Hospital reform


First came the Fitzgerald report in 1968, many of whose sensible recommendations continue to gather dust. A more recent attempt to rationalise hospital services in the Republic was the Hanly report. Now we have the publication of the Higgins report, billed as “the most fundamental reform of the Irish acute hospital system in decades.” In the light of such a poor track record of aspiration followed by inaction, can the latest effort to reconfigure hospitals work?

At present the country has 49 hospitals in which some level of acute care is provided to patients. Even allowing for elements of geographic isolation, this number is excessive. The failure to modernise for over 40 years is the result of local politics consistently trumping best medical practice.

But with economic adversity comes opportunity. A “perfect storm” of medical and technological advances combined with doctor shortages and a dwindling health budget means substantial change may no longer be avoidable. Grouping hospitals together to share a regional workload would, in theory, address these issues. However patient safety must be the ultimate arbiter of the pace and the extent of change within each region.

While the pecking order of flagship hospitals may dominate the headlines, from a patient’s perspective the success or otherwise of the Higgins report will be largely determined by what happens in the State’s smaller public hospitals. Emergency departments are to be replaced with “local injury units.”

Only day case surgery involving planned operations such as the repair of hernias and the removal of varicose veins will take place in the smallest hospitals. They will not have intensive care units; patients who develop unexpected complications will be transferred to a larger institution within the group.

The document provides great detail on how such integration will be seamlessly achieved but it faces a serious hurdle in the form of a severely under-developed primary care system.