. Great eh, considering the massive amount of money the HSE gets from us?:rolleyes:

boomer_ie

Sierra Oscar wrote: »

Heh, that was rumored and then denied - the only air ambulance in the Munster region is voluntary run. Great eh, considering the massive amount of money the HSE gets from us?:rolleyes:

Thats not even operational at the moment so wouldnt be able to help.

DrIndy

The difficulty is the operational issues with a dispersed rural community and lacking access to large, centralised tertiary centres.

The model used in scandinavia and Australia is a helicopter (or even jet plane) retrieval service for people outside of a 1 hour window of hospital access.

There was a lot of talk about HEMS (Helicopter Emergency Medical Service) around the time of the Hanly report and in fairness, centralising services WITH A FULLY EQUIPPED HEMS is actually the way forward rather than a close by A&E and a long transfer to another specialised hospital for treatment.

However, HEMS costs money. Hence it was dropped.
Randomly closing hospitals without a HEMS saves money. Hence it goes ahead.

Who suffers?

easyeason3

The HSE's reconfiguration favored a "center of excellence" approach to healthcare in the region, and suggested that a new center of excellence hospital should be built and A&E services should be centralized to this location.

WTF????

Sierra Oscar

easyeason3 wrote: »

The HSE's reconfiguration favored a "center of excellence" approach to healthcare in the region, and suggested that a new center of excellence hospital should be built and A&E services should be centralized to this location.

WTF????

Yes, basically a state of the art hospital. The problem is no funding has been allocated. I doubt Brian is going to allocate any money tomorrow either.:rolleyes:

The resources should have been allocated before the A&E units closed in my view.

angelfire9

Well Ennis is gone, i was in there this evening as my OH is currently an inpatient and i went in at 8.05pm and faced a 5 minute questioning from security before i got in the door!
Rumour has it though that Nenagh didn't close tonight!

petergfiffin

I guarantee you that within 12 months one of the new VHI/Hibernian treatment centres which have opened in Dublin will open in Nenagh to provide "a service" to the area. I honestly reckon Harney's plan is to make the health service so bad that people have no choice but to use these private facilities.

As always the HSE/Govt looks at what's done overseas and picks bits and pieces. A Trauma Centre without helicopter backup is useless....doesn't seem to be a shortage of helicopters for ministerial transport though!!!:rolleyes:

Bang Bang

petergfiffin wrote: »

I guarantee you that within 12 months one of the new VHI/Hibernian treatment centres which have opened in Dublin will open in Nenagh to provide "a service" to the area. I honestly reckon Harney's plan is to make the health service so bad that people have no choice but to use these private facilities.

In my opinion these medical centres should be taken to task about their form of advertising because quite a few of their patients end up being ferried to a public A&E by ambulance, but not before they cough up the cash for the consultancy fee and x-rays etc. They then join the long queue in the public hospital, usually disalussioned at what's going on regarding "private fast track emergency departments".....

Paulzx

Bang Bang wrote: »

In my opinion these medical centres should be taken to task about their form of advertising because quite a few of their patients end up being ferried to a public A&E by ambulance, but not before they cough up the cash for the consultancy fee and x-rays etc. They then join the long queue in the public hospital, usually disalussioned at what's going on regarding "private fast track emergency departments".....

Regular problem with the clinics in the Dundrum/Sandyford area. Crews from Rathfarnham Fire Station are there quite often after 999 calls are made from the so called A&E. No doubt the patient is still billed.

Why are they not made provide their own ambo on site? Scarce public resourses are being used to prop up a private for profit medical facility. No one in authority seems to have the balls to take them to task.

Oh. Sure i forgot. The private sector operates everything at maximum efficiency and is something that all us cabbages in the public sector should aspire to:rolleyes:

DrIndy

In fairness - these private A&E's are designed to deal with minor complaints which would ordinarily have to wait 6-8 hours in any other A&E. They do give the opportunity to be quickly sorted out because the current public system is so underfunded.

Every now and then someone well sick who should have called an ambulance and gone in as a category 2 (chest pain and the ECG shows a big MI) into a major A&E turns up and they very swiftly send them on.

ImDave

One idea I was toying with in my head is that could the out of hours GP service, we will say in this case ShannonDoc, carry out surgery from the A&E Department? I live near Nenagh and have used ShannonDoc once or twice over the years. They use the out-patient department of the hospital, which isn't in the best of shape being honest about it. The A&E department in Nenagh underwent a recent refurbishment (within the last two to three years I believe), and it just seems like a waste of valuable resources having a (relatively) modern and well equipped A&E department sitting empty and in the dark, while just out back there is a medic and receptionist operating out of a cold, run down building.

I appreciate that ShannonDoc doesn't offer an 'A&E' service, and many cases would not be suited to ShannonDoc, and all cases are screened by a nurse prior to admission to the service, but it just seems like something could be done to improve overall service by slightly augmenting the structure of the out of hours service.

Sierra Oscar

DrIndy wrote: »

In fairness - these private A&E's are designed to deal with minor complaints which would ordinarily have to wait 6-8 hours in any other A&E. They do give the opportunity to be quickly sorted out because the current public system is so underfunded.

Every now and then someone well sick who should have called an ambulance and gone in as a category 2 (chest pain and the ECG shows a big MI) into a major A&E turns up and they very swiftly send them on.

What private A&E? The Limerick Private Hospital has not even been built yet.

ImDave wrote: »

One idea I was toying with in my head is that could the out of hours GP service, we will say in this case ShannonDoc, carry out surgery from the A&E Department? I live near Nenagh and have used ShannonDoc once or twice over the years. They use the out-patient department of the hospital, which isn't in the best of shape being honest about it. The A&E department in Nenagh underwent a recent refurbishment (within the last two to three years I believe), and it just seems like a waste of valuable resources having a (relatively) modern and well equipped A&E department sitting empty and in the dark, while just out back there is a medic and receptionist operating out of a cold, run down building.

I appreciate that ShannonDoc doesn't offer an 'A&E' service, and many cases would not be suited to ShannonDoc, and all cases are screened by a nurse prior to admission to the service, but it just seems like something could be done to improve overall service by slightly augmenting the structure of the out of hours service.

That would not work though, because A) You do not have the consultants in Shannondoc who need to be present in any A&E unit and GP's are not "qualified" to carry out surgeries.

ImDave

Sierra Oscar wrote: »

That would not work though, because A) You do not have the consultants in Shannondoc who need to be present in any A&E unit and GP's are not "qualified" to carry out surgeries.

I think you misinterpreted what I am saying. What do you mean by 'GP's are not "qualified" to carry out surgeries'? To clarify, I mean surgery simply as the physical location i.e. the doctors surgery.

I'm not suggesting that changes be made to the range of basic treatment offered by ShannonDoc, remembering that ShannonDoc is nothing more than an out of hours GP service. Obviously just because the on-call doc will see patients in the physical A&E department would not mean that you'll have acute MI's etc presenting to the service. I am just suggesting this as the facilities are more comfortable, can handle a larger volume of patients in the waiting area etc.

Tango Alpha 51

Most of the S/Doc centres are of excellent quality. What concerns me more is the fact they routinely ring us looking for ambulances for seriously ill patients & then state that they will not be going out to same. This is night 3 of the closures. Clare have been into Limerick a few times but as of yet Tipp North have yet to come in.

One way in which S/Doc could help is in dealing with minor injury cases ie Suturing/Stiching etc. This in turn would free up the Emergency Department from dealing with these. Also if you look at Limerick Regional, the medical day ward is obviously closed at night. Two or three GP's again in doing the minor injury side of things would again free up resources to deal with the more seriously ill patients that we bring in/self refer to Limerick's Emergency Department

Tango Alpha 51

Sierra Oscar wrote: »

What private A&E? The Limerick Private Hospital has not even been built yet.



That would not work though, because A) You do not have the consultants in Shannondoc who need to be present in any A&E unit and GP's are not "qualified" to carry out surgeries.

S/O,
Can assure you that Consultants are not present in the Emergency Department on any night.

DrIndy

I agree with a lot of what you are saying, but there is no surgery training in the current GP scheme - for medicolegal reasons - surgery requires backup facilities which GP clinics don't have (and that unfortunately includes stitching).

Emergency doctors do the whole shabang - but hiring more of them and emergency nurses would be sensible - so that means the government doesn't do it.

dredre

Suturing should be within the competence of any GP. You don't need to have done surgery to do it. You certainly don't need 'back up'.

dredre

buzzman wrote: »

S/O,
Can assure you that Consultants are not present in the Emergency Department on any night.

There are only three of them. To provide 24 hour cover you would need 10 or 12. Some chance these days!

Sierra Oscar

Listen, Shannon Doc is not all that great as it is made out to be - the GP's who are inside operating it would agree, I can assure you of that. They would rather be able to deal with more cases within the center without having to refer to A&E but lack of resources makes this pretty difficult.

GP's in Shannon Doc do deal with the usual stitching case and the like, however if something messy comes in such as a child with a deep injury to the face requiring a number of stitches then the GP has no choice but to send the patient into the A&E, why? Because the GP has no assistance at all, there are no nurses no nothing - and I will tell you something, you do need that backup. If something goes wrong then the first thing that will be said is that GP should not have carried out surgery on that child because its too risky and he had no support. You do realize that there is only one GP in Shannon Doc during a 6PM to mid-night shift, and no one else?

It is not the GP's job to free up A&E units. This should not have to be the case in the beginning! GP's are responsible for providing a service for their patients at all times including night time, and this is what Shannon Doc does. It is not and should not be a substitute for A&E.

The basic problem here is, the HSE has taken away A&E services in Nenagh & Ennis without implementing the necessary resources in Limerick to be able to cater for the people arriving from the Nenagh & Ennis catchment areas. Why should they be allowed do this? I mean . . . basic common sense would tell you that in the interest of the patient the HSE should implement the resources necessary before making the cuts. This is what their own reconfiguration plan suggests.

Instead they have just made the cuts, leaving the resources to be implemented at a later date.

TheNog

Article on Breakingnews.ie today. Does this seem like the HSE is attempting to justify the closure of Ennis' A&E?

Ennis hospital declared unsafe
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Ennis General Hospital has been declared unsafe according to a new report from the health watchdog HIQA.
09/04/2009 - 13:12:11
Ennis General Hospital has been declared unsafe according to a new report from the health watchdog The Health Information and Quality Authority (HIQA).

The investigation was triggered following serious patient safety concerns having been raised by family members of the late Ann Moriarty and the late Edel Kelly.

The report says that in the interests of patient safety, a number of services at Ennis General should be stopped immediately.

These include acute surgeries including cancer surgery, intensive care services, the 24-hour A&E department, and maternity and paediatric care.

The report says there is a serious lack of accountability at the hospital, with no one person responsible for the quality and safety of patient care.

Dr Tracey Cooper, chief executive of the HIQA, said: "The investigation found that the hospital as it is currently configured is unsafe and will need to change the range and types of services it provides for its patients in order to build a thriving, appropriate and safer future for the community that it serves.

"It is therefore vitally important that the Health Service Executive sets about planning the implementation of all the recommendations contained in this report, in conjunction with staff and local communities.

"Similarly, it is important to ensure that appropriate facilities, resources and staff are in place throughout the Mid-Western Hospital Network to effectively manage these changes safely.”

The investigation also found examples of good non-acute care being provided at the Ennis hospital, also known as the Mid-Western Regional Hospital (MWRH), and a committed ethos from staff, however.

It identified a range of services which could be greatly expanded and enhanced at the Hospital in the future, including diagnostic services, outpatients, day procedures, appropriate medical care, minor injuries and rehabilitation as part of the regional hospital network.

The report went on to highlight a lack of clarity and accountability however, and found that there is no single person at hospital level who is fully accountable for the quality and safety of services.

Diane Whittingham, the chairperson of the Authority’s Investigation Team, said: "What has driven this investigation is a concern for safety and quality, and there are significant opportunities for high quality, appropriate services to be provided at MWRH Ennis in the future.

"To ensure that these services are fit for purpose, the HSE should, as a priority, undertake a review of the effective management, leadership and governance arrangements at Mid-Western Regional Hospital Limerick to ensure that appropriate arrangements are in place to guarantee the effective management and safe implementation of these changes.

"However, it is clear that it is unsafe to keep the current service configuration at MWRH Ennis and the changes recommended in this Report must happen in a safe and effective manner."

The findings of the report are informed by national and international evidence on how high quality services should be provided safely in order to ensure that patients are treated in the right place at the right time by the right professionals.

Dr Alan McKinney, a member of the Authority’s investigation team, said: “International evidence shows that patients with certain conditions obtain safer and better outcomes when they are cared for in specialist centres by clinicians who are dealing with high volumes of work where they can maintain their expertise and provide a full multidisciplinary approach to care.

"In this context, acute services at MWRH Ennis are not sustainable because there are simply not enough patients presenting with acute, complex, or specialist conditions in order for clinicians to adequately maintain their clinical skills and to continue to provide safe care for these patients.

"The investigation team does not believe that additional resources deployed in seeking to sustain acute services at MWRH Ennis would be appropriate as it is ultimately unviable as an acute hospital.”

“The international evidence also shows that there is a move towards providing the maximum level of appropriate and safe services as near as possible to where people live. MWRH Ennis therefore has a future if a range of appropriate services are enhanced there.

"The case for change has to be developed and communicated clearly and effectively to patients, the public and healthcare workers. The Authority will request the Health Service Executive to produce an implementation plan for the efficient, safe and effective implementation of the 65 recommendations contained within the report and we look forward to working with it and all other stakeholders to driver safer services."

Source

Sierra Oscar

TheNog wrote: »

Article on Breakingnews.ie today. Does this seem like the HSE is attempting to justify the closure of Ennis' A&E?



Source

Of course it does - Harney's response:

Minister for Health Mary Harney strongly welcomed the report.

The Minister said: 'This report is very important as it underlines the need for significant change in the way acute hospital services are organised in order to ensure a safe and high quality service for patients.

Perfect time for the report to be released, is it not? Listen - the Minister should commission an Independent report into the Regional in Limerick, and we should get a fair idea how safe things are there. I think it would be fair to say that many of our hospitals are not up to International standards when it comes to patient safety.

Our man in Havana

Did Nenagh close?

Traumadoc

http://www.irishtimes.com/newspaper/ireland/2009/0420/1224245022594.html


Nearly 2hours to get to the A+E in Limerick

Hooch

Traumadoc wrote: »

http://www.irishtimes.com/newspaper/ireland/2009/0420/1224245022594.html


Nearly 2hours to get to the A+E in Limerick

Terrible news.

Its a huge disapointment went you see the government trying to safe money at the cost of someones life.
Although all the ES services are pulling together to try cover these areas, its not fair on the public, the patient or ES members, for ambulance personnell to have to work for anything over an hour in the back of Ambulance trying to reach a Hospital. Its also unfair on AGS, using up resources on longer emergency escorts.

boomer_ie

I am confused, why was the patient transferred from an Ambulance to an Advanced Response Car?

A HSE spokeswoman said the service received a call from Mr McDonnell’s home at 4.20am yesterday, where he was complaining of breathlessness. She said the Kilrush ambulance service took Mr McDonnell to Knockalough Cross five miles from the village of Lissycasey, where he was transferred to an advance response car.

Or is this a case of the papers getting it wrong?

dredre

the latter

timmywex

boomer_ie wrote: »

I am confused, why was the patient transferred from an Ambulance to an Advanced Response Car?



Or is this a case of the papers getting it wrong?

Papers got it wrong, according to the independant, they picked up a paramedic from the advanced car, who i assume they mean was actually an advanced paramedic.

At least theyve gone away from the ambulance driver notion

boomer_ie

timmywex wrote: »

Papers got it wrong, according to the independant, they picked up a paramedic from the advanced car, who i assume they mean was actually an advanced paramedic.

At least theyve gone away from the ambulance driver notion

Yeah just saw a copy of the Indo about 20 minutes ago and it certainly sounded right. At least the family is praising the Ambulance Crews for their hard work and they arent holding the can for the failures of the HSE big wigs.

road_high

I'm very worried this could set a precedent for the rest of the country.
For instance here in the south east we could have St. Lukes, Kilkenny, Wexford and Clonmel all shafted into WRH eventually for A&E.

trellheim

We're still waiting on the revised Service Delivery plan from the HSE

maglite

Can i ask if an AP was with the pt, what benifit would an hospital provide?

Traumadoc

The patient could have had many conditions - that caused his symptoms. such as acute pulmonary oedema. Getting an early diagnosis is critical for the patient.
The HSE spokeswoman said the patient got the same treatment as in a A+E. this shows the dangerous thought processes going on in the HSE.