Patient safety and hospital restructuring

A chara, – I am in agreement with Prof Patrick Broe (Letters, July 9th) that seriously ill and injured patients should be treated in centres that offer high-level, specialist care "appropriate to the severity of their condition". I am also in agreement with him that this type of care cannot be offered by many of our smaller regional hospitals.

However, if our politicians are to restructure our hospital system, as Prof Broe suggests, a number of factors must be borne in mind.

First, there must be infrastructure in place to transport these patients in a timely manner to the hospital of choice, either by road or air. Our air ambulance service is improving thanks to Irish Community Rapid Response, a charity that launched its own air ambulance this summer. This augments the existing emergency aeromedical service provided by the National Ambulance Service in conjunction with the Air Corps. The Irish Coastguard also transfers patients by air if necessary. However, the air ambulance service faces many challenges.

For example, the Irish Coastguard helicopters can’t land at many hospital helipads, including the proposed helipad at the new national children’s hospital. In fact, hospital helipad facilities are a major impediment to the transfer of patients urgently between sites. Tallaght Hospital is the only Dublin hospital with a helipad. The Mater hospital, the national centre for heart and lung transplants and where major spinal injuries are managed, opened a new helipad this year but it is not operational yet due to planning issues. Beaumont Hospital and Cork University Hospital, where the nation’s worst head injuries are dealt with, have no current helipads. Our country is compact enough that we should be able to have a co-ordinated, fully functioning air ambulance service where helicopters can land at the specialist centre of choice.


Second, for seriously ill and injured patients to be transferred to the hospital that can provide them with the best care, the severity of their condition must be recognised by the hospital or GP they first present to or by the ambulance personnel who encounter them. Therefore, we must ensure that some of our highly-trained healthcare professionals remain in our smaller towns and cities and help them to recognise that they can still be excellent outside of a designated centre of excellence.

Finally, establishing centres of excellence for cancer, trauma, surgery and other medical specialities is a good thing for our population. These centres will be and should be in our major cities. However, the smaller hospitals and their surrounding communities should be reassured that their healthcare facilities can still be excellent, just in a different way. For example, these smaller hospitals could be ideally used for low-risk elective surgeries, as step-down facilities for patients who have undergone major surgery or medical treatment and to look after patients who are awaiting a nursing home place.

After all, doesn’t it make more sense for patients to recuperate closer to home where they can be near their families and friends and to the healthcare professionals who will provide them with their long-term care? – Is mise,



Dublin 11.

Sir, – Dr Tom O'Rourke's letter (Letters, July 11th) refers to the Hanly report (2001) and the Fitzgerald report (1968), and their recommendations regarding the need to rationalise hospital services.

Less widely known, however, is the fact that many of the same conclusions have been made in earlier generations. In 1928, a government commission commented that: “We are not in sympathy with the attempt to preserve in small towns, district or cottage hospitals on the pleas that the distances to the central hospitals are too great.”

In 1936, the hospitals commission stated: “The grouping of three or four counties together for hospital purposes, in suitable centres would enable not only better and more up-to-date central and specialist services to be provided, but would enable a more complete hospital medical staff to be employed, at less cost to the ratepayers of such grouped counties than the restricted services and personnel than one county can at present afford.”

Plus ça change! – Yours, etc,



Co Meath.