The Cabinet has accepted the Hanly report which recommends the appointment of 2,000 extra hospital consultants and major reforms, including withdrawal of A&E and obstetric services from many local hospitals, write Mark Hennessy, Eithne Donnellan and Dr Muiris Houston
Last night the Department of Finance acknowledged the 10-year implementation of the plan would be costly. "But it is Government policy," it said, adding that "there isn't a huge amount of money needed next year".
The Minister for Health, Mr Martin, said local hospitals would provide more elective surgery and outpatient clinics. They would have well-equipped minor injury units, diagnostic units, antenatal care and convalescent beds.
However, these hospitals will not have a full maternity unit or A&E unit, and this will prove a serious political headache for the Government as local elections approach next year.
Denying that local hospitals would be downgraded, Mr Martin insisted the changes were inevitable, and would result in sharply improved services.
He was speaking during the launch of the Medical Taskforce on Staffing report, chaired by Mr David Hanly, which was submitted to the Department of Health this summer.
Acknowledging the political difficulties ahead, Mr Martin said: "This is a huge political challenge. This report will be manipulated by those who want to create extra space for themselves on the political scene.
"It can be manipulated by those who want to manipulate it. Equally, it can be used to disadvantage of some of my own colleagues in particular areas. I am under no illusions," he told The Irish Times.
Opposition parties dismissed the report as "unimplementable", claiming it would lead to poorer services. Fine Gael's health spokeswoman, Ms Olivia Mitchel, warned of the impact from cutting full-scale A&E units from 40 to 12.
The critical element in the package if it is to succeed is reform of the existing 33-hour week contract enjoyed by consultants. They will have to work in teams, and on day, night and weekend rosters.
The major hospital in each region of 350,000 people will have a full and upgraded range of services, while local hospitals will work largely on a five-day week, 9 a.m. to 5 p.m. basis.
Each major hospital will have anaesthesia, emergency medicine, obstetrics and gynaecology, paediatrics, medicine, surgery, pathology, psychiatry and radiology services available on a 24-hour basis.
Downplaying the impact of A&E closures, Mr Martin said nearly 90 per cent of A&E patients were discharged immediately after treatment, while another 8 per cent were transferred quickly from local hospitals for more intensive care in major hospitals.
"If this model gives you four rheumatologists instead of having none, then who is downgrading who? That applies to the other specialities as well. People need to look at the big picture."
The taskforce plan will be tested in the Mid-Western Health Board, and in the East Coast Area Health Board, which caters for most of south Dublin and parts of Wicklow.
Limerick Regional Hospital has been designated as the Mid-Western Health Board's major facility, while Ennis General Hospital; St Joseph's Hospital in Nenagh; and St John's in Limerick will be regarded as local hospitals and lose their A&E units.
St Vincent's Hospital in Dublin will be the major hospital for the East Coast Area Health Board, while St Columcille's Hospital, Loughlinstown, and St Michael's Hospital in Dún Laoghaire will be in a supporting role.