Commuter towns buck downward health trend
CAN a person’s view of their state of health be influenced by where they live? There is no simple answer, but undoubtedly how people rate their sense of well-being is swayed by a range of influences.
These include their age, state of finances, home supports and sense of loneliness or isolation.
Access to services is also a factor, and the emergence of Clare and Roscommon as the counties where the highest proportion of people perceive their health as poorest may not come as much of a surprise.
Both counties have seen their local hospital downgraded with the loss of A&E services.
Both decisions were taken by the HSE in the interests of patient safety.
But, as we know, the decision was implemented with only patchy back-up services.
One of the growing stresses currently is the restriction in cover by GPs’ out-of-hours services due to a lack of doctors.
There was a lack of planning to fully ensure that there were no gaps in medical cover as essential services were moved farther away from people who may lack their own transport and live in rural areas.
The psychological impact is difficult to quantify.
Older people would have seen the availability of accident and emergency services at the local hospital as something of a security blanket. But there is also the practical effect of patients having to travel longer distances for care.
More patients from Roscommon must now attend University Hospital Galway, which has a major ongoing trolley crisis and long waiting lists.
University Hospital Limerick, to which many patients from Clare are forced to travel, is also among the most overcrowded in the country.
Dr Michael Harty, a GP and Independent TD in Clare, said a hidden factor was unemployment, which can affect how people of working age perceive their well-being.
“In rural counties like Clare, there are a lack of employment opportunities as you go out west,” he said.
“Having a job is almost like a drug. It gives people a sense of well-being, value and contributing to society.”
Many elderly people with a serious chronic illness endure gruelling journeys and longer delays before seeing specialists in the bigger hospitals.
This is often made worse by poor local transport or cuts in bus services.
Dr Harty cited the case of a patient from a rural area outside Ennis who has no option but to use an ambulance to travel the 70km to University Hospital Limerick because of a lack of transport.
“He is not critically ill but there was no other way of him getting to hospital,” he said. “He could not afford a taxi.”
Dr Harty also cited the curtailment of out-of-hours services by GPs as a problem.
He said: “In Kilrush, for instance, there was an out-of-hours centre every evening and for 12 hours on Saturday and Sunday. But it was necessary to amalgamate it with GP services in Ennistymon to a midway location in Milltown Malbay.
“People in Kilrush and Ennistymon would see that as a reduction in their healthcare. That would feed into their sense of lack of wellbeing.”
Dr Harty pointed out that if people have to wait to see a GP for a number of days, it
‘Having a job.... gives a sense of value’
contributes to their perception about how well their health is being looked after.
While Taoiseach Leo Varadkar and some of his more senior ministers have been accused of being out of touch due to their “posh boy” backgrounds, it may not in fact be the biggest cross they have to bear.
The fact that there are so
many “city” or “urban” ministers who are making decisions which affect rural Ireland could actually be damaging our sense of good health.
The pressure on GP services and over-concentration of care in the large hospitals, coupled with a failure to set up outreach outpatient clinics in hospitals such as Ennis, is undoubtedly adding to people’s
sense of insecurity. There will likely be less confidence about health in counties with large rural populations.
It is something to bear in mind when Mr Varadkar dons his pair of wellingtons to visit the National Ploughing Championships shortly.
The people of rural Ireland deserve more than secondclass services.