Hospitals policy the legacy of a failed political system

ON RTÉ radio news a few weeks ago, Dr Chris Luke correctly highlighted the crisis in staffing our A&E departments but also took the opportunity to agree with his interviewer that the closure of smaller hospital A&E services may be no bad thing and would bring about economies of scale and improved quality of care.

He indicated that more resources would need to be invested in the larger hospitals before the transfer of services from smaller units.

While I agree that the concentration of services in larger hospitals provides improved patient outcomes for certain conditions such as breast or oesophageal cancer, heart surgery or severely injured patients in road accidents, the research on many common medical conditions does not necessarily support centralisation to larger hospitals and economies of scale in hospital size are reached at a relatively small hospital size. There is, unfortunately, a limited knowledge among influential members of the medical profession, politicians and HSE officials regarding these issues and, as a consequence, people have been subject to a successful campaign suggesting the only place to get quality care is in a larger hospital.