Changes will lead to better service - Martin

Plans to transform major hospitals into centres of excellence and remove some services from local hospitals will result in a better overall standard of treatment for patients, the Minister for Health insisted yesterday.

Speaking at the publication of the Hanly report, a 10-year blueprint for the restructuring of the acute hospital system, Minister Martin rejected suggestions that the changes represented a downgrading of local hospitals.

While local hospitals may lose specialist services, such as accident and emergency and maternity units, Mr Martin said there would be no closures and regional services would play an important role by linking into the major hospitals.

The report also recommends doubling the number of consultants, halving the number of junior doctors, making major changes to consultants' work practices and cutting junior doctors' working hours over the next decade.

Accepting that he faces a tough political battle to press ahead with the proposed changes, he said he had full Government support and that Irish people would have to look at the "bigger picture."

"We're going to have the fight the fight and make the argument in favour of these changes," he said.

"We have to be careful to provide certain services in hospitals that have the facilities, volumes of activity and expertise to provide the best possible service for patients. This is about safety and quality. It is not about downgrading hospitals or taking away services from local communities."

The Minister said plans to implement the report's recommendations would begin immediately and that phase one of the reform package would be completed by August 2004.

He said local hospitals would provide an increasing volume of elective procedures, day surgery, minor injury and high illness units, pre and post-natal maternity services and convalescence beds.

Dr Cillian Twomey, a consultant physician in geriatric medicine at Cork University Hospital and member of the National Task Force on Medical Staffing which drew up the Hanly report, said the reform plans had the broad support of health professionals.

He said many consultants who had been asked for their views as part of the report's consultation process had been "crying out" for many of the planned reforms which, he said, would lead to improved specialist services.

Mr Martin said there would also be major changes in the work practices of consultants so patients could have better access to 24-hour services in major hospitals.

While medical care is provided today by more than 4,000 non-consultant hospital doctors, or junior doctors, and just over 1,700 consultants, this will change dramatically over the next decade.

Overworked junior doctors will have their working hours cut substantially, while the number of consultants will be doubled.

This means the current consultant-led service will be replaced by a consultant-provided service, where senior doctors work together in teams so patients are diagnosed and treated by health professionals with the skills, training and experience to diagnose, treat and plan patients' care.

Mr Martin said there was no question of moving to such a consultant-provided service in the absence of a substantially changed contract.

He rejected suggestions that the contract negotiations could drag on for an extended period of time, potentially delaying planned reforms, and insisted that most consultants were already in favour of the changes.

Mr Martin also said he was encouraged by the progress made in implementing the 10-year-old Tierney Report, which recommended appointing an extra 1,500 consultants in 1993. During that period of time, more than 1,700 consultants were appointed, exceeding the original targets.

The Minister also said he would press ahead with implementing the reform plans immediately.

The first step will be to reduce junior doctors' working hours from an average of 75 to 58 by next August. He said the Labour Relations Commission has been asked to convene a meeting between management and unions to agree on a way forward.

Mr Martin said that as working hours reduce, training and education would have to be delivered without compromising on quality.