Faced with severe pressure on hospital beds and emergency units, the south-east hopes to increase the use of district hospitals for sub-acute care to assist the larger hospitals.
This interim step to meet the crisis is proposed by the chief executive officer of the South Eastern Health Board, Mr John Cooney, who says it is time for a critical reassessment because of the growing dis-equilibrium in the healthcare system.
He told a conference of the Association of Health Boards in Wexford at the weekend that he saw a major need for an intermediate hospital-care capability, consisting of community hospitals, which might cater for about 25 per cent of patients. After that, acute care in county, regional and tertiary hospitals would apply.
An appropriate model might be a community hospital of under 100 beds, run by GPs with suitable links with consultant-led units in the nearest major acute unit. This type of intermediate care might help to provide an adequate service for the next few decades.
He said recent reviews of services in Cos Carlow and Kilkenny suggested the restoration of the community hospital - "but situating it in the campus of the acute hospital, in recognition of the interactive nature of their roles and to promote the inclusion of the elderly at the heart of the system by facilitating their access to a balance of GP and specialist care".
Medical admissions and discharges in the south-east have risen by about 25 per cent in five years, and already this year the marginal costs have sharply exceeded the board's capped allocations in the acute hospital care sector.
Growth in the numbers of elderly will accelerate, with an unavoidable demand for more care. It is projected that, between 1991 and 2011, the population over 65 years in the south-eastern board region will reach 58,372, an increase of 30.3 per cent. The increase in persons over 75 will be even greater, at 43.3 per cent.
In the following 15 years to 2026, the greatest growth will be in the very elderly, those 85 years and over, whose numbers will more than double.
Mr Cooney said an extended community hospital network would have to be complemented by the development of strong, multi-professional community teams in each sector of about 25,000 people focused on domicilary and local care services.
It was important, he said, that the Department of Finance should not constrain the health services "in a financial strait-jacket which ignores the inescapable reality of demographic change and rising need".