The blueprint for the reorganisation of the State's hospital services, contained in the soon-to-be-published Hanly report, has been dismissed by doctors working in smaller hospitals as totally impractical.
The report has suggested each region should have one major hospital with a full range of specialities and services including A&E and maternity and that others be left to treat minor ailments and convalescing patients.
Dr Gary Courtney, a consultant at St Luke's Hospital, Kilkenny, said at the weekend the proposed changes meant the State would have to replace the main hospitals with several 1,000-bed hospitals to be able to cope with the fresh demands placed on them.
In his region, the south-east, the main hospital had more than 22,000 admissions in 2002, making it bigger than all but one of the major Dublin hospitals. If it then had to cope with admissions from local hospitals in Kilkenny, Wexford, Clonmel and Cashel, the extra burden on it would be some 41,000 acute admissions.
Furthermore, he said, the ambulance service was inadequate to meet the needs of the many patients who would, under the proposed changes, have to be ferried to regional hospitals.
Addressing a new alliance of doctors from smaller hospitals, formed to fight the changes, on Saturday Dr Courtney said he did not believe the report would ever be implemented.
The biggest threat from it was that managers would use the uncertainty around it to postpone decision-making, leading to "paralysis by analysis, collapse in morale, falling standards and a flight from the service".
Dr Christine O'Malley, a consultant at Nenagh General Hospital, said there were many myths around small hospitals, one being that they were costly and inefficient. Citing Department of Health figures, she said the cost of treating patients in a major teaching hospital was €558 per day compared to €391 per day in a county hospital.
"Small hospitals are the workhorse of the Irish hospital sector, and the system would collapse if they were removed. We are the part that works. We do not have long waiting lists or people on trolleys in A&E, and length of stay is shorter than in the large voluntary hospitals," she said.
It was crazy to think of closing acute beds when the system already needed 3,000 more.
She urged the Government to conduct a patient impact assessment of the proposals before they were put any further.
Other speakers referred to the problems they already experience trying to get patients into the bigger hospitals. Dr Prega Pillay, a consultant at Monaghan Hospital, said one of the patients he transferred to Cavan for treatment recently ended up being transferred around the country, first to Dundalk, then Drogheda, then Beaumont and finally back to Monaghan after there was no bed for him in any of the other four hospitals.
However, the Professor of General Practice at TCD, Dr Gerard Bury, told the audience that, while local hospitals were fundamental, they could not and should not be expected to treat injuries from major car accidents.
"I think we have to explain to people that, much as we might like to have services on each of our doorsteps, that it is not possible. We will achieve an acceptable level of service with clear-cut change ," he said.