IF I HAVE a suicidal patient in Tipperary, I sometimes have to send them off to a busy Emergency Department, due to inadequate community-based staffing levels. If I have a suicidal patient in Waterford, I can call an experienced psychiatric nurse who’ll see them in our surgery, potentially a day or two afterwards.
Dr Richard Roche-Nagle is a local GP in Carrick-on-Suir. Both of his parents practiced as GPs since 1971. He also has a practice in Clonea, Co Waterford, just 10km from Carrick-on-Suir, which gives him the chance to see what services aren’t accessible to his patients in his Tipperary practice.
“We have a consultant psychiatrist who visits our health centre in Waterford every two weeks, which facilitates speedy access to their services. We also have a facility called a SCAN nurse, which is a Suicide Crisis Assessment Nurse.
“And that’s someone that we can ring up if someone’s in a crisis, who’ll see them in our surgery for an hour a day or two after referral. [So] the patient knows they’re going to be seen in a familiar stable environment.”
He says that evidence and research that has shown this nurse reduces rates of readmission for patients with suicidal tendencies.
In Tipperary, unfortunately, we don’t have access to a SCAN nurse. And we lost our hospital [St Michael's] about 15 years ago. We were promised additional community services, but unfortunately a lot of posts remain unfilled.
“There has been a high turnover of consultant psychiatrists in Tipperary, and there are several vacancies in the extended psychiatric team. Therefore, the contrast is quite significant.”
If I have a suicidal patient in Waterford, generally I can call a nurse. It’s an experienced psychiatric nurse who’ll see them in our surgery, potentially a day or two afterwards, and the patient knows they’re going to be seen, and then they’re filtrated directly into the psychiatric service. It works in Waterford. And there’s ways around this and we have to think outside the box in Tipperary.
Roche-Nagle called the psychiatric services for children in Tipperary “inadequate”, with “extremely long” waiting lists, as is the case elsewhere in the country.
The GP was one of a number of people who spoke to TheJournal.ie as we visited last week, after we appealed for readers across Ireland to contact us with details of locals issues from their area that they’d like to see discussed as part of our election coverage.
A member of the public emailed in to ask us to look at mental health services in Carrick-on-Suir, calling the closing of St Michael’s Hospital in 2012 “disgraceful”.
Located two hours from both Dublin and Cork City, and at a junction of three county boundaries, Carrick-on-Suir is primely positioned in the heart of the south-east. But it suffered badly during the recession.
In the 2011 Census, 35.1% were unemployed compared to a national figure of 19%. Of its 1,803 workers, 845 worked outside of the area. When asked about their health, 134 people said they were in bad or very bad health, representing 2.3% of the population. This compared to a figure of 1.5% nationally.
Health services in the South-East
Just outside of Carrick-on-Suir’s town centre is a brand new Primary Care Centre, opened just over a year ago. The aim of centres like this is to bring health care and diagnostic tests to communities, and relieve the pressure on hospitals.
Primary Care Centres are a key part of Sláintecare – the healthcare programme which has received support from all parties as the best way to reform the healthcare sector in Ireland. So care centres like this one represent an effort to change the Irish healthcare system for the better.
A government website says they offer “an ideal alternative to hospitals” particularly for those with chronic conditions like diabetes or asthma, and help patients get access to diagnostic tests and minor surgery.
Although this building seems to fit in with plans to deliver on Sláintecare and bring additional services to the South-East, it isn’t quite there yet. In the middle of a weekday last week, the brand-new Primary Care Centre was quiet, with just one person in the waiting area.
Figures within the community told us this was at least partly due to the fact that it’s not properly staffed – so the equipment and machinery that should be available to the community isn’t being used. Added to this, locals said, is the possibility that people aren’t aware of the clinic: it hasn’t, for example, had an official opening ceremony.
With the care centre located at a meeting point between three counties: Tipperary, Waterford, and Kilkenny, it also has the potential to serve a wider community.
The South East Community Healthcare group was asked about the staffing levels at the care centre and they gave a six-page long statement on the extent of the mental health services available in the south-east region.
They also said that “efforts are continuing to fill a vacancy as to the contracting of a GP service at the Carrick-on-Suir Primary Care Centre”.
Carrick-on-Suir: The medieval ‘biketown’
Carrick-on-Suir is a medieval town that straddles the river Suir, and has a grand cycling pedigree.
The town’s bridge, built by the Butler family in the 14th century, is a striking focal point. It’s one of the oldest bridges in Ireland – apart from an elongated arch that was rebuilt after being blown up during the Civil War in 1922.
The rock that Carrick is named after is in the foundations of the bridge, so it goes.
Locals say that it’s always been “a biketown” – Tour de France hero Sean Kelly is from Carrick-on-Suir, as is the professional cyclist Sam Bennett – the town also claims to host Ireland’s oldest bike shop, O’Keefe’s. A new Blueway offers to boost that aspect of the town’s identity.
As mentioned above, Carrick-on-Suir also lies at a point where three counties meet: on the border between Tipp and Waterford, but also just 3km from the Kilkenny boundary line – and so, is ripe for local tourism.
But its location also left it somewhat isolated during the recession.
A tannery, where animal hides are treated to make leather, closed in 1985 – leaving a hole in the town’s identity and knocking the legs out of its main means of employment – a significant proportion of the area had relied on this industry. ‘The Tannery’ is the name of a prominent pub in the heart of the town.
A 2014 index by Teagasc based on unemployment rate and inward migration figures, put Carrick-on-Suir in the bottom five performing towns.
Six years later, things have definitely improved: unemployment has dropped significantly – and while people are at least leaving the town at a slower rate than before, the recovery hasn’t yet resulted in actually boosting inward migration and persuading people who have already left to return.
In their own hands
In 2011, at the height of the recession, Carrick locals began meeting to plan for their town. Their organisation, now called the Tourism and Economic Development Committee, has met regularly ever since, and in 2016 produced a document which lays out suggestions on how to improve the town.
The initiatives centres on the town’s medieval identity: the OPW spent €3 million recently on Ormond Castle, an unfortified Elizabethan manor house which was home to the Butler family, who built the town’s ‘Old Bridge’ and founded the town’s woolen industry in the 1670s. The castle currently attracts around 12,000 visitors a year; the locals’ plan aims to quadruple that to 50,000 in just five years.
A digital hub is also planned for the town: ten desks will go in the olive-coloured Town Hall building built in the 1840s, while another, more ambitious plan aims to put 65 desks in what was a friary building on the other side of the river. Digital hubs give small online-oriented entrepreneurs a space to work and collaborate with their peers; the Carrick group has looked at similar initiatives in Skibbereen, Sneem, and Dublin.
It also has a Blueway, which is a walking-cycling route by the river, open since last May and that cost around €3 million. It means that people can now walk between Carrick and Clonmel, a Tipp town 17,000-people strong, located 20km up the Suir.
One local who sells fuel during the winter has bought half a dozen bikes and plans to rent them out to visitors during the summer, as a sign of the domino-effect that these tourism initiatives can have.
The Tourism and Economic Committee is aiming to raise between €500,000 – €900,000 from private investors to build some of these projects; the town’s committee is working on building relationships in Dublin and London trying to win that investment through harnessing the diaspora.
All they ask for is a €2 million of public funding a year to create €4 million a year over the next 10 years, says Maurice Power, a local accountant and spokesperson for the Carrick-on-Suir Tourist and Economic Development Committee, dubbed COSTEDC (pronounced ‘CosTech’).
It’s hoped this will rejuvenate the entire area, and provide an incentive for people to come back. “One of the problems we have in this town is we don’t keep our talent, we don’t keep our young people… We’re educating them but they’re going elsewhere.”
The committee has looked at what towns like Westport and Kilkenny have done, and have spoken to representatives there to try to do something similar, and turn the medieval town into a “mini Kilkenny”.
Power says that this kind of investment would “do a number of things, it would create, it will stimulate new businesses, encourage small businesses to stay here and creative vibe around the town, so that you have young people coming in, and young people will stay.”
Roche-Nagle says of the town’s future: “Unemployment has decreased recently, so that’s a plus in terms of healthcare, because they’re all they’re all linked. The Blueway, in terms of exercise, is going to be a good thing in the future.
“Carrick-on-Suir has great people: there’s a very strong family structure here we’ve lots of good grannies and moms who look after kids, and I see that every day.”
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Video and additional reporting by Nicky Ryan.
TheJournal.ie visited Carrick-on-Suir in Co Tipperary to hear about the issues facing the town ahead of the General Election. We visited the area before the death of independent candidate Marese Skehan on Monday, which has delayed the election date for voters in Tipperary.
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