More than two dozen hospitals face losing their laboratory medicine services under a confidential rationalisation plan drawn up by the Health Service Executive (HSE) and submitted to the Department of Health for approval, writes Martin Wall
Department of Health officials have briefed Ministers in recent weeks that most hospitals in the State would be affected by the "widespread rationalisation of services" recommended in the unpublished report.
The HSE plan says that a centralised laboratory system would be more efficient and offer guaranteed "turnaround times" for tests ordered by hospital doctors and GPs.
It envisages "a substantial reduction" in the number of technical staff required in the future, as well as significant changes in laboratory practices.
It also anticipates "substantial savings" on the Health Service Executive's current €328 million annual bill for clinical pathology laboratory services.
While there are numerous examples of good clinical and organisational practice, the "whole system quality" in the existing laboratory arrangements "is not good enough", the HSE plan says.
Under the existing system more than 40 hospital laboratories around the country deal with over 58 million tests ordered by hospital doctors for in-patients, out-patients and those in accident and emergency departments, as well by GPs in the community.
The report says that these "hot" and "cold" tests from hospitals and GPs are processed together and delivered within a 9am to 5pm timeframe, with limited work carried out outside this period and then at premium cost.
It expresses concern that there are no hospital laboratories where all the various disciplines are accredited and describes the general condition of the laboratory estate around the country as "poor" and typically "out-moded".
The report also highlights what it terms "inflexible organisational and working arrangements" within the current system.
The new plan would see routine tests ordered by GPs or community services separated from those requested from within hospitals and carried out by new stand-alone, highly-automated laboratories, based in Dublin, the south and the west.
It recommends that the services of the existing 40-plus hospital laboratories dealing with tests requested for hospital patients should in future be concentrated in a much smaller number of advanced new facilities, based at between eight and 14 acute regional hospitals.