The Health Service Executive has ordered a review of acute hospital services in the midwest and west, sparking renewed fears that smaller hospitals in these regions could still be in danger of losing some services.
The midwest review will be carried out by external consultants, following a tendering process, and is due to be completed by the end of the year.
The HSE said the consultants appointed will be asked to make recommendations "on the options for reconfiguring and redesigning services and in particular to identify the elements of healthcare that can be most effectively delivered at each site".
Local activists fear it will end up being another version of the Hanly report, which recommended A&E units at smaller hospitals be replaced by nurse-led, minor-injury units. One predicted it would end up being "Hanly by another name".
The acute hospitals in the midwest region that will be subject to the review include Limerick Regional Hospital, Limerick's regional maternity hospital, Ennis General Hospital, Nenagh General Hospital, and the Mid Western Regional Orthopaedic Hospital in Croom and St John's Hospital, both in Limerick.
The chairman of Ennis Hospital Development Committee, Peadar McNamara, said the review was "another effort to smokescreen an inability to speak the truth about what was going to happen".
He said the Taoiseach Bertie Ahern and the Tánaiste Mary Harney had given verbal assurances that the A&E unit at Ennis would not be removed, but Prof Brendan Drumm, chief executive of the HSE, said the Hanly report was Government policy.
"So our concerns are still as alive as ever," he said.
The announcement of the review in the midwest came as the Nenagh Hospital Action Group published a report entitled Small Hospital, Big Service, highlighting the value of smaller hospitals.
Paul Malone of the action group said he was not aware of the review of services being commissioned by the HSE in the midwest, but if there was to be a review, those conducting it should talk to and listen to the people in each area. This had not happened with Hanly, he claimed.
The HSE said the report from the Nenagh action group, as well as reports from the Ennis hospital development committee, would be considered as part of the review.
The Nenagh report said small rural hospitals treat more patients at a lower cost than larger hospitals.
Drawn up by local health professionals and community representatives, it also said the system used in Nenagh, whereby local GPs can refer patients directly to wards in the hospital, has prevented the problem of patients queuing on trolleys in A&E.
Local GP Dr Colm O'Reilly said the report proved a small hospital could provide acute healthcare to local communities. "What we have to remember is that small hospitals provide 50 per cent of all acute medical care in the country, and if that system falters, it will cripple the bigger hospitals," he said.
Meanwhile, the HSE in the west said last evening it is also to undertake a review of "service configuration" at the two smaller hospitals in its area. The hospitals where services are to be examined are Portiuncula Hospital, Ballinasloe, and Roscommon County Hospital.
This review is to be carried out internally and is expected to be completed by June.
Meanwhile, a review by outside consultants of acute hospital services in the northeast, commissioned in the wake of the death of Pat Joe Walsh in October 2005, has just begun.
Mr Walsh required emergency surgery on a bleeding ulcer, but could not be operated on in Monaghan hospital as surgeons there are not permitted to perform emergency surgery.