GUEST POST

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This is a guest post by Hugh McCloy

Hugh has been a health & family law lobbyist since 2007 involved in groups including Save The Mid, RFFJ and, for a time, F4J. Hugh stood as an Assembly candidate in 2010 for Mid Ulster


The views expressed by Hugh do not necessarily reflect those of LAD

Northern Ireland A&E's have been failing since 2010. This failure has led to compromises in patients safety  and ultimately this has led to the death of some patients who otherwise might have been saved had our politicians and health managers actually acted in the name of patient safety. 

DHSSPS A&E performances show that the acute network in Northern Ireland started showing cracks between Jan-June 2010; this came after the loss of A&E in Mid Ulster, Omagh, Dungannon and Whiteabbey.  Acute hospitals such as Antrim, Criagavon, The Royal & Ulster all failed to meet patients’ needs safely since 2010.  There was evidence of substandard performance, 12 hour trolley waits, ambulances queued up at the doors, nurses and doctors complaining about the working conditions, and patient safety compromised.  Four years later “What Has Changed? Has Performance Got Any Better?” as stated by Health Minister Edwin Poots.

In 2010 Whiteabbey A&E was due to close, followed by Mid Ulster in 2012, but due to the unsafe condition of acute services at Antrim, the Mid Ulster was also closed to try and contain Antrim's problems. Such is the madness of health managers and politicians that the solution to fix the failing Antrim Hospital in 2010, came in the form of closing Mid Ulster A&E and adjoining in-patient ward, 2 years early and before any extra provisions were made at Antrim to cater for more patients.

Circa September 2009 the then CEO of the Northern Health & Local Care Trust, Colm Donaghy, now CEO of the Northern Health & Social Care Trust, was directed by the then Health Minster, Michael McGimpsey, to remove the Mid Ulster A&E, along with that at Whiteabbey.  This decision was then hidden until April 2010 because it might have been detrimental to politicians during the Westminster elections in May 2010.

If patient safety was so compromised why would politicians wait to make changes? Quite simply their election prospects came before patient safety.

(http://savethemid.weebly.com/1/post/2013/12/over-590-patients-waited-over-24-hours-in-ae-in-northern-ireland-jan-sept-2013.html 

In hindsight, we now know that the Mid Ulster closure went against a risk assessment carried out in 2006 by Deloitte Touche.   It stated it was a bigger risk to patients and Antrim Hospital to actually shut the Mid.  As such, the excuses used to shut the Mid Ulster A&E were fabricated; it was not closed because it was unsafe or under staffed, it was closed because Antrim was unsafe and understaffed. (http://savethemid.weebly.com/uploads/7/4/7/7/7477841/stm_briefing_report_tyc_submission_2013.pdf)

Excuses made to shut the Mid Ulster include the same claims used to downgrade Down & Lagan Valley, one being that there are not enough doctors to staff the A&E safely.  There are not enough doctors to staff any A&E in Northern Ireland safely, but are Edwin Poots and the Health Trusts being honest about their failure to attract doctors?

Despite this claim, the Northern Trust stopped recruiting for doctors over a year before they shut the Mid Ulster unit.  Capable and competent doctors had applied for the positions that had been advertised before the recruitment freeze was implemented.   These applicants were not hired and in time, this will most likely prove true for Down & Lagan.

To further rub salt in the wound, the loss of the Mid Ulster Hospital also came at the loss of doctor training posts.  These posts are an important feature in ensuring that our medical staff remain here in Northern Ireland instead of being forced to emigrate to find a training place.  There are not enough training posts available in Northern Ireland for the current number of medical students.  Furthermore these are the very same training positions that the Trust told the public did not exist in their public consultation CSR 2008, carried out during Michael McGimpsey's reign.

We find ourselves now in 2014 with the exact same problems, only hidden in a different way.  In the past weeks since 5th Jan 2014, we have seen 4 acute A&E’s in Northern Ireland fail.

Time line:

Sunday 5th Jan 2014: A second emergency assessment unit was set up in Antrim to clear patients out of the A&E.  This unit was not made up of hospital beds; it was set up after the Northern Trust secured more trolleys from a store in Pennybridge, Ballymena.  On top of this Antrim hospital was placing 8 patients in wards designed to cater for 6 patients.  Infection control regulations were flouted, not to mention health & safety for staff and their ability to care for patients.  In the event of a fire imagine the chaos that would ensue.

(http://savethemid.weebly.com/1/post/2013/02/dangerous-antrim-ae-performance-leads-toescalationbeds-placed-infront-of-fire-exits.html )

Wednesday 8th Jan: Altnagelvin had to divert ambulances and urge people not to attend their A&E unit, as a result of a car crash involving 5 people.

Wednesday 8th Jan: The Royal in Belfast had to put emergency measures in place after having to take up the slack for a failed Antrim & Altnagelvin.  This resulted in up to 42 patients being left on trolleys in the corridors.

Thursday 9th Jan: Craigavon A&E had an ambulance divert in place and was taking patients from a catchment area as far away as Enniskillen, due the issues in the other hospitals.

There was a domino effect here; when Antrim failed on the Sunday, other A&E’s started to take more diverted patients and one by one, the system started to implode in the absence of any medical emergencies happening.  Imagine if there was a crisis, for example a plane or train crash.  It is evident that our emergency services would shut down.

What is the common problem here?  - There are not enough beds so that patients can be admitted.  As inpatient beds fill up, the A&E shuts down, routine operations are called off, staff to patient ratios are unsafe and infection control becomes a problem.   What is happening now is a continuing cycle of our acute system failing and it is being covered up by our political representatives - they all know exactly what the problem is.

Bairbre de Brún began the process of shutting hospitals down in 2000, followed by Michael McGimpsey & Edwin Poots.  Year after year for 4 years we have seen this happening across many different hospitals.  There have been no solutions to fix this problem, with Health Trusts becoming more innovative in covering it up, by using diverse reporting methods. 

The John Compton Cover Up which Is backed by Edwin Poots, and known by the Health Committee and all political parties - The use of medical assessment units is now the norm; this is a clinical area where patients are taken after being seen in A&E.  At this stage they are not admitted into a hospital ward for proper treatment, they are waiting in line to be seen by a doctor or consultant for further treatment, but they are not classed as being an A&E patient and so their waiting time clock is stopped.

Instead of waiting in the corridors on trolleys patients are herded into these understaffed units. This out of sight, out of mind mentality by health bosses must be stopped; if these times were included as part of the performance time measurement system, it would be clear that the time frame for getting a person treated and admitted to the right ward for the correct treatment has got systemically worse over the past 4 years across Northern Ireland.

What is best for patients who attend an A&E or get referred to hospital by their GP? - It is swift diagnosis and if needed direct admission to the correct ward for treatment.  This is not happening in our hospitals in Northern Ireland.  In looking at the problem in greater detail, the bigger issue goes beyond A&E.  After years of poor, and continuing poor performance, this is being covered up by the use of the wards mentioned earlier.

Antrim A&E had a new A&E open in July 2013.  This has a 24 bedded assessment unit and to aid with winter pressures, another 14 additional beds according to Health Minister Edwin Poots.  Despite what should have been a net gain of 38 beds, when you compare how many beds Antrim has with stats realised by the DHSSPS in April 2013, to an Assembly question answered in November 2013, there has actually been a net loss of beds in Antrim (see http://savethemid.weebly.com/1/post/2013/11/more-beds-for-antrim-hospital-yet-there-are-less-available-can-the-health-minister-count.html ).

Despite 38 extra beds, there is a net loss of over 70 beds, and this bluff by the Health Minster and Trust has also led to extra beds being placed on wards, some of which are even placed in front of fire exits, others placed wherever there is room.  (http://savethemid.weebly.com/1/post/2013/02/dangerous-antrim-ae-performance-leads-toescalationbeds-placed-infront-of-fire-exits.html).  While Antrim is highlighted here this practice is likewise across our acute hospital system in Northern Ireland.

Mid Ulster hospital is an example to refer to where bad management decisions were not held accountable by politicians and led to the death and suffering of patients.  What needs to happen in Northern Ireland is the creation of a Quality Care Commission, like the one set up in England post the Mid Staffordshire Hospital scandal.  The Mid Staffs issue came on the back of that Health Trust removing 150 nurses and expecting what was left of the staff rota to cope.

In the report that followed, it highlighted the role of managers and clinical leaders being crucial in achieving positive changes in practice; however one danger is that managers may seek simple solutions over evidence, leading them to adopt management techniques that are ineffective or damaging.  The revelations of the abuse at Stafford hospital were widely considered to be deeply shocking by all sections of the mainstream UK press; for example, patients were left in their own urine by nurses and forced to resort to drinking from flower vases.  Our existing regulatory bodies RQIA and the Patient & Client Council are not effective in dealing with the failures in our health system as they are controlled by the Health Minister. 

The public and patients deserve more accountability.

The English 'turn around' team appointed to try and solve Antrim problems recommended last year that mortality rates be examined in Antrim Hospital; this recommendation is yet to be implemented.  So why hasn’t Edwin Poots, who has paid over £100,000 to this 'turn around' team, still not implemented the recommendation to investigate deaths at Antrim hospital? (http://savethemid.weebly.com/1/post/2013/06/mortality-data-questioned-in-northern-health-trust-including-antrim-hsoptial.html)

In FOI requests, it was found that there was very high levels of mortality in A&E’s like Antrim, The Ulster and the Royal, compared to other units in terms of the number of patients attending it (over 1,600 deaths between 2009-2013) but because there are no checks and balances in Northern Ireland compared to England & Wales, death rates here are not investigated.

Every Hospital in Northern Ireland runs on a CHKS (a leading provider of healthcare solutions) system to record performance.  This secretive and untested system can be used to give whatever result the health trusts wants it to by using averages from all wards rather than specifically looking at which wards are failing. http://savethemid.weebly.com/1/post/2013/06/mortality-data-questioned-in-northern-health-trust-including-antrim-hsoptial.html) 

Health Minster Edwin Poots has lost control of the Health system.   He appointed Chief Executive Officer (CEO) of the Health Board, John Compton, to oversee the 'Transforming Your Care' review.  This is the very same CEO who was in charge while the health system crumbled; he served as CEO during the worst health performances in Northern Ireland’s history and instead of being sacked, he was promoted to the Transforming Your Care team.

After receiving his knighthood, he retires a very rich man on the back of his failures, on top of his salary of £140,00 a year his CETV (golden handshake pension in lay terms) was worth £1.6 million before he got his promotion.

To review Antrim A&E, Mary Hinds was also appointed.  After her review, performance got worse and she excluded the bullying culture in Antrim hospital from her final report.  Does this sound familiar to the recent report on the Royal A&E?  Mary Hinds is now the stand-in CEO of the Northern Health & Social Care Trust.

The accountability must start now by stopping 'Transforming Your Care'. 

Transforming Your Care is not a plan for the health system, it is a list of 99 recommendations that would give Health Trusts the opportunity to make ‘one off’ savings by cutting some services.  Such is the irony of Transforming Your Care, the health trusts need more funding to be able to make more cuts and even that funding is being withheld by Edwin Poots & the Execitive. 

If Edwin Poots and health managers have nothing to fear, then they should take steps now to introduce a Quality Care Commission to Northern Ireland (http://www.cqc.org.uk/ ).  This should be started by an open evidence session by the Health Committee where community groups, health professionals and otherwise qualified individuals, can show the failings of the health system without any recourse from health managers. 

We are entitled to a health service that is evaluated on the problems surrounding patient safety, and not a service that is dominated by saving money instead of lives.

 "Ye wanna do the bouncy...?"

 I argued in my previous article that, looking through the strategic mistakes made by Loyalists at the time of the flag protests and since (in terms, at least, of delivering real outcomes and political influence), it is remarkable how many of the same strategic mistakes are made by Progressives - the very people against whom much of that Loyalist ire was turned! This article looks particularly at the old maxim that divided parties (and movements) don't win elections and thus can't secure influence; concluding by introducing the notion that all politics is based around "bogey men" as the best means of securing unity.

Like Loyalists, Progressives spend too long talking to each other. The problem is not that this results in bad policies (in fact, it tends to result in good ones). The problem is that it results in skewed priorities - and thus the discussion becomes an ever decreasing circle of total irrelevance (from the wider voting population's perspective). This is why, despite good policies in many areas, both Loyalists and Progressives (with the odd notable exception) are left without serious political representation or influence. How often have we seen it? The election campaign was great fun - but the result was bewildering; the policies were well presented - but they were irrelevant to those determining the election outcome, namely the voters!

A particularly peculiar thing about Progressives in the context of Northern Ireland is their own inability to compromise, even with each other! While they preach about how Unionists and Nationalists should be able to sort things out instead of putting obstacles in the way (and they are right about that of course), they themselves put obstacles in the way of working with each other!

There is the aforementioned tendency to set up new parties and groups. More notably, however, there is the tendency of many Progressives to put a particular, narrow policy objective in the way of cooperation with other Progressives. We have surely all seen it: "Yes, I'd support a non-sectarian party as long as it backs the living wage"; "Oh, I'd support a cross-community movement, but only if it's libertarian"; "Yeah, they're okay, but I didn't like it when they walked out of those talks 12 years ago"; "Ah well, I basically like them but I can't join them because some of them are Socialist/Liberal/Conservative/vegetarian/meat-eating/pro-fracking/anti-fracking/brunette/blonde..."

Progressives are a relatively small minority as it is, even smaller when you only count the politically minded ones - so where on earth does this appetite for the luxury of every increasing numbers of small groups with ever decreasing numbers of people (and thus usually zero influence, individually and collectively) come from?!

Perhaps there are two prime reasons for this. Firstly, Progressives do not actually see themselves as a group - they are conditioned not to by an ongoing narrative, backed up by the political institutions, which only really allows for "Unionists", "Nationalists" and "Others" (a deliberately ill-defined and frankly slightly irritating jumble with no common positions of their own). Thus, they do not realise what power they could have if they acted as a coherent, cohesive unit as opposed to sideshow smattering of small conflicting groups. Secondly, perhaps due to who they are, Progressives believe political arguments can be won solely by way of reason - a comforting but actually nonsensical argument given that it has never happened that way in this (or arguably any) part of the world! Thus, they forget (as ever with the odd notable exception) that influence actually derives from hard work on constituency issues.

The fundamental problem which comes from all of this, it seems to me, is that Progressives are so busy arguing over (comparative) irrelevance with each other, they have no idea how to connect with the electorate. Put crudely, when you arrive on a voter's doorstep, they could not care less about your vision for Northern Ireland's political institutions, your magical plan education for the next generation, or your wonderful proposed decades-long reform of the health system. What they care about is immediate. Can you get their bin replaced; can you sort a place in the local nursery for their niece; can you ensure a bed in the local A&E for their grandfather - and can you do it now?! Suddenly, that crazed 50-tweet argument you had about the living wage with someone with whom you otherwise agree on everything counts for absolutely zilch...

I have written before that there is only one thing which really matters to politically minded Progressives keen to make a difference: the anti-Progressive forces of hard-line Unionism and hard-line Nationalism, the DUP and Sinn Fein, between them hold 67 out of 108 Assembly seats; 13 out of 18 Parliamentary seats; and a majority of Council seats. There are three obvious reasons this matters, which are worth re-stating.

Firstly, it matters because of the simple numbers when it comes to passing legislation or voting through policy. If the DUP and Sinn Fein agree, it happens; and if they don't, it doesn't. Until they are deprived of their majority, it will ever be thus. Bring as many Bills to the Assembly as you like advocating "Opposition", or same-sex marriage, or selection without examination at 14, or whatever - you can't win any of them.

Secondly, it matters because of how there were structured to achieve it. Think of the calamities which have befallen the leadership of each party even just this decade - from Irisgate to the horrendous abuse cases around Liam Adams. The DUP and Sinn Fein closed ranks, kept their concerns and divisions internal, and came through as a single cohesive unit capable of winning elections. Compare that to the aforementioned Progressives, going out of their way to find the most minor policy or strategic issue to justify further division into ever smaller warring camps!

Thirdly, it matters because of what they did to achieve it - and, particularly, what they didn't do! The DUP and Sinn Fein got there by being able to answer those immediate questions on the doorstep - in other words through a hard won reputation for constituency work. If you doubt that, look at the exceptions to the rule (say, Lady Hermon or Naomi Long) and ask yourself how they did it. If it looks like hard work, that's because it is! What they didn't do was spent ages and ages sitting about with each other obsessing over detailed policy platforms...

This brings us neatly to the notion of the "bogey man". Perhaps the main way in which the DUP and Sinn Fein remain cohesive lies not in what they are far, but in what they are against. Frankly, this is the same everywhere - the motivation for winning elections is best summed up in the words of Sir Humphrey Appleby: "You know what happens when the right people don't have power? The wrong people get it!"

Therefore, they create a "bogey man" - noting as ever that this "bogey man" need not be entirely or even remotely rational. It merely has to be something perceived (whether accurately or not) to unite against.

Illustration by Brian John Spencer

 For Unionists, the overall "bogey man" is the "United Ireland" or any perceived staging post to it - be it a Sinn Fein Lord Mayor, a Sinn Fein European Election win, or (now, as the others have both happened) a Sinn Fein First Minister. This works best when it is presented specifically - thus, the flags issue was presented as the Alliance Party (a direct electoral rival) forming a coalition with Sinn Fein (not a direct electoral rival but representative of the "bogey man" of the operation) to "tear down the flag". That designated days actually made Belfast a more typically British Council (as most British Councils have designated days) was neither here nor there - "bogey men" are not rational beings!

For Nationalists (including self-identifying "Republicans"), the "bogey man" is a return to Unionist domination (the opposite of which is always referred to as "equality", even if it actually means Nationalist domination). The flags issue was presented (literally - it was even filmed) as Sinn Fein delivery of the end of Unionist domination in Belfast. That it was the first time Irish Republicans had voted for the Union Flag to fly over a civic office in Ireland and was thus reflective of Nationalism's total defeat on the constitutional question was neither here nor there - see above!

Nationalists, of course, see change inevitably as moving away from their "bogey man"; Unionists see it as moving towards theirs. This is broadly reflected in their attitude to any change - even, say, same-sex marriage. (On one occasion, Unionists even opposed a change in Assembly procedures to allow MLAs to take their jackets off in the Chamber on a particularly hot day - and sat their sweltering as Nationalist and Alliance members proceeded with the change!)

And so we return to the two groups we started with - Loyalists and Progressives. Loyalists are in fact trapped by this anti-change Unionist versus pro-change Nationalist narrative, because in fact they do want change in terms of their social circumstances even if not in terms of the constitution. They bought into the Unionist "bogey man" narrative during the flag dispute, but must come to realise their real bogey man is the overarching narrative which doesn't allow Northern Ireland people to seek social change without also seeking constitutional change.

Progressives are also trapped by this narrative. In fact, they found themselves presented as the "bogey man" during the flag dispute, yet they lack one of their own. Not having something to unite against, they divide up all over the place and fail to present a coherent case to the voters. In fact, their bogey man is also the narrative which doesn't allow people to seek social change without seeking constitutional change.

If there is a problem looming, Unionists and Nationalists can simply create another illusion of a problem based on their bogey man, around which they can unite. Loyalists and Progressives haven't mastered that, and thus remain divided.

What is remarkable, at the end of all of this, is how much Loyalists and Progressives actually have in common - despite having been on the opposite ends of a dispute created by others as a "bogey man" issue. Loyalists and Progressives are divided among themselves; they tend to talk to each other too much without engaging enough with wider society; they tend to believe contrary to the evidence that non-voters are all on their side; they haven't recognised that political influence derives from hard constituency work; they haven't taken account of the old maxim that divided parties (and movements) don't win elections - and thus don't attain influence.

Most remarkable of all, Loyalists and Progressives both in fact have the same common objective. They will get nowhere until the DUP and Sinn Fein are deprived of an Assembly majority; and to do that they have to challenge the narrative that those who want social change must also want constitutional change.

That is why, as a Progressive, I want to see Loyalists for democracy. With a bit of hard work, we can make democracy deliver for both of us.

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