There is no easy answer to the pressures that the health service in Fermanagh is facing and along with a new way of practising medicine, there also needs to be a change of mindset among the public.

That is according to Dr. Ronan O’Hare, assistant medical director at South West Acute Hospital.

Dr. O’Hare was speaking at a winter resilience press briefing and spoke in-depth about the difficulties front line staff were facing, touching on funding issues, staffing issues and inadequate care in the community:

“It can be very frustrating for front line staff. The acute hospital needs to move into the community, we have things in the pipeline, such as acute care at home, but these things are dependent on funding,” he said, before adding.

“In some Trusts they would go in to a nursing home and see patients, and say you have a 95 year old man with a chest infection, he is not coming in to hospital in those Trusts, rapid response are going to go and see him, get him an antibiotic. In that instance there is no point in that patient being admitted to hospital, they are much better in a nursing home. But we are not at that stage yet.”

The volume of care home beds, and specifically dementia beds, has been an issue in Fermanagh for some time. The Western Health and Social Care Trust pays a portion of the cost for residential care with the resident or the resident’s family paying the rest. Dr. O’Hare explained that when people have to stay in hospital due to lack of beds in the community that it is financially detrimental to the Trust.

“It is not a question of money. It is far more financially beneficial to the Trusts to have patients looked after in nursing homes than it is in hospital. It would save us money, but there is an issue with the number of beds, especially dementia beds in Fermanagh, and there is an issue with staffing too,”

When asked was there an interest among private care homes to establish more homes in the Fermanagh area Dr. O’Hare revealed that there wasn’t.

“There is no huge interest. I can’t comment on why that is, but there is a knock-on effect to us here in the hospital.”

And while bed resources in the community are an issue, Dr. O’Hare also states that there is a staffing problem within the health service across Northern Ireland and he pointed to the high reliance on locum doctors across the province as evidence of this: “But we have resource issues. About 55 per cent of doctors are locums and that is a trend that is happening across the North.

“You leave medical school after five years and become a FY1 and a FY2 and you decide to go in to training. The year before last the number of doctors who went into training was 38 per cent. This year it is 18 per cent. And a lot are choosing to become locums. In Scotland 68 per cent are choosing to go into further training. That is the question that needs to be answered here.”

Dr O’Hare revealed that there was a pay disparity between doctors and consultants in Northern Ireland and their colleagues in England, Scotland and Wales and that this was also a contributing factor to long term recruitment within the health service in Northern Ireland.

Turning his attention to the public, the assistant medical officer at South West Acute Hospital said that people needed to understand that there were avenues, other than through doctors, open to them when it came to seeking medical help, pointing to pharmacists as health professionals who have a large reservoir of knowledge.

“A pharmacist trains for four years and they have a huge wealth of medical knowledge and can deal with a huge number of common ailments. Pharmacists are becoming prescribing pharmacists; they can do vaccinations and they can go into GP practices and look at people’s prescriptions and rationalise what they are on.

“We are trying to have a full-time pharmacist in ED which again will help with turning people around in ED,” he said before concluding:

“About 40 percent of patients who turn up at a GP surgery could be dealt with by someone else other than a GP. People need to bear this in mind, that there are alternative sources.”