Saturday, 22 November 2014

Bushmills Christmas Tree 2014


They say there are two sides to every story 
- and here are the two sides of the Christmas tree 
that Moyle District Council has had erected in Bushmills.

It looks as if it has been dragged through a hedge!

The 'morning after the night before' look

Today's replacement

If the first was damaged in transit, why was it erected?

Added December 5

Why wasn't the cherry-picker used?
It was in Bushmills a few days ago.

The headless turkey look

Lighting problems in 2011

This blog has attracted a lot of attention but a tree is much less important
than the threat to the future of Dalriada Hospital in the north-east corner of County Antrim
[Facebook link]

Friday, 21 November 2014

#SaveTheDal - Farmer Fury Tractor Rally in Ballycastle

"Minister braves the protesters at Dalriada"
Anne Kelly video
#‎savethedal Farmer Fury Tractor Rally In Ballycastle .... what an amazing turnout proud of our community and the way they have pulled together and supported this. .. Anne
Nicole's video :: Danny's video

Tractor convoy on Quay Road

The Northern Health and Social Care Trust may attempt to restrict the flow of information by postponing Board meetings, discontinuing corporate communication updates and other means but silencing critics is no easy task in this modern media age.

Thursday, 20 November 2014

#SaveTheDal - Ministerial points to ponder

Time is running out
Will the shutters come down this week?

The NHSCT Board appears to have run for cover
It's usual November meeting has been pushed back to December 2
ie after the 'temporary' closure date, November 30

The NHSCT Board ceased publication of its corporate communications updates in June 2014.
This means less information for Board members and staff as well as for concerned citizens.
It symbolises a retreat to the bunker.

Might the enforced changes lead to an increase in operational costs rather than a decrease?

Why change what isn't broken to an untested new arrangement?

Letter from the previous Health minister, Edwin Poots, earlier this year.

Did the level of commissioned activity decrease through lack of interest/promotion 
or was a decision taken to curtail it?

Edwin Poots, ex-Health minister, and Tony Stevens, NHSCT CEO

Official language can be so slippery!

Tuesday, 18 November 2014

#SaveTheDal - Another letter to the Minister

A letter to Mr Wells from the Ballycastle Community Development Group and Paul Kerrigan's family:

Mr Jim Wells MLA
Minister for Health, Social Services and Public Safety
Room 218
Parliament Buildings
17 November 2014

Dear Minister,

Re: Proposed closure of Dalriada Hospital, Ballycastle

I write to you on behalf of Ballycastle Community Development Group, but also on a personal basis. The community of Ballycastle and beyond are deeply concerned and dismayed at the news of the intention, by you and your Department, to close the Dalriada Hospital in Ballycastle.

In the first instance, it has been published that the proposed ‘temporary’ closure will result in a potential saving of £0.6 million to the [Northern Health and Social Care] Trust. It would appear at first glance that the decisions that have been made, have been based on a somewhat flawed economical base and the proposed savings are minuscule in the grand scheme of things. However, the direct impacts on a rural community, staff and patients are unquantifiable.

There are 20 intermediate beds in Ballycastle, each of which costs £850 per week, which equates to a total weekly bed cost of £17,000. In comparison, an acute bed, according to published Northern Trust's figures, costs between £2,100 and £2,800 a week, taking a medium figure of £2,350. This would result in a cost of £47,000 per week equating to a direct increase in costs to the Trust of some £30,000 per week. This, in anyone’s eyes, DOES NOT make economic sense.

Between December 2013 and August 2014, the average occupancy for those beds in Dalriada was 92%, which is extremely high. It would have been higher had it not been for the loss of days due to transport delays in the Northern Trust. That would add another 6% to that figure, which means that we are talking about a real figure of 98%. As many in the health profession will tell you, anything over 90% represents a hospital that is effectively full in terms of intermediate care. Source: Daithí McKay MLA

It has been suggested by the Trust that measures will be put in place to ensure those who have availed of the Multiple Sclerosis respite care in Dalriada will be given an alternative care package – care homes and direct payments to enable families to avail of ‘in-home’ respite care. In the first instance, directing those who suffer from MS to a care home to avail of respite care is neither an economically positive, sustainable nor suitable alternative to the care package currently offered by the facility and staff at Dalriada. The care package offered by the facility at Dalriada is the only type offered by any of the Trusts; it is unrivalled and heavily supported by local residents and groups. It has been publicly stated by you, Minister, that this facility has been under-used. I ask of you, was it promoted and published by your Department? Again I would request information to substantiate your claims. Evidence would suggest that there was no strategic plan put in place by any Trust to refer any MS patients to this facility. I ask of you and your Department to provide clarification on this issue. 

With regards to the second point - offering MS patients the opportunity of availing of respite care in their own homes - this would appear to me as being a somewhat perverse and fundamentally flawed ideology. What kind of respite will the patient or family get and at what additional cost to a Trust which is supposedly ‘temporally’ closing this facility as a cost saving measure?! Again, I would request a full and detailed cost comparison between the current model of care provision provided by Dalriada and what you, and your Department, have envisaged as an alternative.

In my limited knowledge of this particular type of care, I would believe that both carer and patients need time to recuperate. How will this be achieved if both patient and carer are still resident in the same property with the additional burden of a ‘carer’? And, with no disrespect, I use the term ‘carer’ very loosely in this instance.

If, as you and the Trust have publicly stated, this closure is only ‘temporary’, what measures and legal assurances have been put in place to redeploy the staff back to Dalriada?

If this closure is on a ‘temporary’ basis, I ask you, the current Health Minister, what are the associated costs involved in ‘mothballing’ and reopening this facility? To quote you at Assembly Questions ‘we will turn off the lights’ - what are the direct savings anticipated by these measures? I respectfully request a detailed breakdown on the current fixed running costs of this building.

As someone who has just had laid his father to rest, who received nothing but the highest standard of care and attention from all levels of staff, both in the Causeway and in Craigavon, I am somewhat disgusted, dismayed and saddened by the fact that my father was unable to see out his last days in a hospital which is dear to our hearts, due to the restriction imposed by the Trust on admissions to Dalriada. My father helped build the hospital; my mother worked in it for 30 years; and many family members and friends have received unrivalled care, compassion and attention in their final moments in a Hospital which is easily accessible to those who reside in the District of Moyle, and you as the current Health Minister are willing to sanction its early demise.

I ask of you Minster, to consider all the facts and figures, the sustained public opposition to this proposed ‘temporary’ closure and the hurt and pain that this is causing to a very exposed rural community.

Although this has been portrayed as a ‘temporary’ closure, as a community we believe that this is nothing more than a forerunner to the permanent closure of Dalriada. I ask of you Minister and your Department, has your Department put in place measures to undertake an EQIA, substantive and meaningful public consultation, rural proofing and cost benefit analysis? If so, I would be grateful if you could forward any relevant information.

On Behalf of Ballycastle Community Group

Paul Kerrigan BEM

Monday, 17 November 2014

#SaveThe Dal goes to Stormont - Monday, November 17

UPDATED - December 19

Cross-community and cross-party support

BBC report - December 19: "A public consultation on the temporary closure of services at Dalriada Hospital, County Antrim, has been halted due to a court challenge. ..

Earlier this month, a High Court judge ruled that the hospital must continue to accept new patients until the judicial review is heard in full.

It resulted in a temporary reprieve for Dalriada's patients and for the [cross-community and cross-party] Save The Dalriada campaign group (Save the Dal)."

[click images to enlarge]

Early arrivals for the protest

Minister Wells in conversation with Cllr Cunningham, Moyle DC chair

The Minister speaks

The great show of cross-community and cross-party co-operation on the steps of Stormont contrasted sharply and sadly with the bickering inside the Assembly's hallowed portals. Those who need to avail of our health and social services deserve better from our politicians and other public servants and our media ought to shed much more light on the processes of our multi-layered governance*.

* Just how many layers exist between the Minister and the Dal? The following would appear to be the chief layers: The Minister > DHSSPS Permanent Secretary > DHSSPS Departmental Board > Health and Social Care Board > Northern Local Commissioning Group > Northern Health and Social Care Trust > The Dal. According to HM Treasury best practice the Minister should chair the Departmental Board but in the Northern Ireland Assembly the ministers don't even participate in these board meetings. Those who are not around the table when key decisions are being taken may not be in full possession of the facts. This lack of joined-up governance could mean that different stories are being told to different people in this elongated governance process and that decisions are not being adequately subjected to a public interest test.

On November 28, the Minister announced an in-house review of administration to be carried out by the Permanent Secretary whereas much greater independence is required so that more of the departmental budget gets to key front-line and supporting services.

Saturday, 15 November 2014

#SaveTheDal - Dalriada Hospital, Ballycastle, Cuts - Action and Reaction 2

[click images to enlarge]

One of a series of meetings to protest against the hospital's 'temporary' closure
The meeting in Moyle Council offices attracted about 700 people

"I want to provide [someone suffering from Multiple Sclerosis] with a reassurance that we will continue to provide him with a service at least as good as the service he's receiving now. I'm making no promises that it will open, that it has a long-term future, but we will consult, we will give the public an opportunity to have their say on the long term future." .. Dr Tony Stevens, Trust Chief Executive in a recent BBC interview

The public are more likely to pay heed to actions than to promises.

A visit to Monday's Health Budget debate on Monday, November 17, is being organised through the 'Save The Dal' Facebook page and those travelling hope to be able to hand over signed petitions to the Minister of Health, Social Services and Public Safety, Jim Wells.

The workings of the Northern Health and Social Care Trust are new to me. It's an arms-length body [ALB] and it's my understanding that its Board has 11 full time professionals and 8 part-time lay members. None of the lay members, as far as I can see, live in the North Antrim area so their personal experience of the hospital's facilities may be somewhat limited. This snippet from the Trust's management statement [pdf file] may be of interest:

I can find no detailed implementation plan for the proposed 'temporary' closure nor can I, for example, find Trust promotion of the respite facilities on offer at its regional MS centre, facilities that are so much appreciated by users.

And there's more:

Meetings of the Board take place once a month.  These meetings are held in public and are normally on the fourth Thursday of each month, at various locations throughout the Trust.

Trust Board agendas and papers are available prior to the meetings. Following their approval at the next meeting, the minutes of the previous meeting will be available."

There's not to be a Board meeting in November; the next one is on December 2 - after the axe is due to fall. Here's the proposed change to Standing Orders that I found in the preparation papers for the October 2014 meeting:

Why aren't the agendas and papers put on-line prior to the Board meetings?

Sunday, 9 November 2014

1894 - Abuse of Tea-drinking

"Porridge and milk goes down like silk" .. an old saying

"Tea and bread ... "

MR. M'CARTAN (Down, S.) I beg to ask the Chief Secretary to the Lord Lieutenant of Ireland, with reference to the Special Report of the Inspectors of Lunatics in Ireland, whether he is aware that in several of the Reports supplied by the Resident Medical Superintendents of asylums the use of inferior tea is mentioned as one of the sources of the causation of insanity; whether his attention has been called to the Report from No. 16 district, in which it is stated that the tea used is simply a decoction of tannin; whether any steps can be taken to protect the public from such an injurious article; and whether it would be convenient to give a list of the contract prices for tea supplied to the different district asylums in Ireland for the years 1893 and 1894?

MR. J. MORLEY I am aware of the statements referred to in the first and second paragraphs, though I may add that many of the Resident Medical Superintendents attribute the deleterious influence of tea, not to its quality, but to the method of preparation adopted. With regard to the second paragraph, the purchaser of adulterated tea may, at his own expense, proceed summarily against the seller for the penalty prescribed by the Adulteration of Food Act, or the prosecution may be brought under the direction of the Local Authority. I believe, however, that very little adulterated tea is sold in Ireland, and that as a rule the poorer classes purchase teas which are comparatively high priced but strong. Regarding the concluding paragraph, the information referred to can, if desired, be obtained, but it will take some time to collect it.

#SaveTheDal - Letter to the Minister


Copy of letter from local GPs to Health Minister:

Mr Jim Wells 
The Minister
Department of Health, Social Services and Public Safety
Information Office
C5.20 Castle Buildings
Stormont Buildings

Dear Mr Wells,

As you are aware Dr Tony Stevens, Chief Executive of NHSCT announced on Thursday 30th November 2014, the “temporary” closure of Dalriada Hospital in Ballycastle in its entirety at the end of November 2014.

Dalriada Hospital has provided outstanding medical care to the people of Ballycastle and the surrounding areas for decades.

This decision to close Dalriada hospital betrays the substance of Transforming Your Care which promotes intermediate care, with medical care being provided to patients either in their own homes or in intermediate care units as close as possible to their homes.

As GPs who work in Dalriada Hospital we wish to voice our grave concerns about the proposed closure of Dalriada Hospital. Although described as a “temporary” closure, Dr Tony Stevens CEO was unable to give any assurance that this would be the case, merely advising that there would be consultation about the provision of intermediate care throughout the Northern Trust area after the end of this financial year. He also stated that as this was “temporary” he was under no obligation to carry out any consultation.

The hospital encompasses 20 intermediate care beds and 12 regional Multiple sclerosis respite beds. Not only do we the GPs accept patients on a step-down basis from the acute hospital setting (e.g. for rehabilitation following orthopaedic surgery for fractured hips) we also provide a step-up service.

The step-up service allows us to directly admit a patient from home, including Rathlin islanders to Dalriada Hospital who would otherwise require attendance at A+E and admission into an acute hospital bed. As you are aware the cost of a bed day in Dalriada Hospital is a fraction of the cost of a bed day in the acute hospital setting such as Causeway or Antrim Area Hospital.

The doctors also accept and provide medical cover for patients who have been assessed in A+E or admitted to the medical assessment unit and require further short-term clinical care and rehabilitation with the assistance of the multidisciplinary team.

Unfortunately the number of patients requiring complex palliative care treatment has escalated in the past years and Dalriada hospital has highly skilled clinical staff members who are fully dedicated and competent to provide this essential service to patients who otherwise their care could only be provided in the acute hospital setting.

Dalriada hospital also provides a regional respite service for patients with Multiple Sclerosis who have complex medical and nursing needs. During their respite stay the service users avail.

The many services on site including dentistry, podiatry, physiotherapy and occupational therapy. This prevents fragmented care at home. Sadly many of these patients are young. A nursing home environment would be totally unsuitable to their needs. This has been continually voiced by the Multiple Sclerosis Society.
The clinical care provided by the specialist nurses in Dalriada Hospital provides not only for the physical complexities, but also the psychological and social needs of the sufferers of Multiple Sclerosis and their families. This is unique and has been emphasised by the service users and reiterated in the media.

The disbandment of the hospital and these specialist skilled staff will have enormous clinical impact on the provision of acute hospital care and would appear to make no economic sense.

As GPs we are fearful of the impact this proposed major cutback in local healthcare provision will have on the patients in our practices populations. North Antrim and Rathlin Island have become popular retirement areas and hence we have a large proportion of frail elderly patients. In the winter months particularly, many of these patients unfortunately succumb to respiratory infections and fractures due to falls. The only option for these patients will be to attend A+E with long trolley waits and prolonged stay in acute hospital beds. These patients have been treated and have had rehabilitation (including after orthopaedic surgery) up to the present time in Dalriada hospital.

The Northern Trust representatives have argued that they have too many intermediate care beds. Unfortunately they have been disingenuous in their description of intermediate care beds. At present the only intermediate care facilities in the NHSCT area which are staffed by trained nurses are:
• Dalriada Hospital with 20 intermediate care beds. 
• Robinson Hospital in Ballymoney with 21 intermediate care beds 
• Inver in Larne with 16 intermediate care beds 
• Mid Ulster hospital in Magherafelt which has 3 assessment beds.

All the other units which the trust has called intermediate care beds are staffed by care assistants with no trained nurses. Patients can only be admitted to these care assistant staffed units if;
• they can be cared for with the assistance of one person, 
• if they do not have dementia and 
• If they do not have medical complications requiring skilled nursing care.

These care assistant staffed units are in Ballymoney, Ballymena, Antrim, Larne, Whiteabbey and Cookstown. None of these are within easy access of Ballycastle and the Glens.

1. If this proposed closure is enforced what is going to happen to the patients in this area of North Antrim and Rathlin Island?
2. Where are our patients with complex palliative care needs going to be admitted?
3. Can you give assurances that our frail elderly patients will not spend prolonged undignified days on A+E trolleys?
4. Where will the clients with Multiple Sclerosis avail of respite care?

The haste with which this announcement was made has caused enormous anxiety to the people of Ballycastle, Rathlin Island and the Glens. Unfortunately without the answers to the questions we pose we have been unable to allay these fears and anxieties. We would invite you to reply urgently to our questions so that we can assure our patients of a safe and high standard of medical provision.

We would also invite you to come to Dalriada hospital to see for yourself the excellent facilities which it provides, a service which actually saves the Health service money. You will be assured of a very warm welcome.
Yours sincerely,
Dr Mary McLister
Dr Martin O’Kane
Dr Bernie Hegarty
Dr Fergal Hasson
Dr Farah Nawaz
Dr Adrian Sterne
Dr Ian Hadden
Dr Stephen McDonnell
In support of: Dr Dermot Grant, Dr John McSparran and Dr Gillian Elder, Glens of Antrim Medical Centre
Mr Tony Stevens Chief Executive
Cllr Donal Cunningham
Cllr Joan Baird
Cllr Cara McShane
Ian Paisley MP
Robin Swann MLA
Jim Allister MLA
Daithi McKay MLA
Mervyn Storey MLA
Northern Local Commissioning Group

Public meeting to support campaign to keep Dalriada Hospital open arranged for Tuesday 18 November at 7pm in Dunluce School, Bushmills.

Dalriada Hospital, Ballycastle, Cuts - Action and Reaction

Coleraine Times slideshow of Public Meeting [Photos by Kevin McAuley; Slideshow by Una Culkin]

UTV coverage of white-line protest

Ministerial office email address for submission of views: 

Added November 10

Call for judicial review over Dalriada [UTV]

"Philomena McKay has instructed her lawyers to seek a judicial review following the temporary closure of Dalriada Hospital in Ballycastle, Co Antrim.

She said the application is being taken on the basis that the Northern Trust "failed to carry out adequate consultation with patients and staff before the decision was taken".

Ms McKay, who said she relies on the respite centre, added that while officials maintain that the closure is temporary, many of those who use it are concerned it will become permanent."

Written answers to questions 25 February 2011:

"Regional MS Respite Centre at Dalriada Hospital, Ballycastle

Mr M Storey asked the Minister of Health, Social Services and Public Safety to outline his Department's plans for the continued provision of Multiple Sclerosis services at the Regional MS Respite Centre at Dalriada Hospital, Ballycastle.
(AQW 3590/11)
Minister of Health, Social Services and Public Safety: The Northern Health and Social Care Trust is committed to sustaining respite care and has no plans to change services at Dalriada Hospital in North Antrim, for Multiple Sclerosis respite or for other services. The Trust has sought initial views from existing MS respite service users on future service provision, and any plans for changes in service provisions will follow discussions with those who use services."

Did such discussions with users take place prior to the 'temporary' closure announcement?

Ballycastle Chronicle: Route Presbytery behind Dalriada