Role of up to 12 hospitals needs to be 'clarified'

Up to a dozen smaller hospitals around the State would not have the staffing or workload to provide comprehensive acute care services for patients in the future, according to a new internal Department of Health discussion paper on the implementation of the controversial Hanly Report.

The internal document, seen by The Irish Times, says that there are 10 to 12 hospitals which could not support comprehensive care and that their future roles would have to be "clarified". These smaller centres would form part of larger, regional networks of hospitals to be established.

The new paper sets out the steps involved in making decisions on future hospital re-organisation over a suggested 18-month period. It says that the clarification of the role of the smaller centres "would facilitate the development of common solutions and focus on the challenge of providing safe, high quality care" while achieving compliance with EU restrictions on doctors' working hours.

The Hanly Report provoked outrage in many parts of the State following its publication in 2003. Groups protested against proposals which would have seen some hospitals lose full-scale accident and emergency and maternity services. Some groups planned to run anti-Hanly candidates in the next general election.

Earlier this year Tánaiste and Minister for Health Mary Harney disbanded the official group which was examining the implementation of the Hanly reforms. She asked the new National Hospitals Office (NHO) under the new Health Service Executive (HSE) to take on the role.

The new discussion paper, Next Steps in implementing hospital re-organisation, says that the NHO will have four main issues to address. It will have to identify the hospitals that will form part of the proposed new regional networks. It will have to clarify the future role of the smaller hospitals. It will also have to review the distribution of acute services in Dublin and determine where more than 2,000 additional beds promised under the Health Strategy should be located.

The discussion paper proposes that the NHO should carry out this role over the next 18 months.

The paper proposes that the board of the HSE should approve the identification of the new hospital networks by next January.

It also recommends that by January 2006 the NHO should develop a set of standards which hospitals must meet to maintain high quality acute care. The paper urges that it should "identify and describe those hospitals which face significant difficulties meeting those standards in the short to medium term and propose a mechanism for future decision-making at local and regional level regarding the future role of such hospitals".

The discussion paper sets a deadline of December 2007 for a strategy for the future development of hospital services in the eastern region, particularly the provision of supra-regional and national services.

The paper also proposes that by December 2007 there should be recommendations on which hospitals and specialities should receive the additional acute beds. It also urges that there should be new plans for the development of ambulance services.

A spokesman for the Health Service Executive confirmed last night that it had received the Department of Health discussion paper. He said that it was currently considering all issues surrounding hospitals.

A spokesman for the Department of Health said that the Tánaiste was supportive of the concept that regions would be self-sufficient in the provision of health services.