Tag Archives: Barnmeen

07.30.19
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Clinical evidence proves the importance of ‘Golden Hour’ in Emergency Stroke care

The effectiveness of stroke treament within the ‘Golden Hour’ is well documented in clinical research and in the stroke treatment community. (Hussain, M.S.(2018); Fassbender, K.et al (2013); Saver, J.(2006,2010)

Clinical evidence proves the importance of the ‘GOLDEN HOUR’ in Emergency Stroke care, but ‘Golden Hour’ is not recognised by Department of Health (DoH).

It is well known that STROKE is a 999 EMERGENCY where every second counts for the patient receiving acute stroke care and the critically time dependant clot-busting drug Alteplase used in Thrombolysis.

The options given in the 2019 Stroke consultation show clearly that the Department of Health NI are IGNORING the fact that every stroke patient, no matter where they live, needs to be seen and treated as an Acute Stroke Care 999 Emergency ideally within the ‘Golden Hour’. This means making pre hospital travel times as SHORT AS POSSIBLE, so that the patient can ideally be treated within the ‘Golden Hour ‘from onset of stroke to needle time.
Rather than make pre-hospital travel times SHORTER, the DoH are proposing to make pre hospital travel times LONGER for patients living in Newry Mourne & Down and other areas in NI.

Stroke patients who presently are scanned in Daisy Hill (and if eligible) given Thrombolysis are already immediately transferred to the Royal for Thrombectomy if suitable.

If 2019 Reshaping Stroke Care proposals go ahead, dying stroke patients WILL BE DENIED IMMEDIATE TREATMENT and have to be transferred to Craigavon, 45 minutes away (to see if they are even suitable for Thrombolysis, never mind Thrombectomy) and will have much worse outcomes due to the delay in transfer and will be denied the best chance for survival.

TIME DELAY IN GETTING 999 EMERGENCY CARE IS NOT ACCEPTABLE

It is not acceptable that people from the Rural Areas of NI who will already have travelled long distances to access existing specialist Stroke Units, (using up precious minutes of the ‘Golden Hour’ already) will have to travel even FURTHER, losing vital brain cells and causing untold brain damage on the journey. It also means that patients who suffer a stroke when in hospital or ED will be denied access to the existing specialist Acute Stroke/Rehab Unit in Newry and denied immediate treatment.

WHY IS THE FIRST HOUR TERMED ‘GOLDEN’?

The Golden Hour in stroke is well supported by Clinical Evidence

The effectiveness of treatment in the GOLDEN HOUR is well documented in the emergency medicine and stroke treatment community, even if our DoH refuse to recognise the term ‘Golden Hour’ in the recent FAQ/ Frequently asked Questions supplement to the consultation document (see FAQ5).

It is well known that patients receiving treatment within the first 60 minutes of symptom onset, (termed the Golden Hour,) have the greatest opportunity to benefit from restoration of blood flow therapy with respect to disability and living independently. This time-frame is when the volume of salvageable brain and the patient’s capacity to benefit from clot-busting therapy are greatest.
The reason the first hour of stroke is called ‘golden’ is because stroke patients have a much greater chance of SURVIVING and avoiding long-term brain damage if they arrive at the hospital and receive treatment with a clot-busting drug called TPA (Altepalse) within that first hour from onset of stroke:

“Therapeutic benefit is maximal in the first minutes after symptom onset and declines rapidly during the next 4.5 hours.” (Saver MD)

DoH DO NOT RECOGNISE THE TERM ‘GOLDEN HOUR.’

The DoH try to justify selectively making Stroke patients travel further for immediate Emergency Stroke Care during the ‘Golden Hour’ from onset of stroke in Newry Mourne & Down by stating that: “the Golden Hour is not a recognised term in Stroke Care. In our healthcare system we work to the National Clinical Guidelines for stroke, which is the definitive source of how stroke care should be delivered in the UK.”

It is the DoH’s opinion that: “The most important factor in stroke care is not the time to hospital. It is the time to expert assessment, brain scanning and treatment that is critical.” (See FAQ 5:Taken from Questions and Answers Supplement to 2019 Stroke Consultation).

The Golden Hour in stroke is well supported by Clinical Evidence

CLINICAL EVIDENCE SUPPORTING IMPORTANCE OF ‘GOLDEN HOUR’

At the International Stroke Conference 2018 in Los Angeles M. Shazam Hussain, MD, Director of Cleveland Clinic Cerebrovascular Center presented significant findings that the “golden hour” is proving to live up to its name, even for patients with one of the most serious forms of ischemic stroke.

According to this study, 52 percent of individuals suffering an ischemic stroke had better long-term outcomes if they received Thrombolysis medication (Alteplase) within 60 minutes of symptom onset. This compares to only 27 percent of patients showing good long-term outcomes – with respect to disability and living independently — if administered Alteplase beyond the golden hour.

A summary of The Lancet article (2013): ‘Streamlining of pre-hospital stroke management: the golden hour’ reinforces the importance of the narrow time-frame or ‘Golden Hour’:

“Thrombolysis with Alteplase administered within a narrow therapeutic window provides an effective therapy for acute ischaemic stroke. However, mainly because of prehospital delay, patients often arrive too late for treatment, and no more than 1–8% of patients with stroke obtain this treatment.

We recommend that ALL LINKS in the PREHOSPITAL STROKE RESCUE CHAIN must be optimised so that in the future more than a small minority of patients can profit from time-sensitive acute stroke therapy.”

The Lancet article (2013)

Therefore pre-hospital travel time for the Newry Mourne and Down population should also be shortened, not lengthened, in receiving 999 Emergency Stroke Care to save lives with better outcomes.

  • Just as in the Western Trust (with a total population of 301,448*) there is need for TWO Specialist Acute Stroke Units - so too, the Southern Trust (with a larger population of 380,312*) is also entitled to TWO Specialist Stroke Units (HASUs and Acute Stroke Units), at Daisy Hill Hospital, Newry and Craigavon Hospital. This would ensure that everyone in the Southern Trust has immediate access to CT scanning and life saving thrombolysis, followed by direct access into a stroke unit.
  • Act FAST Stroke - HyperAcute Stroke Unit for Newry 2019

DAISY HILL, NEWRY IS THE RIGHT PLACE FOR A HYPERACUTE STROKE UNIT – A VITAL OMISSION FROM THE 6 PROPOSED 2019 STROKE CONSULTATION OPTIONS

Newry Mourne and Down – with a population of 180,000 is the third largest Local Government District population in NI. Daisy Hill Acute Hospital, Newry City with its STRATEGIC LOCATION – is the right place, entitled to have a hyperacute stroke unit co-located with an acute stroke unit.

This option will give a fair and equitable chance of survival with better outcomes for dying stroke patients in this LGD, like the population attending the Royal, Altnagelvin and Craigavon.

‘TIME LOST IS BRAIN LOST.’

The Emergency Stroke Care “Golden Hour” is already a very narrow time-frame. Additional delay in pre-hospital travel times which the DoH are selectively imposing on the Rural Catchment population of Newry Mourne and Down will cost lives, not save saves and cannot be condoned.

The population is entitled to fair and equitable treatment, so this proposal to withdraw emergency and specialist acute stroke care from the combined Specialist Acute Stroke/Rehab Unit, which has existed since pre-2003 in Daisy Hill Acute Hospital, Newry, must be challenged!

You can follow the Daisy Hill Acute Hospital campaign also by visiting and liking our Facebook page at https://www.facebook.com/daisyhillforlife/ – Thank you.

© Daisy Hill for Life on Facebook and http://www.savedaisyhillhospital.com, 2015 – 2021. We welcome sharing of this info and the use of excerpts and links, provided that full and clear credit is given to http://www.savedaisyhillhospital.com and Daisy Hill for Life with appropriate and specific direction to the original content. Thank-you!

07.20.19
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Largest rural population in NI: Newry, Mourne and Down Local Gov. District must have immediate access to life saving 999 Emergency Stroke Care

Withdrawal of immediate access to life saving 999 Emergency Stroke Care, including direct admission into the existing specialist Acute Stroke Unit from Newry, Mourne & Down Locality is not fair and equitable treatment. Under the Rural Needs Act (NI) 2016 due regard must be given by Public Authorities to the needs of rural populations to fairly access key public services. This includes immediate, not delayed access to hospital stroke care. The largest rural population is in Northern Ireland is in Newry, Mourne & Down Local Government District which includes South Armagh.

Under the Rural Needs Act (NI) 2016 due regard must be given by Public Authorities to the needs of rural populations to fairly access key public services. This includes immediate, not delayed access to hospital stroke care.

The largest rural population is in Northern Ireland is in Newry, Mourne & Down Local Government District which includes South Armagh.

Since 2018, the Rural Needs Act 2016 (NI), which aims to deliver fairer and more equitable treatment in Rural areas, must be adhered to by all Public bodies in NI. Because of this, the Dept. of Health filled in a Rural Needs Assessment Form to accompany the 2019 NI Stroke Consultation.

Definition of Rural in Rural Needs Assessment Form

On this form, the definition of “Rural” which according to the DOH “is better able to distinguish between those who will be MOST IMPACTED by additional travel times caused by proposed changes to services is:
“Populations outside of a 30 minute drive time of Derry/Londonderry or Belfast”

Using the above definition confirms that the 5 Urban hospitals in the Stroke Consultation 2019 are:
Altnagelvin, Royal Victoria, Craigavon, Antrim and Ulster hospitals,
while there are only three Rural Acute hospitals:–
Daisy Hill, Newry, Causeway Hospital, Coleraine and South West Hospital, Enniskillen.

The DoH’s reply to Question 2B in the Rural Needs Assessment states:

“The key impact that differently affects rural dwellers is likely to relate to travel times to hospital etc.” They continue:
“ALL OF THE OPTIONS outlined in the consultation document INCLUDE the provision of hospital care” at “Altnagelvin, Craigavon and Royal Victoria Hospital” (all URBAN Sites.) “Therefore people living in the catchment areas for these three sites WILL NOT experience any increase in respect of travel times. Under the potential options, people living in the catchment areas for Causeway Hospital and Daisy Hill Hospital, WOULD experience an INCREASE in journey times if taken to hospital after a suspected stroke.”

INCREASE IN JOURNEY TIMES AFTER A SUSPECTED STROKE FOR RURAL CATCHMENT AREAS

From research by Werner Hacke, MD It is known that the drug “Alteplase” used in Thrombolysis, is nearly twice as effective when administered WITHIN the first 1.5 hours after stroke as it is when administered 1.5 to 3 hours after stroke.

Yet, The DoH have admitted, above, that there WILL BE AN INCREASE IN JOURNEY TIMES for people living in the Rural Catchment areas of Causeway and Daisy Hill hospitals, and that people living in the Urban catchment areas of Altnagelvin, Craigavon, and Royal Victoria hospitals WILL NOT experience any increase in respect of travel times.

They have decided also to WITHDRAW COMPLETELY the existing stroke units in the Rural Locations of Daisy Hill Acute Hospital, Newry and Causeway Hospital, Coleraine. This proposal means dying stroke patients from these Rural localities will have to TRAVEL FURTHER for the CRITICALLY TIME DEPENDENT, LIFE-SAVING drug Alteplase used in Thrombolysis, and direct access from ED into the existing combined Specialist Acute/Rehabilitation Stroke Units in Daisy Hill, Newry, and Causeway Hospital, Coleraine, essential to save lives.

Daisy Hill Hospital Emergency Department is vital for stroke and life threatening emergencies

The 3 Urban Hospitals Altnagelvin, Craigavon, and Royal Victoria will never experience an increase in travel times because they feature in all 6 Options in the 2019 Stroke Questionnaire to be upgraded to Hyperacute stroke units with co-located Acute Stroke Units.

RURAL HOSPITALS OF DAISY HILL AND CAUSEWAY OMITTED FROM ALL SIX OPTIONS

However the two Rural hospitals of Daisy Hill and Causeway have been omitted altogether from all six options, confirming they will be shut down as if they never existed as part of the network providing 999 Emergency Stroke care to the population of NI.

THERE ARE NO RURAL HOSPITALS INCLUDED IN ALL 6 OPTIONS FOR HYPERACUTE AND ACUTE STROKE UNITS.

The DOH forget that Rurality is a factor in allocating Health and Social Care Funding which means that there is extra money to provide services in Rural areas which should be taken into account in deciding where stroke Units will be provided.

*********RURAL NEEDS ACT (2016)*************

To have Three Hyperacute stroke units for Urban Areas of NI in all 6 Options and NO Option for a Hyperacute Stroke Unit for the Catchment population for the LARGEST RURAL POPULATION in NI namely Newry, Mourne & Down (which includes S.Armagh) Local Government District is NOT FAIR AND EQUITABLE TREATMENT in revising policies, strategies and plans, and designing and delivering public services such as Acute Stroke Care under the 2016 Rural Needs Act.

The Rural Needs Act NI 2016, (which is not a devolved matter) is there to PROTECT the Rural Population from this unfair treatment and “can relate to the ability to access key public services such as health, the ability to access suitable employment opportunities, and the ability to enjoy a healthy lifestyle”.

NEWRY MOURNE & DOWN LOCALITY SHOULD ALREADY HAVE A MAJOR ACUTE HOSPITAL

Just as in the Western Trust (with a total population of 301,448*) there is need for TWO Specialist Acute Stroke Units - so too, the Southern Trust (with a larger population of 380,312*) is also entitled to TWO Specialist Stroke Units (HASUs and Acute Stroke Units), at Daisy Hill Hospital, Newry and Craigavon Hospital. This would ensure that everyone in the Southern Trust has immediate access to CT scanning and life saving thrombolysis, followed by direct access into a stroke unit.

There is no doubt that Newry Mourne and Down LGD with the largest Rural population in NI with 179,000 people, SHOULD ALREADY have a major acute hospital, in Newry as proposed by Secretary of State Peter Hain in 2005.

This Stroke consultation shows that the Department of Health are not even prepared to give dying stroke patients from the largest rural Population in NI, the basic essential need of immediate access to Emergency Stroke Care.

The Rural catchment population for Daisy Hill Acute Hospital, Newry, is not being treated fairly and equitability in the same way as the catchment population of the Urban Stroke Units in Altnagelvin, Craigavon and Royal Victoria Hospitals who will have immediate access, as they should, to life saving stroke care, in Hyperacute and Acute Stroke Units without having to travel further than at present.

This deliberate plan to exclude the Rural populations need for IMMEDIATE, not delayed, access to life saving Emergency Stroke Care, including CT scanning and Thrombolysis, followed by direct access into a specialist Hyperacute Stroke Unit /Acute Stroke Unit will COST LIVES, not save lives of Stroke patients and should not be condoned.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BACKGROUND INFO
Link to Rural Needs Act 2016
https://www.legislation.gov.uk/…/19/pdfs/nia_20160019_en.pdf

“RURAL NEEDS ACT (NORTHERN IRELAND) 2016
Duty of public authorities to have due regard to rural needs
1.(1) A public authority must have due regard to rural needs when— (a) developing, adopting, implementing or revising policies, strategies and plans, and (b) designing and delivering public services.
6. In this Act— “the Department” means the Department of Agriculture and Rural Development; “rural needs” means the social and economic needs of persons in rural areas.”
‘PUBLIC AUTHORITIES’ include:
A Northern Ireland department
A district council
A Health and Social Care Trust
Invest Northern Ireland
The Regional Agency for Public Health and Social Well-Being
The Regional Health and Social Care Board

04.14.19
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QUESTION OF TRUST – comparing Southern and Western Trust’s Stroke Proposals for NI

Just as in the Western Trust (with a total population of 301,448*) there is need for TWO Specialist Acute Stroke Units - so too, the Southern Trust (with a larger population of 380,312*) is also entitled to TWO Specialist Stroke Units (HASUs and Acute Stroke Units), at Daisy Hill Hospital, Newry and Craigavon Hospital. This would ensure that everyone in the Southern Trust has immediate access to CT scanning and life saving thrombolysis, followed by direct access into a stroke unit.

One of the Functions of the Southern Health and Social Care Trust under the 2006 Establishment Order is to PROVIDE SERVICES – (not take away existing services) to the population of the five former Local Government Districts (LGD)s  or Localities of            (1) Newry & Mourne LGD  (105,161); (2)Craigavon LGD (100,310); (3)Armagh LGD (62,427); (4) Dungannon LGD (62,149) and (5) Banbridge LGD (50,265).

The Southern Trust have a duty of care to plan provision of services in equal measure to all 380,312* people under their care.

Proof that the future configuration of Hyperacute and Acute stroke Units in the Northern Ireland Stroke Consultation Document 2019 was decided not only by the Department of Health, but also by all of the Health Trusts in NI,  can be seen from the Western Trust website which states:-

‘Speaking ahead of the meeting of the Western Trust Board this week, Dr Anne Kilgallen, Western Trust Chief Executive said:

“The Department of Health is leading on the Stroke Consultation and all Health and  Social Care Trusts have been actively involved in the discussions in preparation. We in the Western Trust are very pleased that both the South West Acute and Altnagelvin Hospitals are part of the options being considered.”‘

If only it could be said that the Southern Trust were also actively involved in discussions and preparations to make sure that the existing Specialist combined Acute Stroke /Rehabilitation Unit in Daisy Hill, Newry City (in the largest locality in the Southern Trust) was being put forward as a vital Hyperacute Stroke Unit, co-located with an Acute Stroke in the future network of specialist Stroke Units in NI.

Compare how inclusively the Western Health and Social Care Trust have reassured their staff and population of 301,448*, that they are doing their best to retain and enhance their TWO ACUTE STROKE UNITS in Altnagelvin Hospital in Derry and the South West hospital in Enniskillen, with the Southern Trust’s approach.

The Southern Trust (SHSCT), has consistently pushed forward at every opportunity, removal of vital life saving stroke services from Daisy Hill, out of reach to Craigavon in their Centralisation Programme of all specialist services to Craigavon.   (Even the 2016 Bengoa Report’s only Local Case Study promoted SHSCTs proposal to centralise all Stroke services to Craigavon and remove them forever from Daisy Hill, Newry City).

Because of this, Daisy Hill Acute Hospital, Newry City specialist combined Acute/Rehabilitation Stroke Unit, (in the largest of the five Local Government Districts in the Southern Trust), does not even warrant a mention on the list of options given in the Northern Ireland Stroke Consultation 2019.

A HASU and ASU is proposed for Craigavon, not on one, but on ALL SIX OPTIONS. It is clear from this, that nobody seems to have spoken out for provision of Stroke services in NEWRY CITY.

It also shows that the SHSCT are proposing to continue with their plans to withdraw existing life saving specialist Acute Stroke and Stroke Rehabilitation Services from Daisy Hill Acute Hospital, without making any provision of a NEARBY alternative Specialist Stroke Unit. They are required to do this under equality of access to provide EMERGENCY timely life saving specialist services e.g. CT scanning, thrombolysis, etc and acute Stroke Rehabilitation.

CONCLUSION

Just as in the Western Trust (with a total population of 301,448*) there is need for TWO Specialist Acute Stroke Units – so too, the Southern Trust (with a LARGER population of 380,312*) is also entitled to TWO Specialist Stroke Units (HASUs and Acute Stroke Units).

This would ensure that everyone in the Southern Trust has, as they have at present, immediate access to CT scanning and life saving thrombolysis, followed by direct access into a stroke unit – the stroke pathway recommended by The Royal College of Physicians for better outcomes.

>The Southern Trust need at this stage to speak up for ALL the population they are duty bound to provide specialist stroke services for in the future stroke network in Northern Ireland, in the same inclusive manner as the Western Trust.

*NISRA 2017

Southern Trust population 380,312 : Western Trust population 301,448  : NISRA 2017

Sources: http://www.westerntrust.hscni.net/about/3857.htm

04.04.19
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NI Stroke Consultation: Presenting an extra Option to include the EXCLUDED populations

Q6 SUGGESTED ANSWER : 5 Hyperacute Stroke Units (HASUs) and 5 Acute Stroke Units (ASUs) at 5 acute hospitals in NI at: (1)Royal Victoria, Belfast; (2) Daisy Hill Hospital, Newry, (3)South West, Enniskillen (4)Altnagelvin, Derry and (5)Causeway Hospital, Coleraine. This option is based on existing acute stroke units that already give specialist CT scanning and Thrombolysis.This option offers timely equality of access to these necessary specialist stroke services more evenly distributed across NI to include the rural population - ignored in the consultation. NI Stroke Consultation 2019: Presenting an additional Option to include all the excluded populations of Northern Ireland.

The NI Stroke Consultation: Reshaping Stroke Care – Saving Lives, Reducing Disability 2019 asks for the public’s agreement to choose an option between 6 possible options of future configuration of both hyperacute and acute stroke units in Northern Ireland (NI) even though many local Government Districts are excluded.

In these proposals, two existing stroke units in acute hospitals at Daisy Hill Hospital in Newry City and Causeway Hospital in Coleraine have been completely EXCLUDED from ALL possible Options to choose in the Consultation Questionnaire, and isolated from the process completely.

ALTNAGELVIN, CRAIGAVON AND ROYAL VICTORIA HOSPITALS SELECTED IN ALL OPTIONS

Altnagelvin, Craigavon and Royal Victoria Hospitals are proposed in every one of the 6 Options, which means the future of these three stroke units is perceived as definitely secure whatever happens.

These three stroke units may be recruiting on the strength of this, while other units and their staff are left out in the cold, despite actively participating in the Pre-Stroke Consultation in 2017, where they were assured that no decisions had been made.

Redress the unbalanced NI Stroke Consultation 2019 - additional Options needed to include the Excluded populations.

RESEARCH BIAS

The approach in the Questionnaire is considered bad practice in Research as the occurrence of the same 3 hospitals in all 6 Options shows bias and favouritism and employment unions may be alerted that this is a failure to follow due process in Employment Law.

This bias renders the whole Consultation invalid as the topic deals with the Change and Withdrawal of existing public services in hospitals, which are paid for using Public Money.

TIMING OF CONSULTATION

The timing of this Consultation is also called into question as it was timed at the same time as the recess for forthcoming Council Elections. This leaves populations without access to advice from full sitting Councils and Council reps on local Health Boards. Therefore the Consultation must be extended beyond the statutory 3 months consultation period to allow Newry, Mourne and Down Council Representatives and other Councils in other areas to make a response on behalf of their electorate.

NEWRY, MOURNE & DOWN COUNCIL – NEEDS A HYPER ACUTE STROKE UNIT & AN ACUTE STROKE UNIT IN DAISY HILL HOSPITAL, NEWRY

>Newry Mourne and Down Council – has the 3rd highest council population in NI of  179,000 people (of which 105,300 residents live in rural areas ). If any of the Six pre-selected Options in the Consultation are chosen – this entire local government district will be left with NO Hyperacute or acute stroke /Rehabilitation Units and no timely access to Thrombolysis.

This deliberate plan to remove without a trace the existing designated Daisy Hill Acute Hospital combined Specialist Acute + Rehabilitation Stroke Unit is deplorable, and a public health injustice which cannot be condoned. (Stroke services are assured in Derry City and Strabane Council with a population of 150,500 with only 49,900 people living in a rural area.)

OPPORTUNITY & HOPE

Despite all these issues – there is STILL an opportunity for our excluded populations to put the best case forward for their existing Stroke Units. The only positive aspect of the Reshaping Stroke Consultation 2019 is that we have been given the opportunity to answer Q.6 with additional options

PRESENTING A NEW OPTION TO INCLUDE ALL N.I.

The answer as shown in the graphic is suggested for public consideration. In the Consultation Questionnaire Q. 6 asks: “Are there additional options that we have not considered?”

Q6 SUGGESTED ANSWER : 5 Hyperacute Stroke Units (HASUs) and 5 Acute Stroke Units (ASUs) at 5 acute hospitals in NI at: (1)Royal Victoria, Belfast; (2) Daisy Hill Hospital, Newry; (3) South West, Enniskillen; (4) Altnagelvin, Derry and (5) Causeway Hospital, Coleraine.

This option is based on existing acute stroke units that already give specialist CT scanning and Thrombolysis. This option offers timely equality of access to these necessary specialist stroke services more evenly distributed across NI and to include the rural population – ignored in the consultation.

In this option Antrim, Craigavon (a satellite town of Belfast) and Ulster Hospital, Dundonald – are all within 30 minutes motorway journey of Belfast and can advantageously avail of both Thrombolysis + Thrombectomy in the Royal Victoria Regional Hospital (already confirmed as having a HASU and an ASU).

Daisy Hill Acute Hospital (DHH) Newry City is in a strategic location where patients from Banbridge (approx 15mins travel from Newry City) and South Armagh and Down can avail of timely access to specialist stroke services (scanning and Thrombolysis ) in Daisy Hill (DHH) Hyperacute Stroke Unit + Rehabilitation in DHH Acute Stroke unit.

CONCLUSION YOUR LAST CHANCE to air your views in support of Daisy Hill specialist stroke unit.

The most meaningful way we can put the best case forward for the existing Daisy Hill combined Specialist Acute Stroke/ Rehabilitation unit and its dedicated staff in the Reshaping Stroke Consultation is by taking our time to respond to the questionnaire (including answering Q6).

Don’t give any rushed answers – the closing date is not until June 2019, and you can only submit one response each.

It should also be noted that the Complete Online Form’ button, and online form is set up to force people to choose one of those six options – which all mean the end for the stroke units in Daisy Hill Hospital and in Causeway Hospital. 

WE CAN and have the right to CHALLENGE these decisions and the options given and put the best case forward for RETENTION and ENHANCEMENT of Daisy Hill existing acute stroke rehab unit and its specialist services to ensure its rightful place in the network of stroke services in NI for the LONG TERM FUTURE.

More posts relating to the Stroke Consultation coming here soon and on: https://en-gb.facebook.com/daisyhillforlife/

The united community of Newry and Mourne and South Armagh will work together to ENHANCE stroke services in Daisy Hill Acute Hospital

© Daisy Hill for Life on Facebook and http://www.savedaisyhillhospital.com, 2015 – 2021. We welcome sharing of excerpts & links, provided that full and clear credit is given to http://www.savedaisyhillhospital.com and Daisy Hill for Life with appropriate and specific direction to the original content. Thank-you!

 

12.16.18
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2 NEW CT SCANNERS required NOW for Daisy Hill Acute Hospital ED

2 CT Scanners for Daisy Hill Hospital Newry city now

The Southern Trust needs to act at once to provide 2 CT Scanners as part of the VITAL diagnostic imaging services in Daisy Hill Acute Hospital, Newry city to meet their statutory duty of care and honour the promises they made in official statements (during the 2014 Stroke Consultation).

It is imperative that a NEW permanent replacement CT scanner and a second NEW CT scanner get Commissioner Approval and are installed AT ONCE in Daisy Hill Acute Hospital to give access to life saving DIAGNOSTIC treatment to save the lives of stroke and heart patients and for other medical emergencies.

IMAGING REVIEW

The Imaging Review Consultation stated the need FOR TWO CT scanners in 24/7 Emergency Departments to ensure resilience when one scanner breaks down so that another one is readily available – when patients URGENTLY need a CT scan.

Every second counts in getting a CT scan to save patients lives and give better outcomes for stroke and heart and other critical medical conditions.

CT SCANNING NEEDED TO CONFIRM TYPE OF STROKE – whether bleed or clot.

computer-tomography-image - CT scanner for Daisy Hill Hospital 2018

 

Major research into the Stroke pathway confirms the importance of diagnostic CT scanning to eliminate brain bleed for suitability for thrombolysis.

The Southern Trust needs to use the same urgent priority planning to address the needs for provision of imaging services for the Newry & Mourne population (the largest locality population in the Southern Trust), as well as addressing the needs of the Craigavon population, which has only the second largest Locality population in the Southern Trust.

In Craigavon, as the Trust Delivery Plan shows, advanced plans are already in place, with Commissioner Approval, for 2 NEW CT scanners, a new twin CT screening room and 1 more NEW MRI scanner. (Two NEW MRI scanners were already installed in Craigavon Hospital in 2014 and 2015).

REFRESH SOUTHERN TRUST IMAGING PLANS

The promises made in a series of official statements, three of which are detailed below, cannot be honoured by the Southern Trust without the provision of continuous CT scanning facilities in Daisy Hill ED, Newry City.

These promises can only be kept if the Southern Trust plan well in advance for replacement CT scanners so that the 7 year Royal College of Radiologists (RCR) recommended replacement timescale for functional life of a CT scanner is adhered to in Daisy Hill, in the same urgent manner as imaging services are planned for in Craigavon Hospital.

The Southern Trust’s IMAGING Plans must be refreshed to change the designated “non priority” for replacement of Daisy Hill’s existing CT scanner to “CAPITAL PRIORITY” and for a second new CT Scanner also as a “Capital Priority.”

The following promises were made by Southern Trust Personnel in Documents as listed below:

>STATEMENT 1:

‘STROKE CARE PROMISE’ (Newry Reporter: 27/08/2014)

“Emergency Treatment (for Stroke) will always be around the clock. If a clot busting drug is required, ….we aim to deliver a door to needle time of 60 minutes INCLUDING A CT SCAN PROVIDED AT BOTH HOSPITALS.”

(Southern Trust Director of Acute Services, Newry Reporter: 27 Aug 2014, Front page p 1, p 4)

>STATEMENT 2:

“Patients who have suffered a stroke will always get IMMEDIATE DIAGNOSIS and emergency treatment, including thrombolysis AT BOTH of our Emergency Departments in Daisy Hill Hospital and Craigavon Area Hospital. This will ensure we can continue to achieve a ‘door to needle’ time of 60 minutes for thrombolysis.”

(Southern Trust Stroke Consultation Document, p.14, June 2014)

>STATEMENT 3:

“People with symptoms of stroke are always taken first to the Emergency Department in either Daisy Hill Hospital or Craigavon Area Hospital for ASSESSMENT and treatment and our proposals would NOT change this”.

(Chief Executive of the Southern Health Trust, Launch of the Stroke Consultation, Southern Trust Press release 19/06/2014.)

CALL FOR ACTION FROM SOUTHERN TRUST NOW

A NEW permanent replacement CT scanner and a second NEW CT scanner must now be a CAPITAL PRIORITY, get Commissioner Approval, and be installed immediately in Daisy Hill Acute Hospital to give access to life saving DIAGNOSTIC treatment to save the lives of stroke and heart patients and for other medical emergencies.

Investment in CT and MRI scanners essential for Daisy Hill Acute Hospital, Newry City.

You can visit – follow and  like our Facebook page at https://www.facebook.com/daisyhillforlife/ – Thank you.

© Daisy Hill for Life on Facebook and http://www.savedaisyhillhospital.com, 2015 – 2017. We welcome sharing of excerpts & links, provided that full and clear credit is given to http://www.savedaisyhillhospital.com and Daisy Hill for Life with appropriate and specific direction to the original content. Thank-you!

 

08.02.17
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Balanced Representation for Newry and Mourne population essential before Daisy Hill Hospital ED Pathfinder discussions

Balanced Representation for the population of Newry & Mourne is essential – before any initial Daisy Hill Hospital Pathfinder discussions on future Consultant led 24/7 Emergency Services and Acute services in Newry City.

 After initial inspection of the membership of the Pathfinder Project Group from the documents – we assert that it is unfairly balanced in favour of the Southern Trust (SHSCT)/Board management in overall membership. (See PIE CHART 1)

Initial suggested membership of Daisy Hill Hospital Emergency Department Pathfinder Group is unfairly balanced in favour of the Southern Trust and Health Board management

REDRESS THE BALANCE

To redress the planning and decision making balance, we are suggesting some immediate changes to the make-up of this Pathfinder Group before any community involvement is even considered, to ensure a level playing field with equal voting rights. This will ensure that community involvement is meaningful and actually impacts upon the decision making and is not merely a box ticking exercise.

NEED FOR EQUAL REPRESENTATION

As the Southern Trust Management feel they are entitled to choose 13 members including the Chair, we are also entitled to choose an EQUAL number of members representing the community of patients, service users, families, staff and politicians, from the Newry, Mourne and South Armagh Locality. (See PIE CHART 2)

Redress the balance of Daisy Hill Hospital Emergency Department Pathfinder Group with an equal number of members representing the community of patients, service users, families, staff and politicians, from the Newry, Mourne and South Armagh Locality

We need to make sure that this is a proper forum and not just a communications pilot exercise by the Southern Trust in their attempt to implement the criteria from the Bengoa Report and the Transformation Implementation Group’s agenda.

There is a responsibility on all sides to ensure the community’s views are gathered, recorded and represented fairly.

CONCLUSION

In view of the seriousness of the threat of change / withdrawal of life-saving ACUTE AND EMERGENCY Services for both children and adults; we are entitled to full consultation and fair representation on the Daisy Hill Hospital Pathfinder Group as shown in Pie Chart 2. The Pathfinder Group is also known as the ‘SHSCT Task and Finish Group.’

Why have we not been given a level playing field in voting rights and a proper consultation?  We need to be assured of equal voting rights and proper consultation immediately.

This is not an ‘exciting project’ for us – we are the people who will bear the brunt of the removal of ED services which deals with all life threatening Emergencies WHERE EVERY MINUTE COUNTS. The present and future lives and outcomes of everyone who needs ACUTE and ED Services in Daisy Hill Acute Hospital are worth fighting for.

We should not have to fight to get Acute & ED services which we have paid for, and is our right.

Background info:

Project Name: Daisy Hill Hospital Emergency Department Pathfinder Project With Identification of Regional Learning.

You can follow the Daisy Hill Acute Hospital campaign also by visiting and liking our Facebook page at https://www.facebook.com/daisyhillforlife/ – Thank you.

© Daisy Hill for Life on Facebook and http://www.savedaisyhillhospital.com, 2015 – 2017. Excerpts and links may be used, provided that full and clear credit is given to http://www.savedaisyhillhospital.com and Daisy Hill for Life with appropriate and specific direction to the original content. Thank-you!

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07.26.17
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DAISY HILL HOSPITAL ED PATHFINDER PROJECT – PROPOSALS 1

Daisy Hill Acute Hospital Emergency Department serves the entire area of Newry and Mourne and South Armagh the largest popultation in the Southern Trust

The people of Newry & Mourne have been invited to take part in Daisy Hill Hospital Emergency Pathfinder meetings with Dr Anne-Marie Telford to discuss how they can work with the Southern Trust:

“to develop a long term plan which will stabilise, safeguard and sustain local emergency care services.” 

We have some thoughts and proposals on this for you to consider – Are these meetings, instead of just being about the Emergency Department – also part of a verbal consultation by the Southern Trust and Health and Social Care Board that starts us on the Bengoa Report Reform, which includes the further change/withdrawal of services, without telling us?

It seems likely, as the Bengoa Report places Emergency & urgent care as Priority 1 : in most need of reform.

In this post we would like to suggest some questions which need answers, and put forward proposals for readers to consider. We think the proposals could be a good starting point to help tackle this concern.

hospital corridor

 

WHAT WILL THE COMMUNITY GAIN FROM TAKING PART IN THE PATHFINDER PROJECT?

What difference will these August meetings make to secure PERMANENT, LONG TERM Consultant- led 24/7 EMERGENCY & ACUTE services in Newry, Mourne and South Armagh Area Acute Hospital – Daisy Hill?

We request that the Southern Trust and Health and Social Care Board (HSCB) explain urgently to the public exactly what they are asking us to support by participating in the Pathfinder Project.  As it is not clear, we request the SHSCT and HSCB to publicly tell us what’s in it for us and WHAT IS AT STAKE before they ask us to participate in individual interviews with Dr Telford.

Daisy Hill Hospital Emergency Department is vital for stroke and life threatening emergencies

Proposals to help deal with the unanswered questions

WHAT WE CALL FOR:  (PROPOSAL 1)

(1) The Health Board/Trust /Public Health Authority host a PUBLIC MEETING in Newry City with the following agenda:

(a) To inform the public the clear purpose of the Pathfinder Project

(b) To give a clear explanation on exactly which services are being ‘changed or withdrawn’ from Daisy Hill Acute Hospital.

(c) Explain what progress the SHSCT recruitment team have made to date, with regard to recruitment for Daisy Hill Emergency Department.

(d) Tell us what Questions will be asked in the verbal interviews with Dr Anne-Marie Telford.

WHAT WE CALL FOR:  (PROPOSAL 2)

(2) We would like A FULL WRITTEN CONSULTATION (as part of the first 20 weeks of the Pathfinder Project) so we can make an informed decision before participating.

The 2 Proposals explained

(1) PUBLIC MEETING, hosted by the Health and Social Care Board/ Public Health Authority/ Southern Trust,  required to be held in Newry City to address and answer the following 4 important Questions.

(1a)What is the PURPOSE of the Pathfinder Project?

Before we consider participation in the Pathfinder Project – it would be mutually beneficial if the Southern Trust (SHSCT), Health and Social Care Board (HSCB) and Public Health Authority hold a public meeting in Newry City (in a suitable large venue) where they can openly explain to the wider public, hospital staff and Unions exactly what is the clear purpose of the Pathfinder Project. This is an opportunity for the SHSCT and HSCB to explain to the public their future long term plans for Newry Mourne and South Armagh Area Acute Hospital – Daisy Hill.

(1B) WHICH DAISY HILL ACUTE HOSPITAL SERVICES WILL BE AFFECTED?

Rather than using the blanket terms of ‘Acute and Emergency services’ in the Pathfinder Project Documents – we request that the Southern Trust and HSCB explain to us in plain language and define exactly which ‘ACUTE AND EMERGENCY CARE’ services in Daisy Hill Acute Hospital will be affected and will they be  changed or withdrawn?

Does the term ‘unscheduled care needs’ or ‘Acute and Emergency Care ’ mean all  scenarios including  children’s emergency, emergency surgery, stroke, heart, unavoidable accidents (work, school, home  and sporting accidents)? Does this also include emergency treatment for car accident victims and emergency caesareans where there is only 30 minutes to save the life of mother and baby? Under EU directives there must be a functioning hospital for mothers and babies. In addition – what ACUTE SERVICES are being affected?

What progress have the Southern Trust recruitment team made to date recruiting for Daisy Hill Emergency department?

(1C) WHAT PROGRESS HAVE THE RECRUITMENT TEAM MADE?

As the original issue publicly reported by the Southern Trust was RECRUITMENT of medical staff for DHH at night in the Summer months – At this public meeting we need to see the continued detailed efforts of the SHSCT Recruitment Team in finding medical staff for Daisy Hill ACUTE HOSPITAL. This must include the detailed job adverts for Craigavon Hospital as well as for Daisy Hill Hospital.

1 (d) We would also like the public meeting to advise us what Questions will be asked in the verbal meetings with Dr Anne-Marie Telford and how will this information be recorded/collated? How will this information be reported back to the Pathfinder group? What impact will it have?

(2) WE REQUEST A FULL WRITTEN CONSULTATION, and not just a verbal consultation

– a written consultation is our right under ‘Change or Withdrawal’ of services. While some may welcome the opportunity to attend a face to face consultation, not everyone will be able, or available to attend the meetings so there must be a written option too.

As part of ‘meaningful consultation’ – Under the 2009 Act on ‘change or withdrawal of services’ – we are entitled to 3 months WRITTEN PUBLIC CONSULTATION so we can make an informed decision BEFORE we participate in the Pathfinder Project. This written consultation must be included as part of the first 20 week period – as a ‘final decision’ is being made after 20 weeks. We need to know what impact will this ‘final decision’ have on ‘acute and emergency care services’ in Daisy Hill Acute Hospital, Newry City?

As part of this consultation document the Southern Trust and the HSCB should tell us in writing, exactly what service change they are planning and why, in clear terms.

We require a full written consultation for Daisy Hill Acute Hospital Emergency Pathfinder Project

A comparison with the Consultation into the Belfast Trust’s change in Adult Emergency Department services

This WRITTEN CONSULTATION must include OPTIONS for possible reconfiguration of services as was undertaken by the HSCB Board for withdrawal of Adult Emergency services in the urban areas of the Belfast Health and Social Care Trust when ED services were only being moved (approx 1.2 miles down the road) from the City Hospital to the Royal. It is vital to note that in the Belfast consultation, the children’s emergency services were not threatened with closure. The HSCB Consultation in Belfast included detailed written explanation for the public.

Newry & Mourne, as the largest locality in the Southern Trust should have the same written public consultation as the population of the Belfast Trust – now- at the start of this 80 week project for the public to be meaningful involved from the start.

CONCLUSION

The united community of Newry and Mourne works together for Daisy Hill Acute Hospital

CALL TO ACTION: If you agree with these proposals/ideas:

Please write to the Chairperson/Mayor of Newry, Mourne & Down Council; Councillor Roisin Mulgrew and also to all our MPs, MLAs and Councillors who represent us, and ask for the following:

  1.  A PUBLIC MEETING hosted by the Health and Social Care Board/ Public Health Authority/ Southern Trust in Newry City addressing the 4 points in this post above.
  2. A written public consultation to accompany the Pathfinder Project in addition to the verbal meetings.

REFERENCES & CONTACT INFO for public representatives:

Newry Mourne & Down Council

Mayor of Newry, Mourne & Down Council; Councillor Roisin Mulgrew

By Post: Newry, Mourne & Down Council, Monaghan Row, Newry, BT35 8DJ, Northern Ireland.
By Email: roisin.mulgrew@nmandd.org
Newry, Mourne and Down Council Telephone: 0300 013 2233

Chief Executive; Mr Liam Hannaway at the same address or by email, care of: info@nmandd.org

Elected members (Councillors) :

http://www.newrymournedown.org/elected_members

MLAs; MP; MEPs

A List of our MLAs and MP, MEPs is available to view at: Write to them website

Newry & Armagh MLAs

Contact info: http://aims.niassembly.gov.uk/mlas/contacts.aspx

From this page, Filter by Constituency > Newry & Armagh

Then select Address> Constituency Offices for local contact addresses for MLAs.

Please EMAIL your councillors MLAs and MPs to support Daisy Hill Acute Hospital

Thank you for reading this post. Please share the proposals if you agree. We must all stay united and continue to support Daisy Hill Acute Hospital and its wonderful dedicated staff.

You can follow the Daisy Hill Acute Hospital campaign also by visiting and liking our Facebook page at https://www.facebook.com/daisyhillforlife/ – Thank you.

© Daisy Hill for Life on Facebook and http://www.savedaisyhillhospital.com, 2015 – 2017. We welcome the sharing of excerpts and links, provided that full and clear credit is given to http://www.savedaisyhillhospital.com and Daisy Hill for Life with appropriate and specific direction to the original content. Thank-you!

This website is a free website from WordPress and adverts which appear here are not endorsed or controlled by the Web admin team of Save Daisy Hill Hospital.com

01.22.17
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Evidence – what Evidence?

The word ‘evidence’ is used a lot in the Bengoa Report and this word alone tries to justify taking acute Specialist Stroke Services from Daisy Hill to offer them only in Craigavon. But the actual ‘evidence’ is NOT PROVIDED in either the Bengoa Report, or the Criteria document, nor is there a list of References WHERE the evidence came from, at the back of either the Report or the Executive Summary, as you would expect in any piece of scholarly work. The Bengoa Report (Systems not Structures – Changing Health and Social Care – Full Report can be read here.

Re change in specialist stroke services in the Southern Trust, What is the evidence? Has it been validated? Who provided the evidence? These 3 Q'S need answers to verify the ‘evidence’ on outcomes for Criteria No 1 in the Consultation on criteria for reconfiguring HSC services

These 3 Q’S need answers to verify the ‘evidence’ on outcomes for Criteria No 1 on the consultation on criteria for reconfiguring HSC services

The Bengoa Report states the case for change must be “fully evidenced”. It also states how this must be done:

“Clinicians must identify the evidence for change, managers must ensure the correct processes are followed, and the Minister, supported by the executive, must act quickly to take the final decision. All three groups will need to be prepared to defend the decision publicly.”

Therefore – we think the Questions shown in the picture need to be asked and we are entitled to answers.

Without these answers – the use of the word evidence alone is NULL and VOID. Given the whole of the criteria are based on ‘evidence’ and must be addressed urgently (Recommendation 13) – The Public who are paying for the services need to know WHAT IS THIS EVIDENCE before such services changes by centralisation of services are made across N Ireland including specialist Stroke Services and A&E.

BE AWARE! – there is no doubt that agreeing to the criteria will be the first step in AGREEING to centralisation ( or otherwise known as “rationalization”) of many specialist services from Daisy Hill Hospital as shown below in the extracts from the Bengoa Expert Panel Report, 2016, page 75-76

“Based on the evidence the panel has received, the specialties that are currently in most need of reform would seem to be:
Priority 1
EMERGENCY & URGENT CARE, STROKE SERVICES, PRIMARY CARE INCLUDING GP OUT OF HOURS, GENERAL SURGERY, PATHOLOGY, VASCULAR

Priority 2
PAEDIATRICS, PALLIATIVE CARE, OBSTETRICS, RADIOLOGY, NEONATAL SERVICES, TRAUMA,
UROLOGY, REHABILITATION, COMMUNITY BASED ELDERLY CARE, BREAST SERVICES

RECOMMENDATION 13
The Panel recommends that the Department should formally endorse the criteria and apply them to five services each year to set out the future configuration of services to be commissioned (or not) from the Accountable Care Systems. If applying the criteria leads to the conclusion that the service is vulnerable, plans for reconfiguration should be developed and actioned within this twelve month period.”

(Source: Bengoa Expert Panel Report, 2016, page 75-76)

It should also be noted that the Dept. of Health was very clear at the first meeting on 16th January that they want us to ‘have our say’ on only the Criteria, but as this criteria comes directly from the Bengoa Report – it is NOT possible to separate the two even though it would be convenient for them for us to do so.

Health Minister Michelle O’Neill has extended the period of consultation on the criteria for reconfiguring health and social care services by a further two weeks at the request of the public. Speaking about the decision to extend the period of consultation the Minister Michelle O’Neill said:

“The views of the public are vital in bringing forward change and I want to ensure that as many as possible get the opportunity to put their views forward. The meetings provide a real opportunity for the public to engage directly with senior professional medical, nursing and policy staff from the Department of Health.  These criteria will be instrumental in shaping change across HSC and it is critical we get it right.

“I would like to assure the public that full consideration will be given to the views expressed as part of this process in determining the way forward.”

As we have been invited to ask Q’s at the second Dept of Health meeting on Monday 30th January, Newry, Canal Court Hotel,  7 pm – 9 pm, it is VITAL we use this opportunity to ask the 3 Q’S as stated in the picture – as the answers are needed to verify the ‘evidence’ on outcomes for Criteria No 1.

Thank-you to all who continue to speak up and show support for Daisy Hill Hospital to keep it for future generations.

© Daisy Hill for Life on Facebook and http://www.savedaisyhillhospital.com, 2015 – 2017. Excerpts and links may be used, provided that full and clear credit is given to http://www.savedaisyhillhospital.com and Daisy Hill for Life with appropriate and specific direction to the original content.

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12.28.16
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Bengoa Report Public Meeting in Newry Mon 16th Jan: 7 – 9 pm

dec-27th-bengoa-meeting-1_3

Click here for meeting info from the Department of Health’s website.

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09.09.15
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3 Ways to use the sample Response letter to respond to the Strategic Plan

Show your support again for Daisy Hill Hospital

Rally for Daisy Hill Hospital

Every person in the house can send a separate letter or email, the more the better to get the message through loud and clear to The Southern Trust that we don’t agree with their Strategic Plan to centralise services from Daisy Hill to Craigavon. Please write to them with your views but if you’re not sure what to write – you can use the sample wording, if you wish. It’s available to view and download as a word document ‘Response Letter’ from this link. RESPONSE LETTER suggested wording -to download

THREE DIFFERENT WAYS TO RESPOND

(We’ve included some hints for those not familiar with using computers or emails)

1. PRINT out the letter,

  • and write your name and address in PEN on the letter and post it with a first class stamp.
  • Postal address to: Mrs Paula Clarke, Interim Chief Executive, C/O Corporate Planning Department, The Brackens, Craigavon Area Hospital, 68 Lurgan Road, Portadown, BT63 5QQ (Last day to post 1st class Wed 9th Sept)

OR
2. EMAIL your Response by adding the text as email message text only.

  • by Sending a New Message from your email address to strategic.plan@southerntrust.hscni.net and Copy and Paste all the word document ‘Response letter’ (Use Edit – Select All and Paste into the blank message field of your email. (Its usually a large white box)
  • Then add a cc copy to: Enquiry.hscb@hscni.net (the all over Health board.)
  • Add your Name and Address within the Email text in the message field
  • Click Send!

OR
3. EMAIL Response by sending the word document ‘Response letter’ as a separate ATTACHMENT.

  • (How – Save this word document ‘Response letter’ onto your computer, then type your name and address at the bottom of the letter, and Save a new copy to your computer.
  • Compose a new email and add strategic.plan@southerntrust.hscni.net to the To field and Attach the New signed response letter as an attachment (using the paperclip Icon)
  • Then add a cc copy to Enquiry.hscb@hscni.net (the all-over Health board).
  • Click Send!

Note: Emails must be sent by this Fri. 11th Sept, If you have problems with email sending. Check the Email address and make sure it’s not a hyperlink (These are blue and underlined) If it IS, remove the hyperlink (by Right clicking mouse and selecting remove hyperlink) or try typing the email address in again and retrying the message.

Thank you all for supporting Daisy Hill.  As a community we are strong.

Save daisy Hill Hospital for life

Please Speak up for Daisy Hill and tell the Southern Trust you do not agree with their Strategic Plan to centralise hospital services from Daisy Hill, Newry city to Craigavon.

This website is a free website from WordPress and adverts which appear here are not endorsed or controlled by the Web admin team of Save Daisy Hill Hospital.com