Rural health services under attack

The Bengoa reform is only the latest attempts to dismantle, rationalise and therefore privatise the NHS in Northern Ireland. The report – which has the agreement of all parties in the Executive – provides a blueprint for services to be withdrawn from rural areas and opens the path for ever greater encroachment by private operators in every aspect of health and social care.

The outworkings of this are to be seen in the growing role of the private agencies who are being paid hundreds of millions every year to deliver staffing – money that could easily fund a fair pay deal for NHS workers sufficient to bring back workers and end the staffing crisis.

But the staffing crisis that results undermines the delivery of services – most especially in rural areas where staffing retention and recruitment are most challenging – and this provides the grounds for Stormont decisions to cut services claiming that staffing levels are unsafe. Of course, those dependent on these fast-disappearing services find themselves forced to pay for alternative treatments – normalising the concept of paid medicine and undermining the ethos of the ‘free at the point of delivery’ NHS.

In recent weeks announcements threatening the acute status at South West Acute Hospital in Enniskillen and Daisy Hill hospital in Newry have been made by the respective trusts.

Neonatal in Enniskillen effectively closed

Working alongside local journalists and acting on information from concerned NHS workers and patients, I forced the Western Health and Social Care Trust (WHSCT) to admit that the neonatal unit in SWAH had effectively been closed due to staffing pressures.

It should be stated that these staff pressures do not relate to Covid but a long-term failure to plan for retirements upcoming and to retain staff. In correspondence with the WHSCT Chief Executive I repeatedly highlighted obstacles to recruitment and challenges impacting retention but no action was ever taken on any of the points raised.

The unit has faced a threat of closure previously – and despite calls by campaigners had been limited to accepting babies only after 34 weeks (with younger babies going elsewhere) – but until recent weeks it been able to offer six cots. Today, the unit has only two cots and these are only for stabilisation before babies are dispatched elsewhere.

The impact of this closure on the care offered to premature and sick babies born in SWAH is obvious – so too is the heavyweight impact it places upon mothers and families forced to travel long distances to see their newborn. What is worse, it has now been confirmed – again as a result of efforts by myself – that babies born in SWAH are being distributed to a range of hospitals – including as far as Dublin.

What is possibly less obvious is the impact that this will have on SWAH’s wider acute status. Expectant mothers who might go into labour prematurely will be much less likely to head to Enniskillen if there would be any way to travel to Craigavon or Altnagelvin instead. This will undoubtedly reduce the numbers of births at SWAH – making it even more difficult to sustain the numbers of babies needed for staff to meet their professional experience requirements.

What is possibly more serious is that the absence of a neonatal unit will raise immediate safeguarding concerns for the maternity unit at SWAH. If a full-term baby is born seriously sick, if there is not the neonatal provision there to stabilise them, then it will simply not be safe to keep open the maternity ward.

Without a maternity ward, the hopes of sustaining Anaesthetics or Surgical at SWAH will be diminished – and with that the hospitals’ A&E service. The acute in South West Acute Hospital will be meaningless.

Emergency surgery to be closed at Newry

A second heavy blow to rural hospital access was delivered at Newry where the Southern Health and Social Care Trust (SHSCT) announced that it planned to end emergency surgery at the hospital due to staffing pressures. There is now only one remaining consultant and they are likely to retire in the coming period.

This situation has been heavily influenced by the decision of the SHSCT to downgrade the Intensive Care Unit (ICU) at Newry to a High Dependency Unit (HDU). The decision severely limits the ability of surgeons to conduct procedures for patients suffering from cancer – and as such severely limits the range of operations that a surgeon based at Newry can perform and therefore lowers the attractiveness of the position to incoming surgeons.

Unlike the decision in Enniskillen, which is as yet only temporary, the decision at Newry is due to go to public consultation before it becoming permanent. The loss of emergency surgery at Daisy Hill will effectively mean that the emergency department will only be a stabilisation centre before injured are send onwards.

Such an outcome very obviously threatens the retention of Anaethetics, Maternity and Stroke departments at Newry. Again, the sustainability of all these services are interlinked – once one domino falls the rest will inevitably fall.

The impact of health service rationing

In the case of Newry, emergency cases in the likes of Kilkeel will now be forced to travel all the way to Craigavon or Belfast – more than an hour’s drive in blue light conditions. The golden hour – the critical timeframe for lives to be saved – is increasingly becoming a thing of the past.

In Fermanagh, the situation is even worse. A mother expecting in Garrison or Belleek faces the prospect of at least a two-hour drive to Craigavon or Altnagelvin. How many lives will be lost along the way?

Rationing amid austerity

The situation is compounded by the fact that in both cases, in Craigavon and Altnagelvin, the services to which service users are being directed are also struggling to cope. With an earlier wave of closures – including Dungannon and Omagh Maternity, these services are already overwhelmed. Now they will be expected to deal with even more patients from SWAH and Daisy Hill.

There is a very genuine risk that we may end up with even these hospitals being closed and all patients having to travel to Belfast for even basic services. That is already in prospect in parts of Armagh where it is arguably faster to travel direct to Belfast.

Bengoa and privatisation

Of course such rationing of NHS services was always the plan under Bengoa – but it could never be admitted openly by the Stormont politicians. Rather than take responsibility for being seen to close services, they are letting the services collapse under the weight of chronic under-staffing. Of course with a looming election and as per usual the Stormont parties will attempt to pretend that they are the greatest opponents of the outworking of their own decisions!

The legacy of this plan will be largely empty but relatively well-equipped hospitals. Some of which may become glorified care homes offering rehabilitation to those who can’t get care – but others may become centres for private medicine. South West Acute Hospital – built with private-finance, with a room for every bed, and with close access to a private airport – has always looks perfectly set up to one day become a private hospital.

Those who don’t want to travel to Belfast will be able to access care locally – but only if they pay. This model is already working across many areas with GP services with desperate people willing to pay to see a doctor rather than wait to see their local practice. The NHS is being undermined from within.

Organise to fightback and defend our NHS!

The NHS was won by the working-class of Britain on the back of the defeat of fascism. Labour won a landslide promising public services ‘from the cradle to the grave’ and a ‘home fit for heroes’.

While the mouths of GPs had to be ‘filled with gold’ just to get them to accept NHS contracts as private operators, the NHS was transformative from the beginnin. Gone were the times when working-class people died of avoidable causes because their families could not afford the price to see a doctor or pay for a basic medicine; gone were the workhouses. It was a huge achievement by working-class people but it was one subject to continuous attack by right-wingers from the very beginning to today.

As Aneuran Bevan, the father of the NHS said, “it will last as long as there are those with the faith left to fight for it”. The NHS was won through the struggle and success of the trade union movement and their party, Labour.

It can, and must, be defended by everyone of us who cares for basic human dignity. Stormont’s latest attacks can be reversed.

The principle that everyone should have local access to basic health and social care services is one that we must organise and mobilise to deliver. Through campaigns, protests, strikes and the ballot box – we can push the Stormont politicians back and re-build our NHS.