Hanly reforms: Victims of road traffic accidents would be less likely to reach an accident and emergency department within the crucial "golden hour" under Hanly reforms, research has shown, writes Dr Muiris Houston, Medical Correspondent.
In a week that saw the death toll on the roads reach 219 so far this year, researchers said the percentage of the population able to reach an A&E department within one hour following a road traffic accident would fall from 82 per cent to 72 per cent.
Ease of access to A&E has been among the most controversial aspects of the Hanly plan for reform of Irish health services.
Researchers at the Department of Public Health and Primary Care in Trinity College, Dublin also found three out of every 10 cases of acute heart attack patients may have to travel for more than one hour to get to an A&E unit. The successful treatment of acute medical emergencies such as road traffic accidents and heart attacks is dependent on getting the patient to an adequately-resourced hospital within one hour of a critical incident - known as "the golden hour".
The research team looked at the potential impact on patient travel times of changes to the location of A&E services as proposed by the Hanly Report - it recommended removal of A&E services from smaller public acute hospitals with a corresponding increase in capacity at larger regional hospitals.
In a paper published in the current edition of the Irish Medical Journal, Dr Joe Barry, senior lecturer in Public Health at Trinity, and his colleagues looked at three possible scenarios involving different levels of A&E services. In addition to the current distribution of A&E units, they examined what would happen if a literal interpretation of the Hanly reforms was to emerge. The third "intermediate" scenario involved a partial reduction in A&E services across the Republic.
When the researchers applied a spatial interaction model to the most literal interpretation of Hanly and compared it with the present availability of services, the percentage of cases able to access an A&E department within one hour dropped considerably. For people with an acute heart attack, 86 per cent travel less than one hour for treatment under the current distribution of services. This drops to 70 per cent when A&E services are concentrated at a single location in each health board. In the case of a major road traffic accident, just under 82 per cent of cases nationally travel less than one hour for treatment. Only 72 per cent of these could access a full A&E service under the Hanly plan.
There is considerable variation in the figures between health boards. For people living in the North Western Health Board, only 44 per cent would be able to access A&E within the "golden hour" following a road traffic accident. The percentage of cases of road traffic accidents within 60 minutes of a hospital in the Western Health Board is just 47 per cent under the Hanly interpretation. The proposed changes will have least impact in the east.
Dr Barry said: "Whatever changes are made, those living along the western seaboard will have longer travel times to A&E. Primary care-based interventions should be prioritised in these parts of the country."
Meanwhile, a Department of Health spokeswoman confirmed Mr Martin has joined the steering group driving reform within the health service. Although Mr Kevin Kelly remains executive chairman of the Health Service Executive, Mr Martin now chairs meetings of its steering group.