A report on the North's hospitals has recommended a capital investment programme of £1 billion and radical changes to the way the health service is run.
The report of the Acute Hospitals Review Group, chaired by the North's former ombudsman, Dr Maurice Hayes, calls for the focusing of accident and emergency services in nine hospitals and a downgrading of A&E services in five.
The report recommends that the Tyrone County Hospital in Omagh, where most of the victims of the 1998 bombing were brought, should have its A&E services reduced to a "nurse-led emergency unit". Similar changes would take place in the Mater Hospital in north Belfast; Whiteabbey Hospital, between Belfast and Carrickfergus; Lagan Valley Hospital in Lisburn, Co Antrim; and the Mid-Ulster Hospital in Magherafelt, Co Derry.
The Downe Hospital in Downpatrick and Lagan Valley Hospital would also lose their maternity in-patient facilities.
Eight existing hospitals would provide acute services: the Royal Victoria and City hospitals in Belfast; the Ulster Hospital outside Belfast; Antrim Area Hospital in Antrim town; Altnagelvin Hospital in Co Derry; Craigavon Hospital in Co Armagh; the Causeway Hospital in Coleraine, Co Derry and Daisy Hill Hospital in Newry, Co Down. A new south-west hospital would be built in Enniskillen, Co Fermanagh, at a projected cost of £75 million.
The review group was set up in August 2000 by the Health Minister, Ms Bairbre de Brun. The report was expected within six months but a number of factors, including the foot-and-mouth outbreak, delayed it. Launching the report, Dr Hayes accepted that the changes would be a loss for some areas but said radical change was needed to prevent the health system in the North from collapsing. Several reports on reforming the health system have been produced in recent years, and Dr Hayes said there was discontent and uncertainty within it.
"If we don't do anything, the whole service will gradually run down and eventually implode." Dr Hayes said that the crucial issue for the North's hospitals was not a lack of bed space but delays in tests and treatment which kept beds occupied unnecessarily.
Consequently, the report recommends a £1 billion capital investment programme over 10 years. Much of this would be spent on transforming the facilities of smaller hospitals. These would be "modern, state-of-the-art" facilities with, it says, up-to-date IT systems. The modernised local hospitals would be "bright, modern facilities providing the vast majority of hospital services required by the local communities that they serve," Dr Hayes said.
Staff shortages have also contributed to long waiting times and the report recommends a doubling of hospital consultants, increasing the number of GPs by 25 per cent and increasing the number of nurses, especially specialists, by 20 per cent.
At present the health service is administered by four health boards with 18 health trusts providing services. The report recommends the four health boards be replaced by one "strategic commissioning authority" while the 18 trusts would be subsumed into three integrated "health systems".
Vehicles in the elderly fleet of the Northern Ireland Ambulance Service should be updated "immediately" and its four control rooms merged. Dr Hayes said the report identified significant scope for cross-Border co-operation in areas such as childhood cancer and transplant surgery.
"There are things we can't do for a population of 1.5 million, there are things that can't be done in the South with a population of 3.5 million but you could do them for five million." The report was presented to the Minister for Health, Ms de Brun, and will be open for public consultation. It may be another six months before decisions are made on its recommendations.