It is unsafe to keep services configured at Ennis hospital as they currently are;
Patients with major or complex emergency conditions should not be treated at the Ennis hospital emergency department;
24-hour emergency department services at the hospital are unsustainable and should be discontinued;
Ennis should not provide acute or elective inpatient surgical services;
All women with symptoms of breast cancer who present at Ennis should be referred immediately to the designated symptomatic breast disease service in Limerick;
Ennis should not care for patients requiring level 2/3 critical care services;
The range of general medical services provided at Ennis should be reviewed;
Acutely ill children should not be cared for at Ennis. Ambulances should take them to Limerick;
Elective inpatient paediatric surgery should cease immediately at Ennis;
Women with pregnancy-related conditions should not be brought by ambulance to Ennis. They should be taken to Limerick;
More staff and resources will not address the fundamental problem as there are insufficient numbers of patients attending Ennis with certain conditions to maintain clinical skills of professional teams;
A robust system for the safe, timely management and reporting of all tests at both local and regional laboratory level should be developed, implemented and regularly audited;
The HSE must ensure there are appropriate numbers of suitably-qualified ambulance staff to provide a safe emergency and non-emergency patient transport service in the midwest;
All acute hospitals in the midwest should form a hospital group which should be led by a chief executive who is ultimately accountable for services;
Ennis should undertake a regular audit of the views of complainants and ensure a proactive patient-centred approach to risk management;
There is no one person at Ennis hospital who is fully accountable for the quality and safety of services and this is unacceptable;
A comprehensive programme of change that is effectively led and managed now needs to be undertaken. The HSE needs to ensure that appropriate facilities, resources and staff are in place through the midwest acute hospital network in order that changes in the location of patient care can be safely accommodated;
The HSE needs to appoint a senior official to ensure a plan is drawn up to implement the report, and this plan should have a timeframe with milestones.