HOSPITAL SERVICES in the midwest require “substantial reconfiguration” if all patients are to receive safe, high quality healthcare, according to a confidential report prepared for the Health Service Executive.
The report, which was completed a year ago but remains unpublished, recommends that round-the-clock AE services should be provided at only one hospital in the region – Mid-Western Regional Hospital in Limerick – which it says should be equipped with a helipad for emergency transfers.
It says round-the-clock AE services provided at Ennis and Nenagh general hospitals should be stopped and replaced with nurse-led minor injury units. The AE services at St John’s Hospital in Limerick should also be replaced with a nurse-led unit, it says.
It claims existing services are “too fragmented” with resources including staff “too diluted and stretched” across four sites to provide safe, continuous, sustainable, high quality care to any recognised standards.
The review of acute hospital services in the midwest, which has been seen by The Irish Times, states that at present there are four AE services across the midwest but only three AE consultants. It says Nenagh has no AE consultant input at all and there is nominal consultant cover and support at Ennis and at St John’s.
“These arrangements are inherently unsafe and not sustainable. Moreover, the workloads at Nenagh, Ennis and St John’s are too low and lack critical mass to provide viable, stand-alone AE services,” the report says.
It points out that the AEs at Ennis and Nenagh are staffed by “external, non-HSE, non-specialist doctors recruited from overseas” and the HSE “must take prompt action to address these matters”.
The review also recommends centralising emergency general surgery, major elective surgery, elective orthopaedic surgery, critical care, coronary care and obstetrics at the Mid-Western Regional Hospital. It said this hospital should provide all specialist acute care for the region.
The review by Horwath Consulting Ireland Limited and Teamwork Management Services Limited states that extra beds will have to be provided at Mid-Western Regional Hospital if the plan is to be implemented. It said the hospital would need 642 inpatient beds. It currently has 472.
The report says the role of Ennis, Nenagh and St John’s Hospitals should change and they should focus on day surgery, diagnostics, outpatient clinics, rehabilitation and urgent but not emergency care. They could also be a base for primary care teams.
But it says these “local centres of excellence” also need investment. It says the HSE should review whether Ennis and Nenagh hospitals should now be refurbished or entirely rebuilt.
Overall, the report says extra consultant staffing is required and recommends better resourced primary care services and teams, home support services and a better ambulance service with advanced paramedics on board before the review’s recommendations can be implemented.
It puts the cost of the capital investment required at about €370 million, which it says is “€260 million higher than identified in the current capital programme”. It says the investment required includes €60 million for Ennis, €25 million for Nenagh and €47 million for St John’s.
The report states: “Overall the acute services in the midwest require substantial reconfiguration, investment and reallocation of existing dispersed resources in order to be in a position to deliver services in line with international best practice standards, so that all patients receive safe, high quality healthcare”. It suggests the plan could be largely implemented by 2010. But it says the HSE should not wait until then to take action.
“Until the action plan is fully implemented, existing services must be made safer for patients through targeted transitional investments and progressive service rationalisation in line with the overall strategic direction”. It says the developments need to be supported by a robust governance infrastructure and reporting system. If their recommendations are implemented the benefits, they claim, will be profound.