A NEED FOR reform within the hospital system is accepted by most people. But when particular services and specific hospitals are identified in that process, all hell breaks loose as local politicians and vested interests make their objections known. It has been so for decades. As a consequence, we live with a sprawling, inefficient system.
Hospitals are seen in much the same context as the local church and are defended with great vigour against change. It is therefore critically important that alternative medical services are put in place before any established arrangements are changed. It is the only way to defuse genuine local concerns.
If the Health Service Executive (HSE) is aware of this imperative, it does not show signs of responding to it. Instead, it has begun to rationalise emergency hospital services without making adequate provision for the immediate impact of those changes. The northeast is a case in point. Acute services have been centralised because local hospitals have become so run-down they are no longer capable of providing high-quality care. But the centralisation of responsibility for acute hospital care has not been matched by the provision of increased resources, improved community services and adequate forward planning.
A similar situation is about to affect the midwest region, where accident and emergency services will be centralised in Limerick from next April. The withdrawal of 24-hour AE services from three local hospitals is probably justified on the grounds of cost effectiveness and patient safety. But it is likely to be a year – at least – before extra beds and additional facilities are provided at the Mid-Western regional hospital centre.
A need to save money is driving many of these changes. Saving money is important but saving lives is fundamental. That should be the core concern of the HSE. Forcing it to operate within an inadequate budget has skewed its responsibilities to such an extent that, at a time of seasonal overcrowding in AE units and inadequate community services, it has to contemplate operating with up to 1,000 fewer acute hospital beds.
The Royal College of Surgeons in Ireland has expressed “extreme concern” over what is proposed for the midwest region, not because of the centralisation of services, but because inadequate provision has been made to deal with changes. Centralised AE and critical services may be unable to cope with the additional influx of patients. That cannot be allowed to happen.