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Wednesday 7 January 2015

Accident & Emergency: a political imponderable

In the past two weeks I have had direct experience of Accident & Emergency…not personally but a member of the family has had a serious bout of pneumonia though she’s now on the mend.  Did the four hour target for getting her on to a ward matter?  Well no.  She needed to be treated in Accident & Emergency before being moved after about five hours to ICU and then to the Coronary Care Unit. The doctors and nurses were brilliant and got her through the initial crisis.  So why is there, in fact is there, a crisis in A & E?

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The problem with targets is that that when they are not met, it is seen as a failure with all the concomitant political flak.  The reality is that when there is increased demand for A & E services, it is almost inevitable that targets will not be met.  The NHS is an organisation that is extensively managed but A & E ultimately cannot be managed…it is a service that reacts to immediate demands.  You also have the day-to-day work that hospitals do…appointments, doing operations, providing support etc.….that are planned.  So you have two elements in many hospitals—the ‘normal’ planned operation of the hospital caring for people and A & E where planning is based on ‘predicted’ demand and predictions are always tentative.  Take an emergency patient who needs to be admitted but the only way this can be achieved is that another non-emergency patient is told ‘your operation has been postponed’ or ‘we need your bed, we’re sending you home’.  It’s a matter of priorities…the emergency patient may died if not admitted but the patient whose operation is postponed may be living with some non-life threatening pain.

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Does this mean that we need to expand A & E services?  Well we could but whether this would be a good use of constrained resources is questionable.  It isn’t a case of there being insufficient A & E services, it’s the reasons why people use them today.  Until relatively recently, A & E was the last recourse for people…it was an emergency option often accessed through calling 999.  That is no longer the case.  Today people who, in the past, would have gone to their GP turn up at A & E because they can’t get an immediate doctor’s appointment.  Many A & E departments deal with this by having a minor injuries section dealing with triage leaving emergency staff to deal with real emergencies.  The problem is that we no longer have a 24/7 GP service…yes I know we have an emergency call out system operating outside GP working hours but how effective this is in practice is open to question. 

A further and an increasingly important issue is the aging population.  With people living longer because of improvements in medical technology, it is inevitable that the number of older people going to A & E is going to increase.  I was recently in a respiratory unit of 24 beds in which 17 of the patients were over 65 of whom half had been there for over a week.  Care in the community does not provide a solution for these patients…they are seriously ill and need to be in hospital.  This does, however, put pressure on the limited resources hospitals have and puts pressure on A & E, the route most of these patients took to get into hospital in the first place. 

So have we, what many of today’s newspapers call ‘a meltdown’ in A & E?  If the four hour target is taken as the criterion for measuring this, probably yes.  But then that target is an aspiration, not a true reflection of the realities in A & E.  Our obsession—or should I say politicians’ obsession with targets—gets in the way of the superb work done in A & E across the country in often difficult circumstances.  We don’t plan to be an emergency patient but if we are what concerns us is the expertise of those treating us, not whether they hit a spurious target.

Wednesday 31 December 2014

Pre-famine Irish transportation: Van Diemen’s Land and elsewhere

Transportation to NSW ended in 1840, by which time a total of 150,000 convicts had been sent to the colonies from Britain and Ireland. Strictly speaking, no convicts were transported directly to the Port Phillip District of NSW. However, convicts did find their way to the District in one of four ways. First, convict labourers were sent down, about 100 at a time, to provide government labour between 1836 and 1842, but most of these men were sent back to Sydney after relatively short terms and there were complaints that more were needed. Secondly, a number of squatters from central NSW brought down some of their ‘assigned servants’ who were convicts. How many is uncertain but there were probably about 550 in the district in 1842 and many of these remained in Port Phillip when their sentences expired. Thirdly, and most importantly, were time-expired prisoners from VDL and NSW. The number is tentative as no records were kept as they were moving within the same colony, though probably they were fewer than those from VDL. These are thought to have numbered over 3,000 in 1846, about 15% of the male population. Probably another 2,000 had arrived by 1848, and after a temporary decline, many more came after the gold discoveries in 1851. Though often described as scoundrels, villains and ruffians, these men provided an important supply of labour to squatters in the 1840s. But they also committed 40% of the district’s crime between 1841 and 1846 and their presence produced strong criticism of the imperial authorities for trying to block the colony’s attempts to stop their arrival. [1]

Finally, between 1844 and 1849, nine ships arrived in the Port Phillip District carrying 1727 ‘exiles’ known as ‘Pentonvillians’ with tickets of leave amongst the passengers.[2] The Royal George arrived on 16 November 1844 carrying 21 convicts and their arrival met with a mixed reception.

It is a resumption of the transportation system, without its discipline, with all its evils, and none of its benefits. We are to have British convicts like the Vandiemonians, but we are not like them to have the balancing advantage of a British Government expenditure of half-a-million annually. We are in short to have cargoes of felons palmed off upon us as genuine immigrants....There exists no law to justify one country pouring out the sweepings of its jails upon another, and when it is attempted we should not be inclined to look to the tedious and expensive delays of the law for a remedy. We should duck the scoundrels if they attempted to set foot in a country of freemen, and send them back as they came to the greater scoundrels who dared send them hither.[3]

Many people saw it as transportation by another name, ‘It will scarcely be believed – and yet such is the fact – that transportation to New South Wales is revived...’.[4] The last of the nine ships, the Eden arrived on 21 February 1849 with 199 convicts. Unlike earlier convicts who were required to work for the government or were hired from penal depots, the ‘Pentonvillians’ were free to work for pay, but could not leave the district to which they were assigned. All of the ‘Pentonvillians’ were male, with an average age of 22 years; the youngest was 11. Nearly all were literate and many came from trade and manufacturing backgrounds. Most of their offences were crimes against property, for which they received sentences of seven years or more. They were given pardons on condition they did not return to Britain until the completion of their sentences.

VDL was first settled in 1804 with a penal settlement established at Sullivan’s Cove, later Hobart and free settlers began to come to the island in 1816. Initially convicts were sent from NSW but from 1817 they were sent there directly from Britain. The Macquarie Harbour penal colony on the West Coast of Tasmania was established in 1820 to exploit the valuable timber Huon Pine growing there for furniture making and shipbuilding. Convicts sent to this settlement had usually re-offended during their sentence of transportation, and were treated very harshly, labouring in cold and wet weather, and subjected to severe corporal punishment for minor infractions. In 1830, the Port Arthur penal settlement was established to replace Macquarie Harbour, as it was easier to maintain regular communications by sea. Although known in popular history as a particularly harsh prison, its management was far more humane than Macquarie Harbour or the outlying stations of NSW. Experimentation with the so called model prison system took place in Port Arthur. Until the late 1830s most convicts were either retained by Government for public works or assigned to private individuals as a form of indentured labour. From the early 1840s the Probation System was employed, where convicts spent an initial period, usually two years, in public works gangs on stations outside of the main settlements, then were freed to work for wages within a set district. Between 1803 and 1853 approximately 75,000 convicts served time in VDL. Of these 67,000 were shipped from British and Irish ports and the remainder were either locally convicted, or transported from other British colonies. This represents about 45 per cent of all convicts landed in Australia. Transportation to VDL ended in 1853.

It has been suggested that the southern colony received the worst of the convicts and therefore its experience was notably different from that of NSW.[5] There appear to be three reasons for this view. First, that in the early years of settlement VDL was used as an unofficial dumping ground for ‘difficult’ convicts by the colonial administration in NSW. Little evidence supports this. Indeed, in numerical terms, VDL benefited considerably from the additional infusion of labour that colonial shipping indents show was largely composed of convict mechanics.[6] Secondly, that following the establishment of Macquarie Harbour and Port Arthur penal stations, VDL received a disproportionate number of re-transported secondary offenders. This charge has more merit, although the overall numbers were relatively small and were to some extent outweighed by convicts re-transported from VDL to mainland settlements. Thirdly, before 1840 relatively few convicts were transported direct from Ireland, VDL received a disproportionate number of urban convicts from the slums of industrialising mainland Britain. However, there is an alternative way of looking at this. As convicts from Britain were significantly more skilled and literate than those from Ireland, the lack of Irish transportees was an economic advantage not a disadvantage.

The Irish community was small before the 1840s when transportation to NSW ceased. Between 1840 and 1853, 7,248 Irish male and 4,068 Irish female convicts arrived in the island, 20 per cent of all convicts. They committed relatively fewer local offences than others. After release, many convicted during the Famine of 1845-1849 settled in humble occupations or followed the gold rushes on the mainland. Despite mythology, few Irish were transported for purely political offences. Some Irish belonging to secret societies, such as the Whiteboys, were marginally political, and several United Irishmen and Defenders from the insurgency of the 1790s reached VDL.

Richard Dry, a radical Protestant and owner of a cloth factory was one of the more significant Defenders in the Dublin area.[7] He was arrested in county Roscommon in February 1797, was tried at the Cork city assizes in September and sentenced to be transported for life. Dry had spent nine months in Cork city jail when the outbreak of Rebellion in May 1798 further delayed his transportation and he did not reach NSW until 11 January 1800.  After four year in Parramatta, where he remained aloof from United Irish intrigue, Dry accompanied Lieutenant-Colonel William Paterson to the site of Port Dalrymple [Launceston], VDL, in November 1804. Having worked as a storekeeper Dry was pardoned in 1809 and appointed commissariat clerk of the town four years later.74  Freedom and business acumen enabled Dry to begin amassing livestock to the number of 7,000 sheep and 300 cattle within a few years, enabling his emergence as one of the island’s most respectable immigrants. By contrast, Michael Rogers’ experience of VDL ultimately proved fatal. He had been sentenced at Meath on 26 February 1844 to transportation for life on a charge relating to ribbonism, was detained at Kilmainham Gaol, Dublin, in March 1844 and transported on the Cadet arriving in VDL in late August. The convict records show his involvement in a sequence of offences escalating from misdemeanour to crime over a period of two years that culminated in the wilful murder of Joseph Howard, a police constable, in February 1848. The Hobart Town Courier reported that Rogers had been bush-ranging with Patrick Lynch and John Riley in the Sorrell district and referred to them as the ‘Fingal bushrangers’.[8] Tried in December 1848, Rogers was executed on 3 January 1849. [9]

The leaders of the failed Young Ireland 1848 Rebellion obtained tickets-of-leave: William Smith O’Brien, John Martin, Kevin O’Doherty, John Mitchel, Thomas Meagher, Patrick O’Donohoe, Terence MacManus. The last four escaped to America, while their colleagues were pardoned and returned to Ireland. W.P. Dowling, a Young Irelander working with Chartists in London, remained in VDL as an artist and photographer.[10] Seven humbler working men, transported after an attack on a police barracks at Cappoquin in 1849, worked their way through the convict system to relative freedom.[11]

In 1829, Western Australia was established initially as a convict-free colony when the Swan River settlement was founded in Perth with the landing of the first settlers at Garden Island and later at Fremantle.[12] However, during the 1840s the lack of skilled and unskilled labour threatening to cripple the colony and there was growing pressure for convicts to provide much needed cheap labour for building the infrastructure necessary to service the colony. Between 1845 and 1847, York Agricultural Society, supported by several merchants lobbied the colony’s Legislative Council to petition the British Government to send convicts.[13] For convicts who were nearing the end of their sentence, a system of ticket of leave was also introduced that helped provide labour for the development and expansion of agriculture. In 1849 by Governor Captain Charles Fitzgerald sent the Colonial Office a set of resolutions from a public meeting held in Perth on 23 February calling for the introduction of transportation. Earl Grey, Secretary of State for the Colonies in London accepted this proposal and by Order in Council allowed the Governor to declare the colony ‘a place to which convicts could be sent’. [14] The first shipment of 75 transportees arrived aboard the chartered barque Scindian on 1 June 1850. Early convicts were men selected because they had almost finished their sentences and were therefore less difficult to control. No female convicts were sent to Western Australia. Transportation of convicts from UK to Western Australia (and to Australia) officially ended in 1868 and ‘It is believed that 9,721 convicts stepped onto Western Australian soil alive.’ [15]

There were important differences between Western Australian convicts and those transported to the eastern states.[16] The men sent to Western Australia were more often convicted of more violent crimes: 19 per cent burglary usually with violence; 13 per cent crimes against the person and 9 per cent robbery. The men in the eastern states more frequently came from rural areas, they were older and a there was a larger proportion of agricultural workers. Within the Western Australian system, as well as being convicted of more violent crimes, the men arriving in the later years were more likely than earlier transportees to have come from an urban background. Consequently, they were more artisans than agricultural workers and they tended to be literate and married: 38 per cent were artisans compared to 8 per cent agricultural labourers; 64 per cent were literate or semi-literate; and 24 per cent were married.


[1] Serle, pp. 126-127.

[2] Clarke, Keith M., Convicts of the Port Phillip District, (K.M. & G. Clarke), 1999 and Wynd, Ian, The Pentonvillians, (Ian Wynd), 1996.

[3] Port Phillip Patriot, 21 November 1844.

[4] Port Phillip Patriot, 26 December 1844.

[5] See, for example White, C., A history of Australian bushranging, Vol. 1, (Lloyd O’Niel), 1970, p. 2; ibid, Giblin, R.W., The early history of Tasmania, p. 130; and ibid, Robson, L.L., The convict settlers of Australia, p 157

[6] Dyster, B., ‘Public employment and assignment to private masters, 1788-1821’, in ibid, Nicholas, Stephen, (ed.), Convict workers, p. 145

[7] Ibid, O’Donnell, Ruán, ‘‘Desperate and Diabolical’: Defender and United Irishmen in early NSW’.

[8] Hobart Town Courier, 26 February 1848.

[9] http://www.jcu.edu.au/aff/history/articles/kennan.htm Keenan, Mel, ‘The Armagh Five: Irish Ribbonmen in Tasmania 1840-1850’, The Electronic Journal of Australian and New Zealand History, (1996-1999) contains valuable material on Rogers.

[10] Davis, R. and Petrow, S., (eds.), Ireland & Tasmania 1848, (Crossing Press), 1998

[11] Meredith, David and Oxley, Deborah, ‘Contracting convicts: the convict labour market in Van Diemen’s Land 1840-1857’, Australian Economic History Review, Vol. 45, (1), (2005), pp. 45-72 examines the problem of declining labour supply.

[12] In 1826, convicts from NSW were sent to King George Sound to establish a settlement and their presence was maintained until 1830 when control of the settlement was transferred to the Swan River Colony. Early in 1839, John Hutt, Governor of Western Australia received a circular from the Colonial Office asking if the colony would be prepared to accept juvenile prisoners who had first been reformed in ‘penitentiaries especially adapted for the purpose of their education and reformation’. After seeking comment from the Western Australian Agricultural Society, Hutt responded that, ‘The Majority of the Community would not object to boys not above 15 years of age....’ but that the labour market could not support more than 30 boys per year. 234 juvenile prisoners were subsequently transported from Parkhurst Prison to Western Australia between 1842 and 1849. These Parkhurst apprentices were then ‘apprenticed’ to local employers. As Western Australia was not a penal colony, contemporary documents scrupulously avoided referring to the apprentices as ‘convicts’. Most historians have maintained this distinction. Gill, Andrew, Convict Assignment in Western Australia 1842–1851, (Blatellae Books), 2004, however, argues that they were convicts and that their apprenticeships constituted convict assignment. See also Stannage, C. T., (ed.), A New History of Western Australia, (University of Western Australia Press), 1981, especially Statham, Pamela, ‘Swan River Colony 1829-1850’, pp. 181-210.

[13] Statham, Pamela, ‘Why Convicts I: an Economic Analysis of the Colonial Attitude to the Introduction of Convicts’ and ‘Why Convicts II: the Decision to Introduce Convicts to Swan River’, in Stannage, C.T., (ed.), Studies in Western Australian History, 4: Convictism in Western Australia, (University of Western Australia Press), 1981, pp. 1-18.

[14] Hasluck, Alexandra, Unwilling Emigrants: a study of the convict period in Western Australia, (Oxford University Press), 1959, pp. 28-29

[15] O’Mara, Gillian, Convict Records of Western Australia, (Friends of Battye Library), 1990, p. 1; see also O’Mara, Gillian and Erickson, Rica, Dictionary of Western Australians, Vol. 9: ‘Convicts in Western Australia 1850-1887’, (University of Western Australia Press), 1994. See also, Reece, Bob, (ed.), Studies in Western Australian History, 20: The Irish in Western Australia, (University of Western Australia Press), 2000.

[16] Taylor, Sandra, ‘Who were the convicts? A statistical analysis of the convicts arriving in Western Australia, 1850-51, 1861-62 and 1866-68’, in ibid, Stannage, C.T., (ed.), Studies in Western Australian History, 4: Convictism in Western Australia, pp. 19-26. See also the papers in Sherriff, Jacqui and Brake, Anne, (eds.), Studies in Western Australian History, 24: Building the Colony: The Convict Legacy, (University of Western Australia Press), 2006.