HSE Scoring Sheet, Part 1

Hey everyone.

Over on our Facebook page we've been doing up a little guide to the "Site Selection Format" - or the scoring system used by the HSE to make their decision to shut down the ward for those who are acutely psychiatrically unwell in Ballinasloe.

The document is simple: There are 13 questions, each facility (Ballinasloe and Roscommon) is marked out of 10 (with ten being the highest mark you can get for matching the criteria). We're going to go through the first six questions here. Ask yourself: are these the questions you would ask if you were making a choice of this nature? (hint: probably not).

Brace yourself.

Question 1: Is the location adjacent to a 'Major' or 'Regional' Hospital?
 

Roscommon:  10 (Excellent)   

Ballinasloe:  3 (Below average)

  

Roscommon gets a 10 here, presumably because the unit there is attached to Roscommon County Hospital (which is a level 2 hospital). Portinuncula in Ballinasloe is a level 3 hospital, and is the hospital of referral for Roscommon County Hospital. Consequentially, this scoring is problematic for the following reasons:

•  The #GE22 unit in Ballinasloe is just over 3km from Portiuncula Hospital (a level 3, and therefore higher grade hospital). In light of this we'd assume the mark should be somewhat more balanced. 
• A €5 million euro unit like the one in Ballinasloe has been approved in Mullingar and this unit is 3.1km from their general hospital. They are almost negating the need to ask this question at all by clearly showing that this particular piece of criteria is not an issue in other cases.
• Portiuncula hospital has A&E services, and is a higher grade hospital than Roscommon County Hospital; any serious breakages, cardiac emergencies, maternity issues among many other things are frequently referred to Portiuncula (if not on to Galway). The GE22 unit places service users much closer to these more specialist and emergency services, and results in fewer transferrs of service users which eat into our already depleted ambulance resources.

Question 2: Is the location accessible to a range of medical/surgical/liaison therapeutic services?

Roscommon: 7 (above average)
Ballinasloe: 5 (average)
 

Definitely an important question.

But it's clear that many of the basic points already listed above have once again, not been taken into consideration while scoring this. So for the sake of clarity, we'll reiterate, and we'll add a diagram or two:

• Portiuncula Hospital has an A&E unit, and a range of other services like cardiology for example, while Roscommon County does not. 
• As stated above, Portiuncula is a higher grade hospital. 
• Again, patients are routinely referred from Roscommon to Portiuncula. 
• Ballinasloe has better access to Galway University Hospital (See maps if you're not from the area, note the journey times by the directions on the left of each map, 41 minutes from Ballinasloe to Galway, over double that from Roscommon to Galway).

Ara sure everyone loves having an extra 42 minutes on the road.
It's not like them ambulances have anywhere else they need to be anyway, right?  

Question 3: Is the location suitable as regards to the provision of a high observation unit?

Roscommon: 10 (excellent)
Ballinasloe: 3 (Below average)

This mark is outright ridiculous.

• €2.8 million of taxpayer's money went into refurbishing the purpose built acute admission unit in Ballinasloe. It is the single most modern bit of infrastructure the HSE has. It has specific provision for observation and is a ligature free environment (i.e it is practically impossible to hang oneself). A situation that, regrettably, does not exist in Roscommon.
• The HSE have been quoted as saying that more money will have to be spent in Roscommon to bring it up to standard. (read: to the same standard as the #GE22 unit in Ballinasloe). 

The over-stretched tax payer has to fork out again, because the HSE are making a decision to shut down the unit with the better facilities? Even though they're currently actively investing in similar facilities elsewhere? 

Question 4: Is the location suitable as regards proximity to relevant third level medical, nursing and other clinical education services?

Roscommon: 3 (below average)
Ballinasloe: 5 (average)

HALLELUJAH, a basic knowledge of geography and primary routes at last. Yes, yes, Ballinasloe IS closer to Athlone and Galway, which both have the aforementioned relevant third level medical educational services. Maybe whoever marked this question should have a chat with whoever marked question 2.

...Angry yet? You're going to LOVE this one.

Question 5: Is the location suitable as regards accessibility within the catchment by private road transport, including emergency vehicles?

Roscommon: 7 (above average)
Ballinasloe: 5 (average)

• Ballinasloe is on the M6 with easy access to Galway and Dublin. See the map above if you're confused.
• Roscommon ambulances travel the M6 to Galway (for the comfort of the service user). They pass both the Ballinasloe unit and Portiuncula Hospital. See the map above.

Have the HSE secretly invented a teleporter? That or the HSE think it's okay to put a document as delicate as this one in the hands of someone so incompetent that they're incapable of using google maps.

If you don't think this whole survey reeks of arbitrary bias yet, just wait until you read...

Question 6: Is the location geographically suitable to support easy access to admission in the context of the location of the planned unit at GUH (Galway University Hospital)?

Seeing as we've answered this question three times this should be an easy one...

Oh...I guess not. 

Let's take a beat here, and just think about the implications of this.

 This is a copy of an official document from the HSE, folks, but you'll note it lacks the finesse of copy editing that you'd expect from a state institution, that it denotes a basic obliviousness to the seriousness and sensitivity of this issue. We come to the HSE with a plea to save public services, a plea for compassion, for common sense, for longer term thinking. In response they can't even summon the will to make a basic amendment to a word document. In the same breath, they tell us we're just going to have to trust them when they say these people will be provided for.

We're asking them for the dignity of our service users. And this is what we get it return. It's callous, lazy, and betrays only a disdainful attitude towards some of the most vulnerable people in our country.

But wait. We've got seven more questions to go, maybe we've got it wrong. Maybe we're being hasty. Let's put this question to the HSE at this half time point. It's multiple choice so even the person who clearly can't read a map can participate.

Is the disgraceful handling of this document so far a sign of:

a) Mind blowing ignorance, on the parts of everyone who was involved with the creation and approval of this document

b) Apathy/contempt towards those who are mentally unwell, on the parts of everyone who was involved with the creation and approval of this document

c) Abritrary political bias, on the parts of everyone who was involved with the creation and approval of this document

d) All of the above

And if it's none of the above, could you kindly point out what part of this document ISN'T matched by the above descriptions? We're having trouble seeing it.

It's becoming pretty clear now why Minister Kathleen Lynch will in no way consent to an independent review; even this extremely basic document isn't standing up to scrutiny. We've got seven questions still to go. If you can't wait for our next blog post, you can see them on our facebook page. We'll be analysing the final seven questions here over the coming days. (Edit: You can read part 2 here now).

If we've got the stomach.

GE22 team