It will take three to five years for the recommendations contained in the recently-published Hanly report on health service reform to be piloted in just two health board areas, it has emerged.
The chairman of the taskforce which drew up the report, Mr David Hanly, told a Dáil committee yesterday he envisaged it would take this length of time to get the necessary facilities and staff in place to fully implement his recommendations in the Mid-Western and East Coast Area Health Board regions.
The report has recommended accident and emergency units in hospitals such as Nenagh, Ennis and Loughlinstown in Co Dublin be replaced by minor injury units led by nurses, and it has led to widespread fear in other regions that they will also lose full emergency services.
However, it seems these regions now have nothing to worry about if, as would appear likely, the report is not rolled out elsewhere until it is fully tested in the two pilot areas.
Mr Hanly told the joint Oireachtas Committee on Health and Children that the Department of Finance was fully aware of the cost implications of his proposals before the report was signed off. An assistant secretary from the Department of Finance sat on the taskforce. "Certainly he signed off on this report and fully understood the costs involved," he said.
Furthermore, Mr Hanly said the report was written on the assumption that the 3,000 extra acute hospital beds promised in the health strategy would be provided.
He said there was no question of closing beds in small hospitals, but he agreed with Labour's health spokeswoman and committee member, Ms Liz McManus, that "big is not necessarily better" in regard to the size of hospitals. Qualifying his remarks, he said there were "relative levels of big", that very big hospitals weren't always better, but hospitals had to be of an "optimal size" to give patients best outcomes.
Mr Hanly said there was no question of replacing small hospitals with ambulances, though ambulance services needed to be radically improved to transfer patients in emergency situations to larger hospitals.
In addition, he said he accepted there was a critical shortage of GPs, but pointed out it was not within his remit to examine this aspect of the health service. Concern has been expressed that if local hospitals lose full emergency services, it will be the already overstretched GP who will bear the brunt of the changes.
Mr Hanly acknowledged that other reports on the health service had not been implemented, but not implementing his was not an option. It had been compiled, he said, to devise a system in which the hours of junior hospital doctors could be cut to 58 hours a week by next August to comply with a new European working time directive. "If we do not implement this report this country will be open to substantial fines," he said.
His colleague on the Taskforce on Medical Staffing, Dr Cillian Twomey of Cork University Hospital, said it was a disgrace that the provision of specialist services around the country was "so uneven and unfair". He said the Hanly report would address that as it recommended the number of hospital consultants be more than doubled.
He urged committee member Dr Gerry Cowley, an Independent TD for Mayo, not to be alarmist when he suggested people would die travelling long distances in ambulances to major hospitals when small A&E units closed. The most critical intervention was at the site of an accident or cardiac arrest, rather than the length of an ambulance journey.