THE HSE will today publish a controversial report into the reconfiguration of hospital services in Cork and Kerry which recommends the centralisation of all acute hospital services at Cork University Hospital which would become a regional centre of excellence for acute care.
The report, some details of which have been leaked, has already provoked an angry reaction among some medics who have vowed to oppose it. It has also run into strong opposition from local politicians.
And the HSE has already moved to reassure people in Kerry that it will not be implementing the recommendation by Horwath Consulting Ireland and Teamwork Management Services to transfer all acute services from Kerry General Hospital to Cork University Hospital.
Prof John Higgins, who has been charged with overseeing the reconfiguration of services, has said the report would be only one of a number of policy documents including the National Cancer Strategy which would be considered in any reorganisation.
Nonetheless, the proposals contained in the report to transfer acute services from Mallow General Hospital, Bantry General Hospital, the Mercy University Hospital and the South Infirmary Victoria University Hospital in Cork look set to prove highly controversial.
Already Mercy University Hospital chief executive Pat Madden has confirmed that the board of the 152-year-old voluntary hospital in the heart of Cork city has voted to reject the report and will not engage in any discussions on reconfiguration of hospital services based upon it.
And local politicians in both Mallow and Bantry have already expressed opposition to the reconfiguration which would see both county hospitals along with the Mercy and the South Infirmary Victoria developed as local centres of excellence for non-acute care.
In the report, Horwath and Teamwork examine the provision of hospital services in Cork and Kerry in terms of “having a critical mass of medical workforce composed of eight or more doctors at each level of seniority of the clinical team”.
This is essential to provide continuous patient access to consultant care, automatic peer review, robust clinical supervision and an equitable share of emergency duties and patient workloads, according to the authors.
The second factor that Horwath and Teamwork identified as being critical to efficient hospital service provision in the region in their review is a matching catchment population of at least 350,000-500,000.
This is the minimum population size required to generate a sufficient concentration of patient numbers and range of acute clinical problems to establish the right professional environment to produce the best outcomes in acute care, according to the report.
“The current configuration of acute hospitals in HSE South with regard to their small catchment populations means that there are too many hospitals, each covering too small a population,” according to the report’s authors.
“The present fragmented systems mean that each one is not in a position to develop services in line with international best practice standards,” they say.
They found considerable variation in the hospitalisation rate for emergency medical admissions per 10,000 population, ranging from 782 for Cork city residents to 448 for Cork county residents.
“If acute hospital services in Cork and Kerry were to make improvements in efficiency to national and international levels, leading to reduced lengths of stay, then around 423 beds, some 29 per cent of the total occupied beds at 2005, could be released for other purposes,” it says.
The authors acknowledge the huge distances involved in transferring patients in emergency situations and suggest that the ultimate objective should be that conveyance by air ambulance service becomes the norm in such cases.