Local A & E units under threat in Hanly reform plan

Out-of-hours accident and emergency units and maternity facilities at many local hospitals will be transferred to regional centres of excellence, under proposals contained in the Hanly report on medical staffing.

The long-awaited report also proposed doubling the number of consultants in Irish hospitals to 3,600 over the next ten years. The number of junior doctors will halve over the same period, according to the plan.

Central to the implementation of this report is renegotiating the consultants' contract, in which significant changes will be sought by the Department of Health.

Publishing the report, the Minister for Health Mr Martin, admitted the steps outlined could not proceed until this issue was resolved. He said the Health Service Employers Agency today wrote to the medical organisations seeking a start to negotiations.

The recommendations have been endorsed and would be funded by Government, said Mr Martin. He added the report would form the blueprint for acute hospital services in the State.

The estimated cost in 2003 prices is €111 million, excluding inflation and capital costs. This is estimated by the Department of Health to be almost budget-neutral, as it is close to the amount paid out in overtime to junior doctors.

Central to the Hanly report proposals is reorganising the State's hospital system into a series of major hospital's - such as the Mid West Regional Hospital in Limerick - supported by local hospitals serving a regional population of 350,000.

It is this proposal that is likely to be most strongly objected to by residents living close to a local hospital currently offering these facilities. The report suggests cutting the number of hospitals delivering A&E services from 40 to 12.

In support of the reorganisation around acute hospitals, the report points out that 60 per cent of those attending hospital emergency departments require non-urgent care. It said one third of patients required urgent or semi-urgent care and between 5 and 10 per cent of patients have major trauma.

As a result, the report says, the minor illness and injury units which will replace A & E units at many local hospitals should be able to cater for a very high proportion of cases.

The Hanly report studied only two regions; the East Coast Area Health Board and the Mid Western Health Board. The Minister said today that Mr David Hanly has been appointed to prepare a plan for the National Hospital's Office on the national reorganisation of acute hospital services.

This is due to be completed by July 2004.

Adding impetus to the implementation of the report's recommendations is the looming deadline of August 1st 2004 when the European Working Time Directive comes into affect. From this date junior doctors will not be allowed to work more than 58 hours per week.

At present junior doctors work an average of 75 hours a week with some working up to 129 hours per week.

This has to be reduced to 48 hours per week by 2009 if the State is to comply with the legislation.

The plan is seeking to achieve the transformation from a consultant-led hospital service to a consultant-provided service. This means consultants will in the future sharing responsibility for patient care and agreeing to on-site 24-hour cover rostering.