The Labour Party has predicted “mass protests” in the mid west over plans by the Health Service Executive (HSE) to integrate hospital services in the region, as set out in a long awaited report.
The HSE has confirmed it is planning to curtail round the clock A&E services at Ennis and Nenagh General Hospitals from the second quarter of this year.
Plans have been drawn up to limit the units' hours from about 8am to 8pm. Outside those times ambulances will take emergency patients to the Mid Western Regional Hospital in Limerick.
In addition, the HSE plans to centralise all acute surgery for the midwest region, including inpatient elective surgery, at the Mid Western Regional Hospital from July 1st next.
The Labour Party's spokeswoman on health Jan O'Sullivan said "behind closed doors briefings" were not the way to progress, and called on the HSE to address a number of concerns, including how the plan would be funded.
The plans were confirmed yesterday by Paul Burke, a consultant vascular surgeon at the Limerick hospital and chairman of the project board charged with implementing the changes by the HSE.
Confirmation of the changes came as the HSE finally published a report drawn up by Teamwork Management Services and Horwath Consulting Limited into the reconfiguration of acute hospital services in the midwest region.
The report published by the HSE yesterday is dated April 2008. Details of a report by the same team of consultants on how hospital services in the midwest should be reorganised, labelled "final report" and dated December 2007, were published by The Irish Timeslast week.
The recommendations of both reports are similar - centralising AE, surgery and critical care services in Limerick - but the language of the earlier report has been toned down in yesterday's edition. References in the first version to current arrangements being "inherently unsafe" have been taken out and replaced with the fact that current services "generate an increased clinical risk to patient safety".
The December 2007 report referred to €370 million in capital investment being required in the region's hospitals. This reference has been deleted from the April 2008 version. Instead there are references to a reallocation of existing resources being required.
The HSE decided to publish its report yesterday after the Labour Party announced it would put it into the public domain at a press conference in Limerick today.
Speaking at the press conference in Limerick, Labour Senator Alan Kelly accused the HSE of making a "botched job" of implementing a report, which he claims is flawed.
"This is a highly dangerous document that would be laughable if it wasn't so serious. What it boils down to is the fact that the HSE plan to take 50,000 patients a year away from small hospitals and put them into beds and infrastructure that are never likely to be build. It amounts to medical lunacy," he said .
"There will be mass protests in the very near future across the mid west region," he added.
Ms O'Sullivan questioned if the HSE had received any commitment at national level that the resources needed to implement the plan would be provided.
"My over-riding concern is that the resources will not be provided to implement the positive proposals in this report and that the reduction in service currently provided in the small hospitals will be implemented," said Deputy O'Sullivan.
"If this happens, the people of the mid west will have a worse service than we currently have and a trolley count in Dooradoyle that will far exceed this winter's numbers," she added.
Mr Burke said the extra workload on the AE unit in Limerick would be relatively small because there are only on average 7.5 attendances per night at AE in Nenagh and 9.2 in Ennis, most of which are self referred and could be dealt with by GPs. In addition, he said there are on average just four 999 calls between Ennis and Nenagh per night and these will be diverted to the Mid Western Regional Hospital in Limerick.
The outside consultants report recommended AEs in Ennis, Nenagh and St John's Hospital in Limerick become nurse-led minor injury units. The HSE says now they will be "doctor-led local emergency centres". Mr Burke said advanced paramedics had been deployed in Ennis and Nenagh to deal with emergencies and two new AE consultants will be appointed to Limerick.
Speaking at HSE headquarters in Limerick today, Dr Burke said the mid west has sufficient consultant surgeons and anaesthetists to deliver emergency general surgery in line with international standards of practice but claimed this was not happening at present because consultants were dispersed across four hospitals.
"Ennis, Nenagh and St John's hospitals maintain a full on call surgical team and two on call nurses seven nights per week. Yet, an average of only one emergency surgical case takes place out of hours per week. In the interests of patient safety emergency general surgery must be delivered as one regional service, based in the Mid Western Regional Hosptial Dooradoyle," he said.
Dr Burke said it was of crucial importance to get patients to the hospital where the best treatment can be provided.
"If you're in a road traffic accident you need to get to the hospital where they have the trauma centre and the best orthopaedic surgeon and that's clearly the Regional Hospital (in Limerick)," he said.
"The critical thing about the 'golden hour' is that at the end point of the delivery of the service you have to be at the place where they can provide you with the service. There is a lot of data to show that stopping at an intermediate place along the way is actually deleterious in that particular situation," he continued.
According to Dr Burke it is hoped that the new A and E structure and local emergency centres will be up and running by April of this year.
He said the integration of all acute surgery work would start in around July or August of this year once the new emergency theatre at the Mid Western Regional Hospital in Limerick was fully commissioned.
Sinn Féin's spokesman on health and children, Caoimhghín Ó Caoláin, said if the report was implemented, it would lead to the downgrading of Ennis and Nenagh hospitals, eventually converting them to "glorified day care centres".
"We are almost at that stage in Monaghan General Hospital where the HSE and Government propose to end all acute inpatient services early this year," he said.
"We have repeatedly warned that the downgrading of Monaghan General Hospital was being used as a blueprint for hospitals throughout the State. This is clearly the case now and communities across the country will feel the effect in terms of poorer healthcare provision."