Statement by Frank Fahy, Mayor of Skibbereen

To TDs/Senator for Cork South West, Doctors of West Cork & HSE Management at two meetings called to discuss an impending but entirely avoidable catastrophe for the region.

The sentiment expressed was unanimously and vigorously supported by all the members of Skibbereen Town Council.

“On behalf of the Council I wish to welcome you to our Chamber and thank you for coming to discuss the proposed action of withdrawing the ambulance service from Skibbereen, the outcome of which would have severe implications and consequences for the West Cork area generally and more specifically the Skibbereen area.

Skibbereen is second busiest and occasionally the busiest 999 ambulance station in West Cork, second only to Clonakilty who provide service from Rosscarbery to Kinsale. Bantry are only busier in the transport of patients and not 999 calls. In Bantry, when the Minor Injuries and Assessment unit is closed from 8pm to 8am in January 2012 as recently confirmed, they will still have the General Hospital, all night South Doc, One 999 ambulance, a patient transport ambulance and an Advanced Paramedic car.

In phase 1, according to Conciliation Conference document C-103261-11 dated 24th June 2011, it is proposed that the ambulance is withdrawn from Skibbereen and Castletownbere from 8pm to 8am and a response car placed in both areas. The response car has no patient carrying capability and will be manned by one Paramedic only. Effectively, the HSE are putting lives at risk over a vast area to save the pay of one Paramedic from 8pm to 8am for four additional nights to the current arrangement. It will still be necessary to call an Advanced Paramedic and/or Doctor and an ambulance to all events involving trauma including fractures or head injuries, chest pain, Paediatric, First time seizures etc. and transport the casualty to Cork all of which clearly negates any savings made.

In the Medical Independent in June 2011 it was reported that the HSE had spent €190.3 million Euro on taxi’s and private ambulances between 2005 and 2010. The current action clearly shows that management have learned nothing and continue to make totally illogical decisions which threaten the lives of our people for no good reason other than change for change sake. A recommendation of the Labour Court on the “on call system” is being used to justify the withdrawal of the service, the on call system being considered to be an unsafe system with staff possibly working and driving for longer than is safe.

I would accept this to be the case and fully support the Labour Court recommendation. What I cannot accept is that the lives of the people of West Cork are being endangered by the manner in which this recommendation is being implemented by the HSE. A Rapid Response car is being used to show an improved response time rather than a more functional and efficient system to remove casualties to an appropriate medical facility.

In Skibbereen there is no South Doc service after 11pm each night which necessitates bringing a Doctor from Bantry. In the Clinical Practice Guidelines for Advanced Paramedics, the principles of which also apply to doctors, Page 15 paragraph 11 it states and I quote; “arrange transport to an appropriate medical facility as necessary and in an appropriate time frame: On scene times for life threatening conditions, other than cardiac arrest should not exceed ten minutes. Following initial stabilisation, other treatments should be commenced/ continued en-route” end quote.

Effectively the maximum time for treating a trauma casualty on site is ten minutes before transporting them to hospital in order to increase their chances of survival. (Referred to as the Platinum Ten Minutes) If there’s an Ambulance available the Advanced Paramedic should travel with the patient after this period to continue treatment but according to the training parameters, the initial ten minutes should not be exceeded.

After 8pm in the case of Advanced Paramedics and Ambulances and 11pm in the case of doctors, this target time is not attainable as both are based in Bantry. Not having an ambulance based in Skibbereen makes a total nonsense of the training guidelines as the minimum time for an ambulance to come from any other station is thirty minutes and considerably more in the case of the Mizen and Beara peninsulas. Even from Skibbereen, they are then faced with a minimum travel time of 75 to 90 minutes to Cork which puts the patient well outside of the optimum period for treatment internationally known as the Golden Hour.

To put it in greater perspective, although the ambulance service is exponentially busier than the Fire Service, we will in phase one be dependant on two ambulances to service an area which necessitates eight full Fire Brigade units to cover. When a road traffic accident happens anywhere in West Cork where there are two casualties requiring hospitalisation, the only two ambulances (if they are available) will be out of the area for at least three hours taking the casualties to Cork. How does the HSE plan to move a third and subsequent casualty from the roadside or a seriously ill patient from anywhere in West Cork during the following minimum three hours when the only ambulances are absent from the area?

In Bohonagh, Rosscarbery on the 18th April this year, one person died and five were seriously injured and taken to hospital in Cork by ambulance. It is tragically clear that if the sixth casualty had not died at the scene, there would have been no ambulance to transport her and another casualty had to be taken to hospital by private car as another ambulance would not have been available for at least an hour and possibly longer. It was only by chance rather than good management that five ambulances were available in a reasonable time.

In future plans Bantry Minor Injuries and Assessment unit will be closed at night so all trauma patients will have to be taken to Cork which means a minimum three hour absence from West Cork. The total patient carrying capacity of the Ambulance service in the West Cork area at this time will be two, and in the entire County the current carrying capacity of eleven patients will be reduced to six. This is down from the original pre ambulance re-configuration capacity of twenty two.

In phase two, the ambulance is being replaced in the quietest station, Castletownbere but not in Skibbereen the second busiest. I welcome the return of the Castletownbere ambulance but fail to see any logic in not restoring the Skibbereen unit; in fact, I can see no logic for removing it in the first place. This curtailment of the Skibbereen ambulance service means that In effect the area from Rosscarbery to the Mizen head will have no ambulance service after 8pm seven days a week. The area covers Leap, Glandore, Union Hall, Castletownshend, Skibbereen, Baltimore, The Islands, Ballydehob, Schull, Goleen and Crookhaven.

We in the Cork South West Electoral area and particularly Skibbereen are being isolated as an area without an adequate Ambulance service and where according to the 2011 Census there is a population 82,815 to be serviced by two ambulances after 8pm. This population figure does not include the seasonal increase which can add a further 35%.

In the current case widely publicised case in Roscommon, the closing of the casualty dept. is being partially offset by the provision of extra ambulances. In West Cork, the opposite is the case with ambulances being taken out of service during the Bantry Minor Injuries and Assessment unit closure times.

At a presentation in the West Cork Hotel in 2009 when the Advanced Paramedic service was being introduced, I was personally given assurances by Professor Stephen Cusack (who acted as representative of the HSE) that the new service was complimentary to the Ambulance service and that the West Cork Ambulance service would be maintained at the then current levels. He also gave the continued ambulance service in Skibbereen as a reason why the Advanced Paramedic Service would not be based in Skibbereen but in Bantry, and that the APs additional training could be better utilised in the hospital in Bantry during their quiet times, and the ambulance cover in Skibbereen would be adequate to cover until the arrival of the AP if required. Professor John Higgins, the Chairman of the reconfiguration Committee of the HSE has reiterated this on several occasions since that the ambulance cover in Skibbereen will be maintained.

The members of this Council together with the TDs and Senator for Cork South West have written to the Minister for Health demanding the reversal of these intended actions, and the members of the Council will lobby their party members in the Oireachtas to have this action stopped immediately before lives are lost, and to obtain some kind of a logical explanation why Skibbereen has been singled out to lose the ambulance service despite being the second busiest 999 station in West Cork.

There is neither sense, reason or economy in this needless action which will undoubtedly put lives at risk, or to use a national newspaper headline this policy could well mean “Death by Geography”. I have been asked personally, and I believe other members of the Council have also been asked, to organise public protests in Skibbereen area and West Cork generally and I have every intention of doing so if this proposal is being further progressed, and I will do so regardless any timeframe for the proposal, long or short.

It must not happen and Skibbereen Town Council will do everything possible to ensure it doesn’t. I know I speak on behalf of all the Council when I say that we will hold the Management of the HSE responsible for the deaths that will certainly occur if this is implemented. I have been assured by Ambulance Personnel in West Cork and other areas that they will keep me informed of any such death or aggravated injury that comes to their attention if this curtailment is implemented in the manner proposed.

As it is I currently monitor all ambulance transmissions on a radio in my home and note the content. I noted last night, immediately after the critical 8.00pm, all four ambulances in West Cork engaged in various parts of the County attending incidents and even in circumstances as good as they are with four ambulances, if another call came in there would be a considerable wait for another if one was available at all.

I also have noted that there were twenty nine 999/Doctor calls in the Skibbereen area alone during the “on call” hours of between 8pm and 8am in the month of July and with five of them on the 31st of the month.

In order to avoid waste of time arguing about the “reason” this measure is being introduced, I would like to state again that we in the Town Council fully accept the need to terminate the “on call” system and that neither the HSE or a small minority of their staff who disagree with the recommendation have a choice in the matter but there the logic and common sense ends as far as an alternative service being provided is concerned. We need assurances from the highest authority that this area is not going to be further isolated from vital services and that the Ambulance Service is not going to be withdrawn from 8pm to 8am.

01/09/2011 All of the above was fully supported by all attending each meeting except Management of the HSE who persisted in using delaying tactics including the projection of irrelevant Powerpoint presentations in order to avoid answering the important questions put to them. When asked to confirm that the Ambulance is being withdrawn from 8pm to 8am, they replied, “Skibbereen Ambulance Station is not closing” This is true, but not the answer requested or an answer to the question asked.