10 hospitals failing to meet acute care standards

NONE of the 10 hospitals in the south and south-east is delivering acute care in line with international standards, according to a leaked report.

A Review of Acute Services in Cork and Kerry, which also looks at hospitals in the south-east, says all 10 hospitals fall into the “red zone” when it comes to “critical mass”, in other words the size of the workforce in each hospital is at odds with the population it serves.

The report’s authors – Horwarth Consulting Ireland and Teamwork Management Services – said that to deliver acute care to international standards, hospitals should have eight or more doctors at each level of seniority on a clinical team and a catchment population of between 350,000 and 500,000. None of the 10 hospitals meets this criteria.

This can create situations where doctors are not treating enough patients to maintain their skills; it can leave junior doctors exposed to working unsupervised; it can leave senior staff professionally isolated and ultimately patients exposed to a potentially unsafe environment, according to the report.

Equally, individual specialities – with the exception of obstetrics at Cork University Maternity Hospital (CUMH) – are not delivered in line with international standards of critical mass.

The report also says A&E services are “particularly poorly served”.

The 10 hospitals in the review include CUH, the Mercy University Hospital (MUH), the South Infirmary Victoria University Hospital (SIVUH), Mallow and Bantry General Hospitals, Kerry General Hospital, South Tipperary and St Lukes General Hospitals in Tipperary, Waterford Regional Hospital and Wexford General.

The report is also critical of paediatric services on the grounds that none of the relevant hospitals has sufficient consultant numbers for round-the-clock emergency care and 10% of paediatric surgery is undertaken by consultants performing fewer than 50 procedures per annum.

The report recommends changes in clinical governance to end a situation where “the system assumes that patients receive a satisfactory quality of care” without systematic assessment.

It highlights a number of “critical risk factors” that have the potential to stop reconfiguration of acute services, including premature withdrawal of services.

The report, seen by the Irish Examiner, also says current A&E services at the MUH and SIVUH “are not sustainable”.

However MUH chief executive Pat Madden said while the hospital had no problem with reconfiguration, it had “now emerged that maybe there was an agenda behind this [Teamwork report] all long”. He said its figures were skewed, it had ignored a proposal put forward in 2007 by MUH and the SIVUH to amalgamate, and had only one aim – to concentrate all acute services at CUH.

Prof John Higgins, who is heading up the reconfiguration project, said acute medicine needed to be reorganised to make better use of a €1.4 billion budget.