This action is unsafe and particularly when the investment in Limerick Regional cannot be met in the present economic climate.who do you believe?

Ambulance services are overstretched and overburdened. Promised and indeed extra staffing and ambulance are a cause for great confusion with Junior Minister Maura Hoctor and HSE managers. Herself says we are getting more ambulance but HSE John Hennessey assures us we won't . who do you believe?

Who will be in charge of the A/E in Nenagh? It is still unclear if it will be nurse led or doctor led. Will they reinstate the Consultant that Nenagh did have once upon a time. who do you believe?

When the road to Limerick from Nenagh is lined with flickering lights and Headstones. who will you believe

If you like me feel this change to Nenagh and Ennis is wrong then come along to Nenagh on the Sat 31st of Jan to the GAA Complex at Gortlandroe be there for 8.00pm because you may have to protest from the playing fields.....

CAN LIMERICK AND THE LIMERICK PEOPLE COPE WITH HAVING TO CATER FOR THE HOSPITAL NEEDS OF NORTH TIPPERARY AND CLARE?

WHAT DO YOU BELIEVE?????????????????????????

4 ambulances have broken down in the past two months - 3 of them went on fire. The HSE is supposed to serve the public who pay for such a service. If I was a tax payer in Clare or Tipperary I'd be livid that the HSE is prepared to gamble with my health because it is unable to properly manage the funds assigned to them. The HSE has more than enough money at its disposal. It just doesn't use it for front line services.

The HSE are seriously putting patients lives at risk all over ireland. they dont seem to care about any of us. only today 15th January i seen on aretel where there is serious overcrowding at Cavan General Hospital. our country is gone to wreck. our government dont care what happens to any of us in my opinion. we all need to get out on the streets of our towns and campaign seriously about the way we are all been treated and demand that our so-called government start taking us all on board. after all we are the ones who put them where they are.

ireland is a disgrace. i am ashamed to admit i am Irish.

"The total number of patients who go to the A&E [in Nenagh] between 8pm and 8am each night is on average 7.6, of whom six are self-referrals. It says many of these patients could have been more appropriately dealt with by a GP" - http://www.irishhealth.com/article.html?id=14888

How can we be expected to pay for a professional staff in Nenagh to look after so few people?

I would LOVE to know who the 20% (one fifth) who voted yes to this dangerous madness?

Do they know ANYTHING about that HSE methods? Have they EVER been to the mid-west? Are they on this planet at all, I'm tempted to ask.

As a consultant in emergency ("A&E") medicine, I must confess that my greatest (and growing) concern is that the current generation of Irish GPs seem either unwilling or unequipped to treat an ever-growing number of patients: almost any injury, toddlers, chest pain, headaches or even minor poisoning, they refer virtually all of them to the nearest hospital emergency department. Indeed, in my part of the country, more than half of ED attendances are GP referrals.

In my darker and more cynical moments, it seems to me that GPs get a great deal (60 euros up front in order to write a few words of referral to the nearest hospital, which actually gets not a red cent from any patient with a referral letter): so the "A&E" department gets all the hassle, risk and labour, but not a penny to do all this so-called "inappropriate" work.

I can understand then why the GPs of Ennis and Nenagh and thereabouts are so annoyed: they are going to have to really justify their referrals of "minor" stuff to the hospital in Limerick or else actually treat more patients themselves.

The real difficulty is that so few of our newer Irish GPs are sufficiently experienced (most of them no longer spend training time in an Irish A&E department but go to Australian hospitals which are awash with consultants - typically a dozen or so even in a small A&E - so the juniors do not learn to make decisions and actually see relatively few cases on their own).

In any event, the fact that GPs get 60 or more euros even when they don't actually treat the patient mean that most of them no longer actually know how to treat such "minor" cases (why would they bother....).

So the HSE strategy - "care in the community" - is based on an imaginary willingness or even ability of GPs to go back to the Olden Days when the old single-handed male GP (the "carthorse" of primary care) looked after most of the walking wounded etc. The fact that the number of GPs is also about to collapse, courtesy of HSE "planning", also seems to have been somewhat over-looked…

(On a positive note, some of the newer generation of Advanced Nurse Practitioner do genuinely offer a much better service than their junior doctor colleagues - it is hugely ironic therefore that the greatest hostility to such nurses comes from female GPs!!)

It would work fine if .....

[a] accidents and emergencies happened at regular and predictable rates and intervals

[b] they happened between the hours of 9 am and 5 pm

[c] they happened in suitable locations

no health service in any western country would expect any of the above to be the case so why does our HSE?

and another thing, A&E's in these countries are built to deal with the real numbers expected to use them in mind, plus a bit extra to allow for the inevitable seasonal increases in occupancy that occur.

Patients who go to the A&E in Nenagh between 8pm and 8am each night . . . could have been more appropriately dealt with by a GP. Amd where precisely Earnest do you imagine you'll find a GP at mid-might or 4am as the poster - GP - above, excellently points out, GPs even during the day are referring a high proportion of their cases to a&E anyway and ifyou think the "out-of-hours" GP service is any improvement on that you are very miuch mistaken as the opposite appears to be the case.

no they are not right again. its a disgrace. lives are being put at risk not only for the patients but the staff as well. what is needed is for the entire county of ireland to start a campaign. why are the people of ireland letting these people away with what they like. isnt anyone listening or does anyone care? people of Ireland get out and fight for what is your legal rights.

Earnest, thank u for re-stating the HSE number, 7.5 patients average number of patients thru A/E Nenagh after 8.pm. But please consider this if a single one of them was someone you loved and cared for, or someone who loved or cared for you. think on, if that one person does not make it to the centralized A/E.

Is one not precious?

would one not be too many?

I am sick and tired of the HSE describing Patients as numbers as statistics they are living breathing people with valuable lives. And the very least we can expect in this fine country of ours is that there is someone and some place to take care of us when we are most in need. We deserve this much.

There may be only 7.6 patients registering after 8pm but usually there is such a back log of patients that the department is busy until well after midnight.

The idea that the department should be busy all the time is nonsense- I suppose they will close the firebrigade because they dont go to fires everynight.

Studies have shown after the reconfigiration of services in the UK , the mortality increased and was directly proportional to the patients distance form acute emergency services.

Drogheda and Cavan have shown that the closure of acute services leads to more overcrowding, which in itself leads to increased mortality.

Good luck to Limerick regional hospital, elective work there is finished (all to be provided for a profit by NTPF). Private clinics will flourish in the towns that lose acute services.

josie, are you prepared to get out on the streets and if so, what do you think that will achieve? The people making these decisions will not be effected by 100,000 on the streets as they are protected by this Government. Government policy is to reduce the number of acute hospitals in Ireland to 12 maximum and to promote the Private for profit hospitals. In order to make the building of a Private Hospital attractive to the investor you must create a market. make sure the existing public hospital cannot cope with the numbers and the private money grabber will move in. Regarding the small number of attendances at nenagh A & E during night hours - someone somewhere is putting a price on a life if they say it is not worth it to have staff there to meet the needs of even one patient in an emergency. However there are innovative methods of providing full A & E services in a rmote hospital by using modern methods opf communication and inventive methods of staffing. Would this be too difficult to organise and manage?

nk says I would think differently if someone of my own family was sick. Probably I would, but this doesn't make it a viable use of public resources. Where do you stop? If the emergency was on Loop Head, they'd never make it to Ennis on time, so you end up with demanding a hospital every five miles.

the HSE and the government are a total waste of space and a disgust to our nation. they dont care about anyone.

they all should be kicked out of office and a new team put in with people who care about us, not ones who are treating us worse than animals.

No. What if it means a loss of life due to distance needed to travel!!!!!!!!!!!

Very Sad that ones life is of so little importance. CRUELTY.