27 February 2003 Edition
Brown cuts the gain and piles on the pain
At last, an announcement has been made about the reform of the hospital services in the Six Counties. NIO Health Minister Des Brown made his decisions on Monday following a final round of consultation.
Just as all were agreed that hard decisions needed to be made to ensure the survival of hospital services outside the metropolitan areas, all were also agreed that great sensitivity and fairness was required in taking those decisions. Little sensitivity or indeed fairness was shown by Minister Brown, however.
One of the most innovative aspects of the Developing Better Services proposals was that relating to maternity care. It was proposed that stand-alone midwife-led units should be piloted in two hospitals and, if successful, be expanded out to other hospitals. This proposal meant that women would have greater choice in the way that their childbirth would be managed; it provided an alternative to medical-led services that tend to see pregnancy as an illness rather than a natural process; and it gave women the opportunity to have their child in their local hospital.
Unfortunately, Minister Brown, perhaps responding to the obstetric lobby, which saw its monopoly of control over childbirth being challenged, decided to fudge the issue and take the units out of the package. In the absence of midwife-led units, local hospitals will not be able to have maternity units on their sites, and women will have to travel to acute hospitals to give birth.
Local hospitals west of the Bann were further hit by the Minister's decision to site the promised protected elective surgery unit in the new Enniskillen acute hospital, rather than one of the hospitals designated as local. This decision displayed little regard for the sensitivities relating to reform of hospital services west of the Bann, in that it stripped local hospitals of services that they would be perfectly able to provide and concentrated services to a far greater degree than was necessary. It disregarded Bairbre de Brún's plan to balance the acute hospital with an enhanced local hospital, thus ensuring a reasonable spread of facilities while concentrating the areas that needed to be concentrated.
There was also little sensitivity in the way that Des Brown dealt with the decision of where to site the second west of the Bann hospital. Much of the debate centred on travel times. The original decision in favour of Enniskillen had been made by Bairbre de Brún on the grounds that a significant population south of the lakes in Fermanagh would have to travel for longer than an hour to get to an acute hospital in Omagh. However, Minister de Brún put great efforts into bringing the 26 Counties' health service into the equation. By the time we got to Des Brown, all of those efforts seemed to have been forgotten, and we were back into the old partitionist mould. He had the gall to talk about 'use of hospitals in Ireland' for people living in Fermanagh - where on earth does he believe Fermanagh to be located?
Rather than attempting to seek clarification of Minister Mícheál Martin's written commitments for 26-County border hospitals to deal with northern patients, he decided to use the caveats contained in those commitments to take Cavan and Sligo out of the equation. Regardless of whether their inclusion would have meant a change in the location decision, it is a disgrace that in the wake of the Good Friday Agreement, a British Minister running part of the health service in Ireland should still look on the Six Counties as if it was an island on its own in the middle of the Atlantic.
Finally, it became clear after the announcement that the commitment to fund the reforms was not as solid as was first thought and that it is envisaged that considerable amounts of private involvement will be encouraged. This route to funding would be a disaster. It would burden future administrations with huge debts to service, it would undermine democratic control over health services, and it would mean that taxpayers' money would be going to make profits for private companies, rather than into much needed services.
The reforms should be funded in full, and they should be funded now. There is no time to waste in constructing a health service that we can be proud of.
Sinn Féin Assembly chief whip Sue Ramsey has expressed disappointment that Health Minster Des Browne has fudged key decisions on the future of maternity services.
"On the ground there is widespread support for midwife-led maternity units," she pointed out. "Des Browne has missed the opportunity to build on the momentum for modernising our health services by putting in place a number of pilot projects. We are already playing catch up in the development of such units and by postponing a commitment to midwife-led units, my concern is that Des Browne has caved in to the consultant lobby.
"It is also a matter of serious disappointment that Des Browne has put off, yet again, the long overdue announcement of the location for the new maternity hospital.
"We have been waiting for seven years for a decision of where to site it. The last decision in favour of Belfast's Royal Victoria Hospital was blocked by supporters of the City Hospital, this pushed back a start date on a new hospital even further. It is time that the Jubilee campaigners stood back at looked at the two cases based on merit alone as opposed to securing services for themselves.
"The RVH represents the best site for the new maternity hospital - clinical evidence backs the Royal and the proximity of the Children's Hospital on the Royal site should also be a decisive. Evidence of the development of community midwifery services in West Belfast also points to the dynamic team in charge at the Royal being best placed to push such a vital developments forward.
"This decision is long overdue. We need to make a start on a new regional maternity hospital and make a decision that is in the best interests of both expectant parents and newborn babies."
Just as all were agreed that hard decisions needed to be made to ensure the survival of hospital services outside the metropolitan areas, all were also agreed that great sensitivity and fairness was required in taking those decisions. Little sensitivity or indeed fairness was shown by Minister Brown, however.
One of the most innovative aspects of the Developing Better Services proposals was that relating to maternity care. It was proposed that stand-alone midwife-led units should be piloted in two hospitals and, if successful, be expanded out to other hospitals. This proposal meant that women would have greater choice in the way that their childbirth would be managed; it provided an alternative to medical-led services that tend to see pregnancy as an illness rather than a natural process; and it gave women the opportunity to have their child in their local hospital.
Unfortunately, Minister Brown, perhaps responding to the obstetric lobby, which saw its monopoly of control over childbirth being challenged, decided to fudge the issue and take the units out of the package. In the absence of midwife-led units, local hospitals will not be able to have maternity units on their sites, and women will have to travel to acute hospitals to give birth.
Local hospitals west of the Bann were further hit by the Minister's decision to site the promised protected elective surgery unit in the new Enniskillen acute hospital, rather than one of the hospitals designated as local. This decision displayed little regard for the sensitivities relating to reform of hospital services west of the Bann, in that it stripped local hospitals of services that they would be perfectly able to provide and concentrated services to a far greater degree than was necessary. It disregarded Bairbre de Brún's plan to balance the acute hospital with an enhanced local hospital, thus ensuring a reasonable spread of facilities while concentrating the areas that needed to be concentrated.
There was also little sensitivity in the way that Des Brown dealt with the decision of where to site the second west of the Bann hospital. Much of the debate centred on travel times. The original decision in favour of Enniskillen had been made by Bairbre de Brún on the grounds that a significant population south of the lakes in Fermanagh would have to travel for longer than an hour to get to an acute hospital in Omagh. However, Minister de Brún put great efforts into bringing the 26 Counties' health service into the equation. By the time we got to Des Brown, all of those efforts seemed to have been forgotten, and we were back into the old partitionist mould. He had the gall to talk about 'use of hospitals in Ireland' for people living in Fermanagh - where on earth does he believe Fermanagh to be located?
Rather than attempting to seek clarification of Minister Mícheál Martin's written commitments for 26-County border hospitals to deal with northern patients, he decided to use the caveats contained in those commitments to take Cavan and Sligo out of the equation. Regardless of whether their inclusion would have meant a change in the location decision, it is a disgrace that in the wake of the Good Friday Agreement, a British Minister running part of the health service in Ireland should still look on the Six Counties as if it was an island on its own in the middle of the Atlantic.
Finally, it became clear after the announcement that the commitment to fund the reforms was not as solid as was first thought and that it is envisaged that considerable amounts of private involvement will be encouraged. This route to funding would be a disaster. It would burden future administrations with huge debts to service, it would undermine democratic control over health services, and it would mean that taxpayers' money would be going to make profits for private companies, rather than into much needed services.
The reforms should be funded in full, and they should be funded now. There is no time to waste in constructing a health service that we can be proud of.
Disappointment as minster fudges maternity
Sinn Féin Assembly chief whip Sue Ramsey has expressed disappointment that Health Minster Des Browne has fudged key decisions on the future of maternity services.
"On the ground there is widespread support for midwife-led maternity units," she pointed out. "Des Browne has missed the opportunity to build on the momentum for modernising our health services by putting in place a number of pilot projects. We are already playing catch up in the development of such units and by postponing a commitment to midwife-led units, my concern is that Des Browne has caved in to the consultant lobby.
"It is also a matter of serious disappointment that Des Browne has put off, yet again, the long overdue announcement of the location for the new maternity hospital.
"We have been waiting for seven years for a decision of where to site it. The last decision in favour of Belfast's Royal Victoria Hospital was blocked by supporters of the City Hospital, this pushed back a start date on a new hospital even further. It is time that the Jubilee campaigners stood back at looked at the two cases based on merit alone as opposed to securing services for themselves.
"The RVH represents the best site for the new maternity hospital - clinical evidence backs the Royal and the proximity of the Children's Hospital on the Royal site should also be a decisive. Evidence of the development of community midwifery services in West Belfast also points to the dynamic team in charge at the Royal being best placed to push such a vital developments forward.
"This decision is long overdue. We need to make a start on a new regional maternity hospital and make a decision that is in the best interests of both expectant parents and newborn babies."