A radical re-organisation of acute hospital services is required across the State, according to the Hanly task force report published yesterday.The report said acute hospitals in the Republic had evolved without a national plan.
"Often they were developed in response to local needs, or owe their origins to history rather than to clear national or regional priorities. This has resulted in inefficiencies, duplication and a system that is often designed around institutional, political and administrative concerns rather than those of patients."
The task force consulted widely, particularly in the mid-west and east coast area health board regions where its recommendations in relation to reorganising hospital services will initially be piloted.
These consultations, it said, highlighted problems of inadequate bed capacity, poor integration of services, barriers to efficient patient management, lengthy waiting times and frequent cancellation of non-emergency treatment. Other issues raised included problems with equity of access to public hospital care for public patients.
There was, the report said, "consistent criticism of local pressure which is focused on safeguarding local facilities without regard to the best way for providing safe and effective care".
"A failure to deal with difficult decisions affecting the location of services was also cited. These problems can and must be addressed," it added.
The report made recommendations on the reconsideration of hospital services in two regions only, each with a population of about 350,000, and said the principles it set out should inform the reorganisation of services in the rest of the country.
A blueprint for other areas will be published next summer and will be devised by a small group, again chaired by businessman Mr David Hanly.
The report says that in the pilot regions, acute hospital services should be organised into regional networks which are "as self-sufficient as possible".
This will mean each region has one major hospital - Limerick Regional Hospital in the mid-west and St Vincent's Hospital in the east coast area health board.
These regions will also have a number of local hospitals. Local hospitals, it says, should do more elective surgery, hold outpatient clinics, have minor injury units, diagnostic units, antenatal care, and opportunities for patients to convalesce.
They would not have a full maternity unit or accident and emergency unit, however, which is bound to be one of the most controversial elements of the report. The hospitals to be redesignated local hospitals in the east coast area health board are St Columcille's Hospital, Loughlinstown, and St Michael's Hospital in Dún Laoghaire. In the mid-west, Ennis General Hospital, St Joseph's Hospital in Nenagh and St John's Hospital in Limerick will be redesignated as local hospitals. Nenagh and St Columcille's will therefore lose their A&E units.
The major hospitals will, the report says, provide a full range of services in nine major specialities, including anaesthesia, emergency medicine, obstetrics and gynaecology, paediatrics, medicine, surgery, pathology, psychiatry and radiology.
The report acknowledges that its recommendation on A&E units will cause concern.
"The conclusion that the full range of emergency services can only be provided in major hospitals may raise concerns about the access of patients to treatment in life-threatening situations. It should be noted, however, that many of the main life-saving measures in emergencies are not affected by the immediate proximity to a hospital.
"The critical concerns are early resuscitation and early access to skilled diagnostic, medical, surgical and anaesthetic care. This can best be provided in a consultant-staffed major hospital, supported by appropriately trained ambulance personnel."
It emphasised the need for a well-organised ambulance service to take patients to these hospitals rapidly.
Furthermore, the task force said that "in an ideal situation", services currently provided at single speciality hospitals should be provided on the site of a major hospital. Single speciality hospitals would include the three main maternity hospitals in Dublin.
"This would enable more speedy access to on-site specialist support, increase efficiencies in staffing cover and reduce the duplication of staff and support services," the report said.
Furthermore, it said that in certain large geographic regions, there may be a need for general hospitals in addition to local and major hospitals. These could provide A&E services in addition to a wide range of other specialities.
The task force said the reorganisation of hospital services was necessary in order to comply with the European Working Time Directive which requires non consultant hospital doctors (NCHDs) to work no more than 58 hours a week by August next year. Some are now working over 100 hours a week. To comply with this, it says, the number of hospital consultants in the system should be more than doubled, from 1,731 to 3,600, over the next decade, at an estimated cost of €111 million. This will mean patients will be more likely to be treated by consultants than by junior doctors.
The report also recommends that consultants be rostered to work in teams around the clock and that theatres and outpatients clinics have a longer working day, from, for example, 7 a.m. to 8 p.m. for up to six days a week. "It is inefficient to leave expensive plant and equipment such as theatres, laboratories, CT and MRI equipment idle for a sizeable proportion of each 24-hour period". There was considerable scope for increasing the role of nurses and midwives.
In addition, the report recommends that medical staff have considerably greater involvement in the management of hospitals. Each network of hospitals, it said, should have one chief executive.
It also recommends establishing a national hospitals authority which would have responsibility for resource allocation, workforce planning and strategic development.
The report says the task force was determined to "recommend solutions designed to provide the best possible health service for patients and staff, without regard to the potential political implications of its proposals".