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We must be honest about what our hospitals can do

'SHAME on you, Stephen Donnelly," the man shouted, on Arklow's main street last Friday. The next day, in Bray, a driver stopped his car in the middle of the road to dish out more of the same.

I don't blame them. They were referring to my support for changes to the emergency department at St Colmcille's Hospital in Loughlinstown. They, and the others who had protested outside the hospital earlier that day, were angry. And they were right to be angry.

In an act of extraordinary incompetence, the HSE had effectively announced the downgrading of emergency departments across the country by way of an appendix to a report that had slowly found its way into the media.

These plans were not communicated as part of a comprehensive plan to provide better healthcare. They were not communicated to the people's public representatives. No context was provided. No explanation of the improvements intended for Loughlinstown accompanied them.

The result? Many people in Wicklow now believe that the 21,000 people who present at Loughlinstown's emergency department annually will be dumped into an already creaking A&E department at St Vincent's Hospital.

They believe that they and their families are now at greater risk because, in an emergency, they will have to travel an extra seven miles for emergency care.

The truth is that the proposed changes will affect no more than half of those who currently present at Loughlinstown. The truth is that these people should already be going to St Vincent's, where they would have a better chance of survival and recovery. The truth is that the full-service emergency department in Loughlinstown should probably have been shut down years ago: one senior clinician at Loughlinstown told me there was unanimous agreement that it should be closed down.

The money should then be reinvested in increasing capacity at St Vincent's, expanding ambulance cover and making Loughlinstown the best 'Level 2' hospital in Ireland.

Sceptics might say this is all palaver to justify a "closure" that is the result of a cuts agenda. I'm not naive about this agenda -- I spent much of last week campaigning against the egregious cuts to special needs assistants. But, unfortunately, money would not solve the problem.

Let's take two of the most serious scenarios for A&Es: heart attacks and strokes. According to a 2006 report from the NHS in Britain ('Mending Hearts and Brains'), emergency treatment in these cases needs to be delivered "on a 24-hours-a-day, seven-days-a-week immediate access basis", in settings with sophisticated facilities and by a "wide range of highly skilled professionals".

They conclude: "This means concentrating services in centres of excellence rather than spreading staff, skills and equipment over too many sites."

For this very reason, bypass protocols are being developed so that ambulances will take heart attack and stroke cases straight to St Vincent's. The paramedics do this routinely anyway. A bypass protocol has been in place for heavy trauma for years now.

Why is this? If you present at an emergency department with a serious, complex problem, you want to encounter the following two-step process. First, the emergency department must be able to assess and stabilise you. Second, the other specialties in the hospital must be able to treat you.

Take the example of a crushed leg: the emergency team will stabilise you, ensuring you don't bleed to death. But it is the orthopaedic team who will try to save your leg. In a heart attack, the emergency team will assess you and resuscitate you, if necessary. But it is the cardiology team who will perform the angioplasty.

Loughlinstown has challenges in both of these areas. First, due to the relatively low volume of complex cases it sees, the accident and emergency teams there simply cannot gain the level of experience of teams in St Vincent's.

Second, the hospital cannot maintain the wide variety of specialist teams and equipment needed for the subsequent treatment.

So, what can be done? Here is what the experts are saying. Turn the nominally full-service emergency department at Loughlinstown into a first-class minor injuries unit. This will free up resources. Use these to increase capacity at St Vincent's, and to bring additional services to Loughlinstown: stroke and orthopaedic rehab units, and an expanded range of outpatient and elective inpatient services.

In short, we need to create a joined-up plan for healthcare in Wicklow that will save lives and provide high-quality treatment and care.

With the right leadership, this can be achieved. But that leadership is badly lacking. Eamon Gilmore's response last week was, in my opinion, appalling. He must have spoken to many of the same experts as I have. As a long-standing local TD, he should have been doing so for years. He knows, or should know, that keeping a full-service emergency department at Loughlinstown is, at best, an irresponsible use of resources; at worst, it may be costing people their lives.

Yet, last week, he refused to endorse the change to the A&E service -- even as the Government's backbenchers in Wicklow/East Carlow and Dun Laoghaire-Rathdown rowed in behind it.

Instead of communicating the reasons for the proposed changes, he has allowed fear and anger to spread through the community.

The path forward is clear: between now and November, the HSE must put in place a clear plan for the reconfiguration of health services in south Dublin and Wicklow.

This must be led by the clinical community, or it will never see the light of day. Then, they must set about consulting and communicating it -- with the public representatives, and with the communities directly.

After the unseemly failures of previous policy and obsolete politics, this process should have two key outcomes. Most immediately, and urgently, a comprehensive strategy for healthcare and emergency medicine in Wicklow and east Carlow, and south Dublin, based on facts and needs, rather than tradition.

The other outcome is less immediate, and less local: a new model for politics in Ireland, based on frank confrontation of the evidence and honest communication with the people. Until we, as politicians, provide that, shame on us all.

Stephen Donnelly is Independent TD for Wicklow

Sunday Independent