Just one A&E each for Cork and Kerry
The ambitious reconfiguration plan, which has not been costed, will effectively create a single hospital network where hospitals no longer compete for patients and services but work together in a “complimentary way” according to Professor John Higgins, director of reconfiguration, Health Service Executive (HSE) South.
Prof Higgins said it was “unprecedented” that all six acute hospitals in the region had bought into the blueprint for future delivery of healthcare, which spells the end of 24-hour emergency care at all but Cork University Hospital (CUH) and Kerry General Hospital (KGH) and the end of orthopaedics at St Mary’s Orthopaedic Hospital (SMOH).
The Mercy University Hospital (MUH) will retain an ED that opens 12 hours a day, seven days a week. It will also have an Acute Medical Assessment Unit (AMAU) and an Urgent Care Centre (UCC), open 12/7, to treat minor trauma and minor illness. The South Infirmary Victoria University Hospital (SIVUH) will lose its ED and become primarily a hospital for scheduled surgery. It will also become the regional centre for elective orthopaedics, ending the 55-year involvement of St Mary’s in this speciality. St Mary’s will acquire an urgent care centre (not designed for “blue-light ambulances”) under the auspices of MUH and, together with a proposed primary care centre, will offer more relevant healthcare to the local population, according to Prof Higgins. This proposal is not outlined in the roadmap for reconfiguration, published yesterday, but Prof Higgins said it was only “solidified” in recent weeks.
The transformation plan will involve consultants working in specialist teams covering a number of hospitals and all consultants appointed in the HSE South in the past 12 months have a clause in their contract requiring their participation in “outreach” services.
Work is also under way in developing a single electronic referral system for GPs, allowing them to make referrals online directly from their surgery, view waiting lists and gain equal access to hospital consultants. The project is gone out to tender and will act as a regional pilot for the rest of the country.
Work is also under way on developing a single patient identifier, in other words a unique ID for every patient in the system, that will eventually result in a single patient chart used by all six acute hospitals, cutting out unnecessary duplicate tests and investigations. So far, €3.8 million has been set aside for this project. Other capital investments include €1m at CUH to turn a Day Procedures Unit (DPU), delivered at a cost of €15m in 2006, into an AMAU; €3m for three newoperating theatres at SIVUH to accommodate orthopaedics; €1.2m for an advanced paramedic service in West Cork (a paramedic service in north Cork is a priority for 2011) and €3m earmarked for the AMAU at MUH. In addition work is under way on a new ED in KGH, costed at between €5m-€6m. Additional money is not expected to be provided in 2011 for the reconfiguration.
Progressing the plan will depend on the signing in 2011 of a Memorandum of Understanding between the HSE, the voluntary hospitals and University College Cork. The plan also envisages, as a long-term goal, a new hospital for specialist elective in-patient and day-patient care, and walk-in diagnostics, to act as “a new home” for MUH and SIVUH.
Successful implementation of the plan will depend largely on union buy-in and staff agreeing to redeployment. Yesterday the Irish Nurses Organisation (INO) said it saw “no clinical justification” for some of the suggested changes.
Cork University Hospital (CUH).
* 24/7 Emergency Department, Acute Medical Assessment Unit, Surgical Assessment Unit, Urgent Care Centre.
* Centre for complex and cancer care.
* Centre for paediatric services.
* Centre for cardiac, renal, maternity and neuroscience services.
* Home of the regional laboratory.
South Infirmary Victoria University Hospital (SIVUH).
* Loses Emergency Department.
* Will become primarily an elective surgery hospital with focus on day and inpatient surgery.
* Location for the National Cervical Screening Programme.
* Regional centre for dermatology; ear, nose and throat; elective orthopaedics and pain medicine.
Bantry General Hospital (BGH).
* Medical Assessment Unit and Urgent Care Centre 24/7.
* Consultant-delivered select acute medicine and geriatric medicine.
* At least five consultant physicians to ensure viable consultant duty roster. It currently has three, a fourth is in the process of being appointed.
* General day surgery.
Mallow General Hospital (MGH).
* Medical Assessment Unit and Urgent Care Centre 12/7.
* Consultant delivered services should include geriatrics and selected acute medicine. It currently has three medical consultants, two more are to be appointed.
* General day surgery.
* Set to acquire a paramedic service in 2011 and an intermediary care vehicle to transfer non-emergency patients.
Mercy University Hospital (MUH).
* Emergency Department and Urgent Care Centre 12/7.
* Acute Medical Assessment Unit. Strong focus on acute medical services.
* Regional gastroenterology diagnostic centre for ambulatory and outpatients that includes the National Colorectal Screening Programme.
* Regional centre for elective general surgery, urology and vascular surgery
* Regional centre for a new rehabilitation medicine service and a new regional amputee service.
St Mary’s Orthopaedic Hospital (SMOH).
* End to orthopaedic services.
* Establishment of an Urgent Care Centre under umbrella of MUH to deal with minor trauma and illness.
* 6/7 bed outpatient suite.
* Proposed primary care centre and ambulatory diagnostics centre.
* Outreach maternity.
Kerry General Hospital (KGH).
* Emergency Department 24/7.
* Acute Medical Assessment unit and Urgent Care Centre 12/7.
* Maternity Services.
* Expansion of rehabilitation unit for the elderly.
* Orthopaedic surgeons to have admitting rights to SIVUH because of insufficient caseloads at KGH to maintain certain skills.
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