Some hospitals may lose emergency services as part of reforms

Emergency care may be removed from some hospitals in the Dublin Midlands Hospital Group as part of a new five-year reform strategy which was launched on Monday.

The new strategy involves the development of services in some areas and improving patient access. However it maintains some services may be realigned between different parts of the seven-strong hospital group.

The strategy is likely to again raised concerns among activists in the midlands regarding the future role of the regional hospital in Portlaoise where campaigners have been opposed to any downgrading of existing 24/7 emergency services.

The new document says a trauma network within the group will be formalised between Tallaght Hospital, the Midland Regional Hospital Tullamore and St James's Hospital.

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Portlaoise Hospital has not been included in this proposed trauma network.

The strategy also says that an ambulance by-pass for trauma patients will be implemented at Naas General Hospital when appropriate.

The strategy says a medical assessment unit (MAU) would be developed in Portlaoise.

“In conjunction with the emergency medicine programme, we will develop appropriate streaming of patients for minor injury treatment.”

As part of a restructuring of cancer services in the group, the strategy says that “all relevant cancer surgeries in urology and gastroenterology will be transferred to St James’s Hospital”.

It says some non-cancer surgery may have to be transferred from St James’s Hospital to other group hospitals in order to release the required resources to facilitate this transfer.

The document says that increased capacity for benign urology services in the Midland Regional Hospital Portlaoise, Midland Regional Hospital Tullamore, Naas General Hospital and Tallaght Hospital were “contingent on the recruitment of additional consultants and nurses”.

The Dublin Midlands Hospital Group comprises Coombe Women and Infants University Hospital; Midland Regional Hospital Portlaoise; Midland Regional Hospital Tullamore; Naas General Hospital; St James’s Hospital in Dublin; St Lukes’ Radiation Oncology Network and Tallaght Hospital.

Not best practice

At present the group did not utilise its resources in the most effective way “because our hospitals offer too broad a range of services at multiple locations”.

The report argues that spreading the constrained resources of the hospital group in such a way was “not in the best interest of patient safety, is not efficient or best practice”.

“As a hospital group, if we wish to achieve our priorities, then reform of the group’s existing service delivery model is an essential prerequisite. The way, and in some cases the location, in which we deliver particular clinical services must be re-aligned within the group.

“Re-aligning how and where services are provided across our seven hospitals, such as high volume but low complexity services versus lower volume but higher complexity services, will ensure patient treatment is delivered in a more efficient, effective and collaborative way across the group. The consequence of addressing this issue is that some high complexity services may move from regional hospitals, in particular, emergency care services. However, these hospitals will benefit from the addition of new facilities and a broader scope of services of lesser complexity.

“Developing the specialist capacity of regional hospitals within the group such as in the areas of endoscopy, diabetes care, geriatrics or elective surgery will ensure that these hospitals remain vibrant and critical parts of their local healthcare network and improve access and reduce waiting lists across the hospital group.”