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Big hospitals to lose funds to small centres
[Posted: Wed 28/09/2011 by Niall Hunter, Editor www.irishhealth.com]
A major report to be presented shortly to Health Minister James Reilly by the HSE will outline how funding can be taken away from larger hospitals in order to develop new services at smaller hospitals.
The framework document on the development of smaller hospitals will also outline which services, such as 24-hour emergency departments, critical care, and complex surgery will be removed from some smaller hospitals and transferred to larger centres, and when it is planned that these transfers will take place.
The Department of Health recently told the HSE that more services will have to cease at some hospitals on safety grounds before the end of the year.
The document is also due to outline which services will move from larger hospitals to the smaller centres and when.
In a letter written on July 29 to HSE CEO Cathal Magee, Department of Health Secretary-General Michael Scanlan said the framework document should specify by hospital exactly which services will transfer from larger hospitals and by when.
"It is also to include an estimate of the additional funding that would be required in each case to provide these additional services."
However, Mr Scanlan said that given the current budgetary situation, the report should also identify the impact of making a corresponding reduction in the funding available to the larger hospital.
Mr Scanlan said the framework report should also detail which services will transfer from each of the 10 identified smaller hospitals to larger centres and when they will be transferred.
The smaller hospitals targeted for the removal of some services and the introduction of additional services are Navan, Dundalk, Portlaoise, Loughlinstown, Mallow, Bantry, Ennis, Nenagh, St John's in Limerick and Roscommon.
Some of these hospitals, including Roscommon, Ennis , Nenagh, Dundalk and St John's, have already lost services such as 24/7 A&E.
According to a recent HSE update given to the health safety body HIQA, Mallow is due to have its ED converted to an urgent care centre from November, with a similar change due to take place shortly at Loughlinstown Hospital in south Dublin.
Concerns are also being expressed locally about the future of services such as 24/7 ED at Portlaoise Hospital. The HSE document states that a decision is required on the future level of surgical and emergency services to be provided there.
However, Health Minister James Reilly recently indicated that Portlaoise's services would not be downgraded.
Mr Scanlan, in the letter to Cathal Magee, released under FOI, stresses that the planned report on smaller hospitals should address safety issues recently raised by HIQA.
"The first priority in this regard is to ensure that there are no remaining safety issues (at the smaller hospitals) that require immediate attention. The next is to confirm that other safety issues have been addressed by immediate risk mitigation measures, to HIQA's satisfaction, and to clarify the nature and timing of the service transfer required as part of a safely managed transition."
Mr Scanlan added that the HSE should also outline for each hospital what other services may be 'at risk' for other reasons over the next three years, for example for budgetary reasons or because of junior doctor or other staff shortages.
The Secretary-General added that the framework document should include a communications strategy to elicit as much support as possible from the general public and other stakeholders for the changes planned for smaller hospitals.
"This should be built around a clear, accurate and complete explanation of the changes involved, immediately and over the next few years."
The HSE has been criticised recently for how it has communicated the changes planned for smaller hospitals.
Mr Scanlan said ' a sequential phased approach' for changes to individual hospitals 'will not meet requirements... and the need to start implementing some of the required safety changes later this year means we need to have as complete a document as possible available by the end of September which covers each of the 10 hospitals.'
The HSE document, when finalised, is due to be considered by the Cabinet sub-committee on health next month.
Expert queries HIQA's hospitals policy
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