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| All Together. issued 12-Nov-2012 | reply to | Well done to the people of Waterford for coming out in strength to protest at the plans to remove services from Waterford Regional Hospital. The plan, as put forward by consultants is incongruous, absurd, and totally unsafe for patients.
The lives of a huge number of people will be put at risk and many will lose their lives needlessly because their access to immediate, appropriate and timely medical intervention will have been removed and transferred to a distant hospital.
Another consequence of this transfer of services is that extra costs are imposed on the patient and the family. The cost of travel, which is increasing rapidly, will have to be borne by the patient’s family if they wish to visit their loved one in hospital. The visit to a loved one will demand extra time due to the long travel distance and time off work will be necessary. The patient too will have to bear the cost of travel to that hospital for follow-up clinics and after care.
The elderly and the very young will suffer most as they are removed from their customary surroundings and taken to a strange environment with family far away. This isolation will lead to stress, anxiety and a further rapid deterioration in their condition and shorten their life expectancy.
However the question remains – will the quality of care be improved and the answer is a clear NO. Our hospitals all around the country have provided the sick with excellent care given the resources made available to them and the management of the system within which they worked. Problems arose when the systems were not robust enough and resources were limited. When euros became more important than patients the quality of care could not be maintained.
Centralising care will not improve the quality of care. Much publicity and spin has been given to the mantra that volume will improve outcomes. The HSAG (Health Services Action Group) has, over the years, asked for the definitive research results which show that centralising all these services leads to better outcomes but it has never been produced. The independent research, which is available, shows that for a small number of major and complex surgeries volume will result in better outcomes but that for most of the general medical and surgical procedures and treatments smaller hospitals are on a par and in some cases better. A Clinical Review of medical services in Monaghan General Hospital in 2007/8 showed that outcomes were on a par with and, in some cases, better than some of our larger hospitals. However the HSE and Government removed those from Monaghan with a promise of a better service replacement but this has never materialised.
Waterford must fight this plan tooth and nail to prevent the people of Waterford and a wide catchment area from suffering the consequences as the people of Monaghan, Nenagh, Ennis, Roscommon have suffered. The ideal would be if all hospital areas, both those already downgraded and those under threat, united their strengths and formed a huge lobby base to influence Government policy and help to provide the people of this country with a safe, workable, sustainable and efficient health service. It is clear from past experience that no individual hospital will stop the carnage of our hospital network but it can be stopped if all pull together.Back to Top | | Back on Track issued 11-Nov-2012 | reply to | It has been some months since we posted news here but that is not to say we were inactive. The new regime is just more of the same. Mary harney refused to meet with us and now James Reilly refuses to meet us too. This is the man who made the promises to the people of Monaghan from the steps of the Courthouse. This is the man who asked us to 'fight' for our hospital. This is the man who stated clearly and distinctly that 'Fine Gael will fight with you'. Now we know what that means.
There has been a fiasco over the selection of places to have Primary Care centres and this man has not given us a satisfactory explanation as to how he added the two extra Primary Care centres in his own constituency and in Roscommon.
This man has now made the decision for the site of the New Childrens Hospital. It is confusing - How did one group decide that the Mater site was the preferred location and then another 'expert' group decides a different site is the preferred location? So what criteria did the Minister use for this decision? Was it the same as the Primary Care?
We are also puzzled re. the need for the Childrens Hospital to be co-located with an Adult Hospital. Who decided that it had to be so? They tell us it is 'International best Practice'. That is a great mantra to cover a multitude. ‘International Best Practice’ would also claim that children should be treated by specialist paediatric doctors and nurses – so what do they need an adult hospital for? In times of necessity when children need the extra speciality at the moment, they are not sent to an adult hospital in Ireland but are sent to England or the USA. Why are they not sent to an Irish adult hospital but will when the new hospital is built? It does not make sense.
Building a New Hospital will not improve the outcomes for children as it is doctors and nurses, with their expertise and resources, which makes the difference. Even in times of plenty our Government and its agents could not manage and resource our hospitals and health system properly and the record of this country would not fill me with confidence that they will be able to do so with the new Hospital. I hope history proves me wrong.Back to Top | | Would Money Have Changed Their Minds? issued 23-Mar-2012 | reply to | During our campaign to save services in Monaghan General Hospital we always felt that we were so insignificant in the scheme of things that it was very difficult to get them to even listen, never mind act. At one stage, in order to get closer to them, the Dublin Committee of the Alliance raised money and hired a Lobbyist, who supposedly had the ear of top people in Government and their advisors. He was an expensive item but he was never really on our side and did not have the ‘what-with’ to influence those who needed to have their minds changed nor could we provide the ‘what-with’ if asked. On another occasion we almost signed up to another ‘lobbyist’ but pulled back just in time. After hearing what the Mahon Tribunal says about the entire system prevalent in Irish politics we have to ask ourselves the question – had we offered financial inducements could we have succeeded?
One decision the Alliance made very early in the campaign was that we would at all times remain dignified, principled and honourable. I think we adhered to that decision through thick and thin. The one occasion, where the media seemed to revel in blaming the Alliance for stepping outside that stance, was one that was begun by others, fuelled by others and carried out by others and it was also something which was brought about by design or lack of cop-on by those who should have known better or were so out of touch with peoples’ feelings that they provided the opportunity for the local anger to manifest itself in the way it did.
However I cannot now say that we were treated with the same respect we offered to others. On many occasions we were treated with contempt and sidelined by those in power. They seemed to regard us a culchies from the country and fed us valium to get rid of us. Worse still we suffered more abuse at local level and, even when we were openly attacked with verbal venom, we maintained our composure and did not allow ourselves to go down to their level. It is so sad that we now hear The Mahon Report painting such a picture of those in power and perhaps Mahon did not get to the full story. This might be only the tip of the iceberg and look at what it has cost us.
But the big question is – have things really changed? Is all that type of corruption behind us? Are all the brown envelopes gone? Are all our politicians, their advisors, their backroom staff, the decision makers, and those in power beyond reproach?
As far as we are concerned many faulty decisions were and are being made because of pressure from commercial interests, from vested interests, from profiteers, from those who are greedy for power and/or wealth. Many of the decisions in our health system have been made without the evidence to substantiate the decision. Many of the decisions in our health system have been made to suit finances but not with patients welfare at the heart of the decision. Many of the decisions will further the interests of some and the wealth of others but the patient is the poorer. But if decisions are being influenced by payments and financial support then it is very likely that we cannot win our battle to have proper services for the patients of Monaghan.Back to Top | | Great Reading. issued 15-Mar-2012 | reply to | The Northern Standard for this week (March 15th 2012) makes great reading for those of us who have been involved with the campaign to get services restored to Monaghan General Hospital. There is no mention by anyone of the ‘Minority Report’ prepared and published by Dr. Illona Duffy but there is the usual political bantering as to who said what, when and where. The complete reversal of statements is ironic where some are now trotting out the same old spin which we had to listen to from the other side during the term of the last Government.
Some one referred to the statement made by Brigid Clarke, Manager of the Cavan/Monaghan Group, in an interview on local radio. I heard that interview and we were bombarded by statements which made little sense to me though I can see how such language might persuade others that Monaghan Hospital is a thriving place and that the health services in this region are improving by the day. Not so and no amount of spin will change the situation for many patients. Now I am not going to get into the question of how the numbers of patients from Cavan availing of surgery in Monaghan will be kept and who exactly will be counted as we have no way of verifying the figures presented. Just as there is constant discrepancy in Trolley figures and knowing how figures can be manipulated in the past, it is difficult to accept figures presented unless we have some method of seeing the evidence.
The real problem, which is constantly being pushed into the background by the HSE, the Department of Health and the Minister is that the people of Monaghan do not have a proper and reliable emergency service and we are constantly hearing of problems with the provision of that service. We have been told of long waits for an ambulance to arrive from Cavan, of problems in getting a patient to a hospital in time, and, from experience, we have to wonder if all patients, who were dead of arrival or who died shortly after arrival, were given the best chance of survival. We have asked HIQA to review the safety of our pre-hospital emergency services but they have refused. We have asked to see the medical evidence to support the centralisation of all acute care far removed from patients but that has also been refused. Just claiming that it is ‘best international practice’ is not good enough – where is the independent research and evidence? A poor economy and lack of money is the only answer they can give us but surely that is no basis on which to put people’s liv3es at risk.
We were promised a ‘better service’ but the stories we are getting are far from ‘better’. Would anyone claim the following to be ‘better’ – a Monaghan senior citizen falls at home and is injured, an ambulance is called, the patient is taken in great pain to Cavan; after many hours on a trolley the patient is given three pain relief tablets and a prescription and told to go home as there is only bruising, the patient has to call a neighbour to get them to come to Cavan to bring the patient home, terrible pain and more than tablets needed, the following day the patient receives a call from the hospital telling the patient to return to Cavan hospital immediately as the pelvis is broken; the patient has to get a neighbour to get back to Cavan still in agony. The patient is now recovering but terribly shaken, and will take months to heal but the trauma of the event is even more difficult to deal with. Is this a caring Health Service? Is this a better service? Is this the great replacement we have been given? Yet to read the Northern Standard reports one would think that we should be happy with what we have - that what the HSE has given us in Monaghan should make up for having patients treated like this senior citizen. Back to Top | | Management by Spin and Fear? issued 04-Mar-2012 | reply to | Is our health system managed by spin and fear? That question came to mind as I listened to Professor Michael O’Keefe from Temple Street state that children would go blind and some might die as a result of the cut backs in his hospital. Children would not get their elective surgery and treatment as planned and that any delay could be fatal. However he went on to say that he would likely get into trouble for speaking out as had happened to him previously. It would appear that there are many consultants, doctors, nurses and administrators who would like to speak out but are too afraid of losing their jobs or being overlooked for promotion. That fear is real for so many, especially in todays’ economic slump, and management seems to be using that fear to keep within budget knowing that fear will prevent staff from highlighting the dangers for patients as a result. That is how I interpret what the Professor is saying.
Now I am convinced that I am right because I have heard that story too often. The reason why I became involved with the Hospital issue was because the old NE Health Board was putting pressure on Monaghan Hospital Consultants to keep quiet or their contract would be called into question. I was asked then to be their mouthpiece and inform the public what was happening and what was going to happen with the services in Monaghan General Hospital.
I have also been told by various members of staff, and not just in Monaghan General Hospital but in others as well, that what was going on was wrong and that patients lives were being put in danger but they could not speak openly or they would lose their jobs. Members of staff were afraid not to do as instructed by their bosses. Unfortunately I am torn between sympathy and justice.
Too many heard our message and agreed but did nothing about it – ‘leave it to them who are protesting’ seemed to be acceptable. Too many heard our message but because of political allegiance, business dependency, or lack of understanding – they too did nothing, except perhaps for some who would write anonymous letters or make anonymous phone-calls to members of the Alliance. For many it was not all that important – ‘sure you cannot have a hospital at every crossroads’ attitude etc, and they listened to and believed the ‘spin’ being churned out by Health Service and Government, (‘spin’ which they were paying dearly for with their taxes) - but then when they depended on the service and found it far away from them they realised just what we were fighting for. When they had an emergency, or a close relative lying on a trolley or sitting on a chair on the corridor of another hospital, it became very important and a big issue. When they had to wait for appointments, travel to distant hospitals, expected to be in a Dublin Hospital for a 9am appointment, or wait weeks for the result of tests, the reality hit home. Thankfully there were big numbers who agreed with what we were doing and were willing to be seen and heard objecting to what the Health mandarins and the political parties were doing to us, the people of Monaghan.
Recently it was announced that Monaghan would not have a Medical Assessment Unit and that services would be curtailed due to cut backs but that patients would not suffer. If you believe that then Professor O’Keeffe is wrong but I would put my faith in a man like him who is working at the coalface rather than administrators in some office. Back to Top | | Postpone Your Sickness. issued 06-Feb-2012 | reply to | About 3,500 workers in the Health Service will accept the terms offered for their early retirement and sign out for good at the end of February. There are also big numbers retiring from other Departments and sections of the Public Service and these will leave a huge gap in the ability of that service to continue offering the same level of service as in recent years. Where this may not have an instant impact and cause major problems in some departments the effects of such a loss of frontline personnel in Health will be immediately felt by the patients and staff.
Consultants working in hospitals and nurses at the coalface have warned that patients will suffer and lives will be lost but they are ignored as having their own agenda for ‘scaremongering’. The Minister has acknowledged that frontline services will be effected but seems to be pointing the finger at the staff, even before anything does go wrong. The Minister for Public Expenditure, Brendan Howlin, is reported in a Sunday newspaper as blaming the HSE managers if anything goes wrong. Talk about setting the scene and blaming someone before the event happens!! Does the Government forget that they are ultimately to blame; they must take the responsibility, the buck stops with them?
However Minister Reilly has offered the solution to any problems that might arise – each patient should just sit tight and wait as he/she will be treated within 9 months and in an emergency room you will only have to wait 9 hours. Somehow an old adage comes to mind about a ‘cat having 9 lives’ but then a sick cat would be seen and treated within an hour of arriving at the Vets or the Vet arriving with her. Does the Minister remember Susie Long, who had to wait but was too late when she was finally diagnosed? It was promised then that such would never happen again but it has and it will again unless this Government begins to get their priorities right. We can all recall a relative or friend who was diagnosed and only lived a couple of weeks – now patients will die without even getting the diagnosis. We all know a relative or friend who survived because they were diagnosed early – well fewer patients will be diagnosed early with the resultant outcome. We may know a patient who has had to wait for weeks in severe pain before they could get treatment to relieve their pain – now that type of patient can wait for 9 months but that is OK – we all must make sacrifices in these tough economic times as we must repay the gamblers who thought they would make a fortune by buying bank shares but lost – we cannot have them suffering the mental anguish of losing their money – aaaargh! – maddening, isn’t it?
Behind all this there is a plan and one that we need to see implemented. The Croke Park agreement was agreed in order to reduce the Public Service numbers and to reorganise work practices. That process was moving too slowly and this is an ideal opportunity for Government to force new work practices where a smaller workforce does the same amount of work in a shorter space of time – we get increased productivity for the same or less money. It might be easier to achieve the objective this way instead of taking on the Unions. The old, the infirm, the sick, and those who depend on the public health system are easier targets. And just a word of caution – Private Health Insurance companies are offering a reduced Health Policy at the same premium for those having trouble maintaining their Health Insurance level. You may discover that the very illness you get is not covered by your policy and you have been paying big premiums for something that has little chance of befalling you. One example of this is where you now have to pay about €2,000 to get a hip replacement even with the same Health insurance policy that covered it two years ago.
Back to Top | | Told Them So! issued 02-Feb-2012 | reply to | Back in 2006 we told the policy makers that the Public Health System was heading for collapse but they did not listen. We told them that more and more people would rely on the public health system in the future (or as they would say – ‘going forward’) but they did not listen.
Instead they pandered to the private investor and offered all sorts of incentives for the private industry to build hospitals and dictate the policy. They pandered to those who wanted only to build little empires for themselves using the illness of people. They allowed costs to spiral out of control and they allowed the staffing levels of administration to expand till every manager had a team of assistant managers and each of those with assistant assistant managers yet so many of them were unable to do the work assigned. Now they have to hire in, at huge expense, outside consultants to show the managers how to manage and do the jobs they were employed to do.
All the while the front line services were being starved of resources and staffing. Public hospitals and services became inefficient and, in places, unsafe. How do they solve the problem? – they closed the service down as the managers could not manage to recover it without further problems. They did not listen to us when we told them that International evidence did not support the policy of centralising all acute care into what they called ‘Centres of Excellence’ (I don’t hear much mention of Centres of Excellence these days). They paid spin doctors huge salaries to counteract any statements we made and, using an agreeable national media, they bombarded the public into believing that closing these ‘unsafe hospitals’ was the only way to improve the health services in this country. ‘Patient Safety’ was the buzz word for everything they did.
The public at large sat back and allowed this all to happen. There was plenty of money for the middle and upper classes and they were able to afford the cost of Private Health Insurance. They were able to get silver service in the private hospitals and did not have to wait very long to get into the bed. But the Susie Longs of this country did wait and paid for it with their lives. Susie’s family was promised that all would change and that there would be no more deaths because of delays – like all the other promises, it was forgotten about.
What people with Private Insurance seemed to forget was that Private Insurance means nothing when you have an emergency – you just need to get to the nearest hospital as soon as possible but now you find that that hospital is closed for emergencies and you must take you chances and wait for treatment just like the public patient. It is now all about budgets and saving money but patient safety no longer seems important. However there is less money in the country now, there are less jobs, there are less hospital beds, there are fewer nurses and doctors, and your chances of survival have decreased dramatically. Not only that but with all the increases in the cost of the Private Insurance, you cannot afford to have it and you are once again dependent on the Public System – yes the system you sat back and watched disintegrate and fall apart and to be taken from your local hospital. Susie Long’s story will be repeated over and over again in the coming months and years.Back to Top | | NO answers. issued 25-Jan-2012 | reply to | The response to the highlighting of James Reilly’s empty promises to the people of Monaghan and the people of Ireland has been nothing more than we expected. We were reminded of all the enhancements which have taken place and are currently taking place at Monaghan General Hospital and the setting up of a Sexual Health Clinic was hoisted as a main sail for us to gloat over. Were we expected to genuflect to the HSE, the Department and the Minister because this Clinic is going to be held in Monaghan? Are we to forget all the people who will suffer added trauma, have further inconvenience heaped on them or die needlessly, as James Reilly himself predicted in that speech on the courthouse steps, just because we will be able to have all our sexual problems examined in Monaghan, close to home? Will some research unit in the future months be able to state that a greater percentage of sexual problems are dealt with in Monaghan than in any other county in Ireland but that a greater percentage of patients with emergencies in Monaghan die as a result of the delay in getting to a hospital?
The fact that there is a delay in the announcement of the budget for the HSE does not give us any confidence in the future provision of treatment at the Minor Injuries Unit in Monaghan. It is obvious that the budget is going to be less than last year and that further millions must be saved to pay the bondholders. To save this money areas like the Minor Injuries Unit in Monaghan will be obvious targets and will likely close and James Reilly will allow a further service to be taken from us without an alternative. We also have the problem that the policy of not filling vacancies in staff will lead to the closure of the Unit as they will claim that they cannot get staff to replace retirements and relocations.
Back to Top | | Distances to A & Es issued 20-Jan-2012 | reply to | NUI Maynooth’s National Institute for Regional and Spatial Analysis has developed a mapping tool by which you can discover the distance you are from services like GPs; Fire Station; dentists; airports; hospitals and a range of other services. The ability to find out how far you are from a 24 hours emergency department has been the one to catch the public’s eye and it is getting fair coverage on radio and papers. Now this is something which we in the HSAG (Health Services Action Group) brought before the Oireachtas Committee on Health back in 2003 and we have passed on detailed information on distances to A & Es to various groups of TDs and senators but it has always been ignored.
This particular system of determining the distances seems to be somewhat inaccurate as places known to be further from an A & E gets a better rating than a place which we know is closer. For example it would claim that Emyvale is 39 minutes whereas Tirnaneil is 41 minutes from Cavan and that is only an example. However the principle is still very important - that the length of time it would take an emergency getting to the A & E is too long for many.
Of course the times which this tool presents do not take many things into consideration – things which will impact heavily on the times. These include volume of traffic, road conditions, weather conditions, or indeed closed roads like the road from Clones to Cavan, which is closed regularly. It also cannot take into account the length of time it takes the ambulance to get to the scene and again our experience of that would not be very heartening. Similarly it does not give consideration to the length of time it will take the ambulance crew to get the patient loaded into the ambulance and again this can be a lengthy process in some cases. We could also add time for the space between the occurrence of the accident or incidence and an emergency call being made and the ambulance called.
Based on all this we would put the times for Main Street, Emyvale, as more likely to be: Call to ambulance 5minutes +; arrival of ambulance 25 minutes +; time at scene 15 minutes +; time to Cavan 41 minutes +; thereby giving us a total of 86 minutes +, which is almost half an hour over the ‘Golden Hour’ and these times are minimum and could stretch another hour. What then for an incident further North in Monaghan or to the West or East, where narrow country roads have to be negotiated. Having to go to Cavan does not give you a great chance of survival as Prof Nicholl, Head of Medical Research Unit in Sheffield University, stated at a lecture in the Royal College of Surgeons in Dublin last Friday – that every 6 miles you have to go in an ambulance your chances of survival reduce by 1%. He also says that closing the local emergency departments (like Monaghan) is wrong and will cost lives.
Modern methods of delivering safe services are being used in other countries to provide rural and isolated communities with emergency care and acute in-patient care. They have found that in-hospital times reduce when the patient is nearer home and in familiar surroundings. As well it is easier for the services to discharge patients, when they are aware of patient background and home conditions. But the big question is – how do we get this message across to the policy makers and how do we get them to look at the bigger picture.
Back to Top | | Are Promises Made To Be Broken? issued 18-Jan-2012 | reply to | That is the question asked as the heading of a clip on Youtube at this link - http://www.youtube.com/watch?v=CDY9dG89iBU – which features part of a speech delivered by the now Minister for health, when he attended a Protest March organised by the Community Alliance on May 6th 2008. There is certainly a message there for all would be politicians – don’t promise something unless you are 110% sure that you can deliver.
We wish to make comment on some of the things Dr James referred to during that speech.
1. He said that he was after coming from Monaghan Hospital where he saw a terrific A & E, a state of the art theatre, highly qualified and hard-working staff, and a great facility under-used. He also referred to documents from consultants in St. James’s Hospital praising as ‘excellent’ the results of a medical audit carried out in 2007 in Monaghan. He stated that the outcomes for Monaghan were excellent. With all of this he asked why any of these services should be taken away when the people of Monaghan will not get as good as a replacement. If this is so we ask – why would he not put those services back into Monaghan when he came into power.
2. He asked the people at the protest to let Fianna Fail know that the people of Monaghan would not forget what that party did to Monaghan General Hospital when in power. It is now the turn of the Monaghan people to let Fine Gael know that we will not forget what they did to our hospital, and did not do, when they were in power.
3. He then made a promise to the people of Monaghan and the people of Ireland – that Fine Gael would fight with us for our hospital. We now know that he has reneged on that promise and will not meet with our Councillors or ourselves to discuss the future. However he has been quick to lay off the blame but this time it is the fault of the HSE and not Fianna Fail because he is now using the same language as Mary Harney, Brian Cowen and Michael Martin did when they were Ministers of Health. The very health policy which he condemned in his speech and for which he disparaged Fianna Fail, has been continued by himself since taking office.
4. The 2012 HSE Service Plan has a range of cuts which will seriously effect frontline services in this area and there are further severe cuts coming during 2012 and there are no replacements or alternatives to these but he seems to expect us to accept them as necessary evils and forget that he promised to retire from politics if his Government did this. He may claim that the economy, the Troika, the IMF, the EU, the bondholders, and lets add the Bankers too, have all forced him into this position and that this is all the fault of Fianna Fail’s failed fiscal policies. Well we say – he was at the heart of Government and should have known what was happening and should have known what was ahead as Brian Lenihan made it very clear long before the General Election. The dogs on the street knew. However in his speech he stated that one of the first things he was going to do was to find the ‘Black Hole’ where the money for health was disappearing. He referred to the numbers of Grade 8 managers rising from 6 to almost 800 in a couple of years and the amount that was costing. Has he found that Black Hole and how many of the 700+ are still earning the wages of Grade 8? Has he looked at other sections of administration where money can be saved, and at other areas of Government where savings can be made - like the massive tax-free pay-outs to TDs and Senators? Patients, the sick, the aged, the young are easier targets.
5. He may say that the reconfiguration of services is necessary for patient safety. If that is the case then why have we experts to claim the opposite. Why did Professor Nicholl, head of the Medical Research Unit in Sheffield University, state in a lecture in the Royal College of Surgeons of Ireland last Friday, that research shows that it is wrong for the Government to close the local A & Es except for the very severe and major trauma. He claimed that your chances of survival diminish by 1% every six miles you travel by ambulance to a hospital and that many lives are lost for relatively minor reasons because of the delay in getting to a local hospital – not a big hospital or a teaching hospital or a very high-tech hospital – just your local hospital. Why was the opinion of the Doctor, who resigned from HIQA, ignored as he claimed that there was no research, which proved that centralisation of all acute care was the proper policy. Where is the research which proves that all acute care must be centralised?
6. In his speech Dr. Reilly asked – ‘How many more have to die on the road to Cavan?’. There have been some and more that we cannot prove but we can say that these were not given the best chance of survival. There have also been some whose lives have been saved by Monaghan General Hospital and in some cases the serious outcomes have been averted by the excellent staff in our Minor Injuries Unit. We cannot name them but many families know the benefits they have received due to the services still available in Monaghan but which are now under threat. This threat has been imposed, not by the HSE but by Dr. Reilly’s Government and its policy. He is the Minister, he must accept the responsibility, the buck stops with him, that is what the taxpayer is paying him for and his name will be added to the others who have been responsible for taking our excellent services away.
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