HSE instructs hospitals to deal with catchment area referrals

Failure to attend to patients from historically served zones may result in hospital budget cuts

HOSPITALS HAVE been told by the Health Service Executive and the Department of Health that they should stop refusing to accept referrals of patients from within their historic catchment areas.

They have also been instructed that they should reverse any such decisions put in place since the start of the year.

The HSE and the Department of Health said the new “interim” measures would remain in place for several months pending a final set of rules being determined with regard to catchment areas.

They warned that hospitals which failed to comply with the new instructions could potentially see their range of services narrowed and some of their budget transferred elsewhere.

In a letter to HSE regional directors earlier this month, senior HSE management and the department’s special delivery unit said there was no statutory basis for hospital catchment areas although “they have been part of custom and practice in the health service for many years”.

Management said that in recent months “no doubt very much driven by the growing budgetary and activity performance pressures on hospitals, there has been a growing incidence of hospitals seeking to ‘more strictly enforce’ what they view as their catchment areas for different aspects of their service”.

Management maintained that as part of the recent “strict catchment area enforcement” there had been: an unplanned approach; often unilateral action; limited if any notice beyond general references or flagging at meetings; reversing long-standing attendance patterns without clarity about alternatives for patients; and, in some cases, patients in ongoing treatment being told they would no longer be accepted in their current hospital.

Minister for Health James Reilly told the Dáil last week that it was unacceptable for a patient to be informed at short notice that a hospital would not treat them because they were in the “wrong” catchment area. He said he had been working with the HSE to clarify policy.

In its new interim principles, the HSE and the department suggested that the recent “run rate” over, for example 2009-2011, for referrals would in a general sense be reasonable for discussion. “For example, hospital X feels it has been funded to do say 10 of referral/procedure A. Hospital X has been accepting/doing: 2009 – 15 referrals/10 procedures; 2010 – 20 referrals/15 procedures; 2011 – 18 referrals/12 procedures.

“All other things being equal, it may be reasonable for hospital X to say it cannot accept/do any more than about 18-20 referrals/12-15 procedures. Hospital X in limiting to same must allow access equally to whatever catchment area it had previously accepted from and must do so on the basis of strict chronological order other than in cases of evidenced clinical urgency including relevant cancer cases.”

Management said thereafter it would not be unreasonable for hospital X to manage a waiting list and not accept referrals from new locations from which it had not accepted patients in the past.