Midwest hospital review sparks acute fears of money-saving cuts


ANALYSIS:Many feel HSE will bring in only those parts of the acute services review that could cut spending, writes Eithne Donnellan 

THERE HAS been much speculation over the past year about the precise content and recommendations of the review of acute hospital services in the midwest carried out for the HSE.

The review was completed in December 2007, but the HSE has never published it. Minister for Health Mary Harney indicated in November that the decision not to put its findings into the public domain was a deliberate one. She told the Oireachtas health committee that if the review conclusions were published before the HSE got "buy in" from staff, it might never get implemented and then the cost of the review would be money down the drain.

Today, the findings of the review are revealed and as expected they mirror the recommendations of the Hanly report published in 2003. So controversial was that report and its recommendations, particularly in relation to the rationalisation of smaller AE services, that it had to be buried.

Now though, its recommendations have been revived - under the name of different, outside consultants - and the HSE is making plans to implement them.

The main recommendation is that round-the-clock AE services in the region be retained only at Limerick Regional Hospital. The centralisation of major surgery, critical care, planned orthopaedic surgery and obstetrics at Limerick Regional is also recommended.

The HSE's service plan for 2009, published recently, states that it will move ahead on plans to implement the review this year. Already, a small group has been put in place to look at the reorganisation of surgery services.

There is no doubt that if all review elements are implemented - that is, if properly resourced primary care services and a state-of-the-art ambulance service with air ambulance back-up - are put in place, then a better service might be achieved.

It is worrying that at present, as the review notes, there is little or no consultant cover at the smaller AE units in the midwest, an issue highlighted by at least one of the recent cancer misdiagnosis cases at Ennis hospital.

In August 2007 when mother of one Ann Moriarty (53) attended the hospital's AE unit, having lost a lot of weight, she was discharged home by a junior doctor with a prescription for an upset stomach. A few days later, after a second opinion was sought at another hospital, she was told her breast cancer, which had been in remission, had spread to several of her organs and she was dying. She died last April.

Reconfiguring the current system in the best interests of patient care, as this latest review points out, will cost money, and many in the midwest fear the HSE, in the current economic climate, will implement the parts of the review that could save money - like closing acute beds in the smaller hospitals - but not the other elements which will cost it significant sums, such as beefing up services at Limerick Regional to cope with the influx of patients from other hospitals.

We have already seen how one major recommendation from a HSE review of acute hospital services in the northeast was put on the long finger because it cost money, while the HSE continues to implement other parts of the review.

That recommendation was that a new regional hospital be constructed in the region, but when it emerged that it would not be built in Minister for Justice Dermot Ahern's Louth constituency, he made it clear the Government had not got "a red cent" for such a facility anyway.

In relation to beds, while the midwest review notes that more than 100 extra acute beds will have to be provided at Limerick Regional if its proposals are to be implemented, many of these extra beds will ultimately be used, not by patients moving from Ennis, Nenagh and St John's hospitals, but by obstetrics patients moving there from the region's maternity hospital and orthopaedics patients moving in from Croom hospital.

The result will be fewer acute beds, but the HSE argues that fewer beds will be required as more day surgery is performed, hospital stays are shortened and community services are improved.

Carrying out all this simultaneously will be the real challenge.