Spring has arrived!

The white stars of Magnolia Stellata

There's something wrong with the weather! I don't think I can recall such lovely warm weather on St Patrick's day. What comes to mind is watching the Dublin parade in sleet, with the long bare legs of a Florida girls' marching band turning blue with cold.

Winter is behind us now, spring is accelerating, and summer will come in its own good time. I count myself so very blessed to live in the country in a land with seasons, where every spring day brings something miraculously new. Already the first green shoots are showing on elder and whitethorn in the hedgerows and golden celandines glisten in shady places, a foretaste of summer abundance. Birdsong surrounds me on my morning walk, and nesting has begun - today I saw a chaffinch fly off with a feather for her nest. And as I write I am watching my neighbour’s mare with her foal cantering around her.

Prunus incisa 'Kojo-no-mai'

Another sign of spring is that I suddenly want to be out working in the garden again. I find it very difficult to work up enthusiasm to do so in winter, when so many jobs should have been done. Already the grass has had its first trim and manners have been put on the rambling roses. But now there is soil to be dug, overgrown beds to be cleared and hedges to be trimmed. Signs of spring’s advance are everywhere. The snowdrops and crocuses have been succeeded by daffodils, the snakes-head fritillaries are not far behind, and the tulips are poking their snouts up. The early cherries and forsythia are in full bloom, the first white stars have opened on Magnolia stellata, and the buds are bursting on the espalier pears.

Prunus subhirtella v Rosea

But we mustn't get ahead of ourselves: we still have two months to wait and prepare for summer – we might get a late frost as late as mid May to burn the shoots and ruin the fruit.

Darning Socks

Did you see the TV adaptations of Henning Mankell's Kurt Wallender novels, with Kenneth Branagh as the Swedish detective? I found the gritty realism set against the beautiful flat landscape around Ystad quite compelling - so like the Cambridgeshire fen landscape of my childhood and my dreams. I'm looking forward to more of them, and Susanna has found a new literary enthusiasm in Wallender. A couple of days ago she read me this little extract from The Fifth Woman. Wallender is talking to his grown-up daughter Linda.

Linda poured herself some tea and suddenly asked him why it was so difficult to live in Sweden.
“Sometimes I think it’s because we’ve stopped darning our socks,” Wallander said. She gave him a perplexed look. “I mean it,” he continued. “When I was growing up, Sweden was still a country where people darned their socks. I even learned how to do it in school myself. Then suddenly one day it was over. Socks with holes in them were thrown out. No-one bothered to repair them. The whole society changed. ‘Wear it out and toss it’ was the only rule that applied. As long as it was just a matter of our socks, the change didn’t make much difference. But then it started to spread, until finally it became a kind of invisible moral code. I think it changed our view of right and wrong, of what you were allowed to do to other people and what you weren’t.”

My mother, God bless her, kept up the old ways - she was a champion knitter right up to her death, and for every family birthday, Christmas and Easter she produced new pairs of lovely woolly socks. I still have one pair left which I wear in my hiking boots, still intact because I don't use them very often. As a teenager and young adult it was an everyday task to darn socks, or sew a button on a shirt, but as Mankell observes like everyone else I have long since stopped doing so.

It's increasingly clear that our throw-away culture and the attitudes that go with it are unsustainable. We throw away things, and we throw away people too, where once we mended broken things, and cared for broken people. Is Wallander right to detect a link between all that and ceasing to darn?

Visitors

We had a mystery visitor yesterday: Susanna tells me that while I still slept she saw a bird drinking at the famine pot in the Labyrinth garden which she did not recognise. "Black on the head, back and wings like a cape, with white at the side of the throat, and a dove-grey underside, definitely not a magpie, and big, almost like a turkey or a goose", so she described it. "A Hooded Crow?" say I - but no, "Definitely not that", she said, when we looked at the picture in Collins' Birds of Britain & Europe, and she has since poured through every picture in the book without finding what she saw.

I suppose I was mulling over black and white birds at the back of my mind, because later that afternoon I heard a rapid, low drumming, and immediately thought it might be a very distant Woodpecker. Now that would be really exciting. Until recently we have had no native woodpeckers in Ireland. But Birdwatch Ireland say that a good many Great Spotted Woodpeckers (Dendrocopus major) have been seen here in recent years. They speculate that this species, common in Britain and mainland Europe, is about to colonise Ireland.

This morning I went out in my dressingown to see if the first asparagus is ready for picking - it is, just two spears, to be poached in a little butter to garnish poached eggs for breakfast tomorrow! Then, I heard the drumming again, in the direction of the house, and discovered I was mistaken. It was not a Woodpecker, but a frog calling from the little overgrown pond on the patio! I hadn't realised our common frog (Rana temporaria) had a mating call, and it wasn't very loud, but that was what I was hearing. I am delighted to have heard it. There were at least three frogs in the pond, and a large mass of frog spawn had been laid overnight - no doubt there will be even more tomorrow!

Common frogs (Rana temporaria) in a pond

We have had other visitors too recently. For about three days we had a pair of Common Redpolls (Carduelis flammea) feeding on the peanuts, a species I've not identified before. Their diagnostic black beards distinguish them from Linnets. They have gone now, so perhaps they were only passing through on their spring migration. And we have also had a few Siskins recently (Carduelis spinus), the first of the winter.

Redpoll, Carduelis flammea, Male

A View from the Pew - Reconfiguring Our Hospitals

View from the Pew is a regular column I write for Newslink, the Diocesan magazine for the Diocese of Limerick and Killaloe. This one appeared in the March 2009 issue.

Concerned citizens listen in the rain at Nenagh Hospital Rally (photo Bridget Delaney)

What in the name of heaven is the HSE up to?
It has been an open secret that the HSE planned to ‘reconfigure’ acute public hospital services in the Mid-West. But they did not tell us - the people they are meant to serve – what this would mean until mid January. That was when they finally published a report by management consultants Teamwork and Howarth dated April 2008. And only then did they publicly announce they would remove services from Nenagh and Ennis General Hospitals and St John’s Limerick to the Mid-West Regional Hospital in Limerick: A&E is to go by April this year, acute surgery in July, and critical care services in 2010. In effect the smaller hospitals, which currently handle about half of acute admissions, will be converted to step-down and day-case/minor injury clinics, and acute admissions to the Regional Hospital will be doubled.

The case for reconfiguration
In so far as I understand the Teamwork/Howarth case for reconfiguration, it is that the present services are unsafe and unsustainable: unsafe, because there are too few consultants to provide adequate consultant supervision in all four hospitals; and unsustainable, because the workloads in the smaller hospitals do not justify employing more consultants or keeping operating theatre and intensive care units open around the clock. Teamwork/Howarth also says that doctors admit many patients who should not be in hospital, and do not discharge them early enough: acute beds can be cut, if doctors can be made to follow best practice clinical guidelines. In other words, they believe that the proposed reconfiguration will save money.

But they also claim that the changes will lead to: ‘much better patient experience and interaction with health care services; patients accessing more care at home and in their community setting; fewer patients spending unnecessary time visiting or being an in-patient in hospital; and safe and sustainable local and regional hospital services for patients, the population of the Mid-West, and for staff.’

Who could possibly object to all that? Better patient care and money saved too!

The case against
But I do not believe in the tooth fairy, and I do not trust the HSE reconfiguration plan. Here are some of the reasons why:

Reconfiguration of hospital services in the North East has been a disaster – Teamwork consultants advised the HSE there too. A&E services in Cavan, Monaghan and Navan hospitals were closed and transferred to Our Lady of Lourdes in Drogheda. As a result the Drogheda A&E service collapsed this winter, and the hospital was forced to suspend A&E services for a while. Following this crisis morale is very low, and many senior staff resigned in protest. The promised new regional hospital has been put on the long finger - local TD and minister Dermot Ahern said there isn’t a ‘red cent’ available to build it.

Howarth/Teamwork says clearly that reconfiguration in the Mid West will not succeed unless pre-requisites are met. These include more A&E consultants, more resources for primary care around the clock, enhanced ambulance services with advanced paramedics (they even mention air-ambulances!), urgent care/step down centres to take pressure off acute beds, and IT services to support electronic records and telemedicine. An earlier draft report is said to have called for 165 extra beds in Limerick Regional, but this is omitted from the published version. I suspect their HSE paymasters found this recommendation unacceptable.

These pre-requisites will cost money – a lot of it! Do we seriously believe the Department of Finance will provide it in this recession? The HSE claim they will provide sufficient advanced paramedics, though they are not in place yet. But the HSE is already cutting expenditure – as recently as 29th January the Mid-West Hospital Group manager John Hennessy said, “The 2009 budget allocation will require reconfiguration and service efficiencies in excess of €10 million”. The jargon is barbarous, but I think it means that reconfiguration is being rushed in now as a cost saving measure, and the costly pre-requisites will be ignored.

The HSE is forcing this plan through by stealth without consulting the public, hospital staff or GPs. Minister Harney refused to publish the plan earlier, admitting she feared it would engender opposition and prevent implementation. Consultants, doctors and nurses that I respect have publicly said that reconfiguration will harm their patients. And not one of 80 Mid-West GPs who recently attended an HSE briefing voted confidence in reconfiguration.

No wonder people are up in arms!
I attended a public meeting in Nenagh on 31st January, organised by the Nenagh Hospital Action Group at the request of Nenagh Town Council and Mayor Virginia O’Dowd. As least 1000 people turned out on a wet Saturday night, many standing outside in the rain because they could not get into the hall. They listened to doctors, patients, politicians from all parties and other speakers express their concern, even outrage, at how reconfiguration would affect Nenagh hospital.

Rev Marie Rowley-Brooke speaks her mind (photo Bridget Delaney)

Nenagh Rector Revd Marie Rowley-Brooke, as Church of Ireland Chaplain to the hospital, spoke from the floor of the healing benefits for patients being cared for in their own community surrounded by loved ones, something not factored in by HSE accountants. She expressed shock that unelected and unaccountable people were given the authority to impose ill thought out plans against the wishes of the community, threatening trust and the whole basis of our democracy.

Outrageously, although invited, no one from the HSE chose to attend and speak. Local Minister for Older People Maura Hoctor also disgraced herself by her absence.

I feel sure the people of Clare and Limerick are no less concerned than those of North Tipperary.

How should a Christian respond?
My own fury at the HSE attempt to ram this reconfiguration through must be obvious by now! It is not that I think change is unnecessary – after all medical science develops all the time and services must change accordingly, as they always have done. But I do believe these changes are ill-planned and dangerous. The public hospitals belong to us all, and the HSE has no right to proceed in this underhand, undemocratic way. All of us, but particularly the chronic sick, the vulnerable young and old, and those without private medical insurance, will pay the price if they succeed, I think.

The author expresses his opinion (photo Bridget Delaney)

My conscience tells me that I must resist the HSE plans, and that is what I intend to do. I shall go on the protest march planned for Saturday 21st February, where I confidently expect to join several thousand others. That will only be the start of a campaign which will continue until reconfiguration is rescinded. The ultimate decision will be a political one, and if the people are united I am sure we will prevail.

I shall also pray for the success of the campaign against reconfiguration. I may be on dangerous ground here. Some may feel it is wrong to invoke God’s help in what is a political campaign: much better Christians than I will take the opposite side. But I believe they are wrong, and I must obey my own conscience, as they should obey theirs. Jesus prayed in the Garden of Gethsemane, ‘Father, if you are willing, remove this cup from me; yet, not my will but yours be done.’ I think it is right and proper to pray for what we desire. But, like Jesus we must also pray that God’s will be done.