Leaked report finds only one viable emergency unit in Waterford

WATERFORD Regional Hospital is the only hospital in the south-east with a clinically viable Emergency Department (ED), according to a leaked report.

A review of acute services in the Health Service Executive (HSE) South found a number of services at hospitals in the southeast “clearly lack either clinical viability now or sustainability into the future”. These included EDs at Wexford Regional Hospital, St Luke’s General Hospital and South Tipperary General Hospital. The report, re-drafted four times, was also critical of the split, across four sites, of obstetrics and paediatrics and the “fragmented nature of critical care services”.

The hospitals included in the report are Waterford Regional, Wexford General, St Luke’s General and South Tipperary General.

In the area of obstetrics, the report proposes that the National Maternity Hospital in Dublin be a referral centre supporting obstetric units at Wexford General and St Luke’s General and that Cork University Maternity Hospital be a referral centre supporting obstetrics at Waterford Regional.

The report proposes reconfiguring hospitals in the south-east along the same lines as reconfiguration proposals for the south, ie one regional “centre of excellence” and up to five local centres of excellence.

The regional centre would deliver all acute care and the local centres all non-acute care. Non-acute care would include outpatient clinics for the majority of specialities; adult day surgery delivered by outreach teams; nurse/therapy-led services including rehabilitation; nurse-led urgent care centres open 12 hours per day, seven days a week, to treat minor illness and injury; and enhanced diagnostic services.

The report says that hospitals in the south-east “fall well short of providing acute care to the recommended [international standard] minimum population of 350,000-500,000 for a regional centre of excellence, the actual range being from some 80,000 to 150,000”.

The number of senior staff is also at odds with international best practice which recommends at least eight full-time doctors at each “layer” of the clinical team within each speciality.

However, the report acknowledges further detailed study in needed.

“Given that... many residents in HSE South East elect to go to Dublin for their clinical care, a key consideration will be how best to reconfigure or relocate the regional centre in line with the HSE’s policy of regional self sufficiency, such that patients choose not to travel outside the region for their care,” it states.

Residents in Carlow (where there is no acute hospital) and Wexford are more likely to access services in Dublin and the midwest, according to the report. In the south-east, 16% of patients travel outside the HSE South to access acute care.