‘Fragmented and unpredictable’: Healthcare services failing island communities
Broken down ambulances, no storage for supplies and outdated clinics among a litany of healthcare provider concerns.
MAKING SURE THAT you don’t forget your life jacket and wellies, and worrying if there will be a “hurricane squall” making your commute impossible, are not normal concerns for your average GP.
But they are for Noreen Lineen-Curtis, who, weather-permitting, serves the needs of the 165 Clare Island residents every Wednesday, as well as Inishbiggle off Achill in Co Mayo that she accesses on a currach.
Then there are the nights “having to jump in the lifeboat and tear out across the bay” in emergency situations. “I suppose it’s not your normal job,” reflected Lineen-Curtis, but she wouldn’t change it for the world.
“I love the people, they’re fabulous. I wouldn’t work anywhere else. You know them all so well. You build up a really good relationship with them over the years. It’s more like a big family. I love it.”
It is not all rosy, however, as Lineen-Curtis has a raft of concerns about the condition of the health centre, lack of storage for vital equipment, and the absence of emergency transport on the island.
And she is not alone in her concerns, with engaged community members on other islands also banging the drum over concerns that services are shrinking as populations start to decline.
- This article is part of the ISLAND NATION series by Noteworthy, the crowdfunded community-led investigative platform from The Journal, examining depopulation concerns on our offshore islands.
Not your average doctor
Lineen-Curtis is one of a handful of doctors who work on the mainland and visit islands on a regular basis to hold clinics or deal with emergency situations.
The importance of the role played by Lineen-Curtis and other GPs was recognised in a 2017 HSE review of primacy care services for the islands as they provide “a much broader range of services to their patients”.
But they are up against it, with the HSE review pointing to a “fragmented and unpredictable service” where healthcare professionals are working “extremely hard to provide a holistic high quality service with inadequate resources”.
This is certainly true on Clare Island, according to Lineen-Curtis. Her main concern is the condition of the health centre that includes accommodation for a nurse, and transport on the island.
Back of the van
While the island is well serviced for medical evacuation, the journey to the lifeboat or helipad is not so secure as there is no specialised vehicle on the island. Instead, Lineen-Curtis and the nurses rely on islanders.
“When we have an emergency, every time it’s the same: ‘Okay, who’s got a van, hike all the tools out, [and] get a patient on the stretcher into the back in the dark’.”
This summer, for example, Lineen-Curtis said that a lady came off her bike, broke her hip and “had to be transported in agony” to the helipad in the back of a van, while a nurse used the light on her phone to keep an eye on the injury until the helicopter arrived.
“In this day and age, that’s just simply not humane. It’s not adequate,” said Lineen-Curtis. “We need a decent Jeep with accessibility for a stretcher. It’s not rocket science and I’ve been beating this drum for the last 10 years.”
The HSE did not respond to our request for comment on this issue and if plans are in place to improve the transport services on the island.
Constant need of repair
Other islands are facing similar issues, including Arranmore off the Donegal coast. According to John McCafferty, manager of the island’s community co-operative and volunteer emergency medical technician (EMT), islanders have been crying out for a new ambulance without any answer.
The current vehicle is an older model brought over from the mainland, where, McCafferty said, it frequently ends up for weeks at a time for repair work.
According to the National Ambulance Service, operated by the HSE, the ambulance has been brought to the mainland for repairs six times in the last four years, including twice last year.
This is “a big issue”, McCafferty said, as the large island can have up to 50 medical evacuations a year. When the ambulance isn’t working or is off the island for repairs, there is no choice but to improvise.
This included carrying a stroke patient in the back of his van to the waiting helicopter, as well as tow-starting the ambulance to get a heart-attack patient safely to the lifeboat, he said.
“The list of both dangerous and embarrassing times we have had to do this is growing and we have had enough… We’ve been fighting to update the ambulance for a couple of years now.”
In a statement, the HSE confirmed that the National Ambulance Service currently has no short-term plans to replace the existing vehicle on Arranmore Island.
Arranmore is also down a public health nurse after one of the two on the island retired last year to be replaced by a community-registered general nurse (CRGN) based on the mainland and responsible for child development and screening.
McCafferty said the community was promised a new public health nurse within a year, with no action to date – an “unacceptable” situation, he said.
A HSE spokesperson told us that the full-time community registered nurse “is suitably qualified and competent to meet the demand for the nursing needs of the population of 450 people” and that there is “currently no plan to recruit a Public Health Nurse”.
“The registered nurse works alongside the Palliative Care team and the Enhanced Community Care team as required to bring the best care to this population group. There has been no decline of services on the island,” they added.
‘Not fit for purpose’
Back on Clare Island, Lineen-Curtis has also raised concerns with the conditions of the health centre itself. While the facility may have been suitable at some point in the past, it’s now “completely outdated [and] completely unfit for purpose”, Lineen-Curtis told us on our visit to the island.
“We’re incredibly lucky that we have two amazing nurses from the island but once they retire, the centre is not fit for somebody living in it right now. It’s not suitable,” she said.
“The centre is in dire dire need of an upgrade,” she said, airing her frustration in an email to HSE regional staff last October as the clinic was freezing with no functioning radiators. When Noteworthy visited the island in mid-November, Lineen-Curtis was using electric heaters to heat the clinic.
A spokesperson for the HSE told Noteworthy that extensive external insulation works were completed at the end of 2022 along with repairs to resolve heating issues, with the GP “involved in the discussions at all stages”.
Lineen-Curtis confirmed that the heating issue was “finally repaired” but that she has emailed various times about proposed renovations to the centre without any reply. “The place is not fit for purpose but they are not listening,” she added.
Storage space non-existent
Another issue is the lack of storage, with “an awful lot of equipment” stored in the parish house a few miles away, according to Lineen-Curtis, who wants a storage shed built on-site.
When items arrive on the ferry they are collected and brought to the house by a nurse. Then, if an item is needed by a patient at the clinic, the entire process has to be repeated.
The HSE, Lineen-Curtis said, has “completely flat out” refused to entertain the idea, even a “shed big enough just to take all the stuff that’s big and bulky” like mobility walkers.
When HSE staff visited in July last year, she raised the issue and followed up on several occasions via emails, seen by Noteworthy, in which she asked for plans of the site to draw up a “more definite proposal” for the storage unit.
Airing her frustrations at a lack of any progress in August 2022, she said “the entire situation is completely unsuitable” with space available at the side of the centre for a sizeable shed that “needs to be put in place as soon as possible”.
The HSE told her that, while a good idea, the area suggested is over the current septic tank due for replacement and said that an alternative solution would have to be found.
In a statement, the HSE said that it plans to install a wastewater treatment plant and internal renovation works this year once funding is approved.
These works, it said, “should address the ongoing issues that have been highlighted in relation to storage”, adding that Lineen-Curtis will “be included in further discussions prior to the internal renovation works being agreed and completed”.
Progress to date
Recommendations that came out of the HSE’s review in 2017 are set to resolve many island healthcare issues. Through a Freedom of Information (FOI) request, we received details of progress with recommendations in the plan – and progress has been slow.
The HSE uses a traffic light system to track progress with the recommendations – green for significant progress, orange for tasks in progress and red where significant work is still needed.
In June 2022, just under half of the 70 recommendations were in the red, including ensuring that all HSE premises on the islands “should be fit for purpose” and carrying out a review of transport of patients on islands.
Other areas that required significant work related to medication management, emergency care and support for people with long-term mental health conditions.
However, 21 of the action points in the red last summer are now showing significant progress and are listed as green, according to a January update provided by the HSE.
This includes developing island health action plans, regular meetings on islands, supporting people with mental health conditions, developing major accident plans for individual islands and improved connectivity services for healthcare staff.
The HSE spokesperson said that work is ongoing across the island service project with “significant levels of collaboration and co-operation through local and national organisations and beyond”.
“The recommendations of the Islands Report are dependent upon a range of other factors such as broadband availability, Sláintecare reform programme and digital advances,” they said, adding that “island progress will develop in tandem with these”.
Glimmer of light shining through
There has been great progress on some important recommendations, such as e-health services. This is particularly important as the logistical difficulties of leaving islands pose significant barriers to accessing mainland health services.
The HSE, for example, is involved in the Home Health project on Clare Island, launched by the University of Galway last September. The project is combining video consultations from health pods at the island’s community centre, with remote sensor monitoring for the likes of blood pressure.
According to Ian McCabe, a NUI Galway medical engineering researcher and Clare island native involved in the project, it is a real game-changer for islanders – including his 80-year-old father.
“He has a track worn between Clare Island, Castlebar and Galway to see various consultants. He leaves here, maybe a day or two beforehand depending on the weather and stays on the mainland for two, three, maybe four days and then comes home – having seen the consultant for five minutes.”
His father’s most recent appointment with a diabetic consultant took place in one of the island pods and lasted 20 minutes. “He was home having his tea by 11 o’clock”, according to McCabe.
Lineen-Curtis is also fully behind the project as patients get the full services of consultants without the hassle of getting on a boat and spending days on the mainland. Instead, they can just “go into the hub, switch on the screen and go ‘Hi, Dr. so and so’… it’s fantastic”.
Yet, for the GP, there is still the reality of the issues faced with the the bread and butter day-to-day healthcare service on the island that need to be resolved before islanders can get the true medical support that they deserve.
“It’s not for me, it’s not for my benefit, I’ll be retired in 15 years time. But for the patients on the island, they deserve better and their children and their grandchildren deserve better.”
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By Niall Sargent of Noteworthy
This article was developed with the support of Journalismfund.eu as part of a cross-border project with Jamie Mann for The Ferret in Scotland and Giacomo Zandonini for IrpiMedia in Italy.
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