Madam, - Dr John Hillery is being less than honest in his appraisal of the evidence that patients brought rapidly in paramedic-staffed ambulances to large centralised hospitals do better ( Head 2 Head, November 5th).
The evidence in fact suggests that the critically ill patient may not get to the large centre of excellence alive and may therefore have a better chance of survival if treated in a local emergency department.
While it is undoubtedly true that certain patients, such as those with multiple trauma, will benefit from this policy, Prof Jon Nicholl of the Medical Care Research Unit of the University of Sheffield has recently shown that mortality among patients with severe respiratory or heart problems rose by 1 per cent for every 10 kilometres travelled by ambulance. The findings were so stark that he suggested the current policy in the UK of closing local emergency departments should be reconsidered.
Commenting in 2006 on the reconfiguration of acute hospital services in the UK, the British Association of Emergency Medicine and the College of Emergency Medicine said: "There is no evidence that any other professionals can manage seriously ill patients without emergency department back-up". They also stated that the safety and effectiveness of paramedics or other health professionals treating the majority of seriously ill patients was still unproven. Prof Nicholl's research appears to bear this out.
Dr Hillery also states that increased specialisation for acute and chronically ill patients is the best way forward. While I accept his argument for certain conditions, research carried out in 2005 by Dr Barbara Starfield, professor of public health at the John Hopkins School of Medicine in the US, revealed that the more general practitioners there are within a given population, the lower the death rate; but having more specialists did not confer a similar benefit and in addition, resulted in a more expensive health system without any improvement in quality.
According to Dr Hillery, big hospitals are best for patient care. In 2003 the Department of Health in Britain published a report entitled "Keeping the NHS Local - A New Direction of Travel". One of its key messages was that the mindset "biggest is best" needed to change. I note with some pride that obstetric patients recently voted our small hospital number one for obstetric care in the country.
The health service our people deserve has failed to materialise. This is not because members of the public, politicians or local hospital doctors protest at the closure or downgrading of certain hospital services. It is in part a result of politicians, lay public members of health societies and respected members of the medical profession not being wholly honest about the findings of international health care research - or, at the very least, failing to have a balanced view about such research.
It is also because members of the professions in small and medium hospitals have not been given an equal voice in assisting the development of health policy. For example, there was not one medical doctor from such hospitals on the National Cancer Forum that produced the National Cancer Strategy.
Health "reforms" that deny people involvement in debate about such reforms and deny patients timely access to appropriate care are leading us in the wrong direction. Hence the recent, entirely legitimate protests in Sligo, Castlebar, Ennis and Monaghan. - Yours, etc,
Dr JOHN BARTON, Physician/Cardiologist, Portiuncula Hospital, Ballinasloe, Co Galway.