Hospital services across the State will have to be reorganised, the head of the Health Service Executive (HSE) said yesterday.
Prof Brendan Drumm said the HSE would be going into each area and asking if the services provided there were in the best interests of patients. He warned that people should not argue for the retention of services in their area "because the buses go this way or the trains go that way".
He said Minister for Health Mary Harney was still committed to the Hanly reforms but even without Hanly there would have to be "some reconfiguration of Irish hospital services".
He was not convinced of a need "for all small hospitals to move to large hospitals . . . but there has to be an approach that's totally orientated on what's best for the patient".
Prof Drumm was speaking in Dublin at his first press briefing since he took up his post as CEO of the HSE in August. On the A&E crisis, as reported in yesterday's Irish Times, he said he expected no real improvement in overcrowding for some time. It could be 1½ to two years before there was real improvement, he said.
Primary and community care services, including services for the elderly, needed to be improved to reduce pressure on A&E. Although the Government had developed a strategy to improve primary care Ms Harney had indicated that there wasn't enough funding to implement it.
Again yesterday there were 256 patients on trolleys in A&E units, including 35 in Wexford General Hospital alone, the Irish Nurses' Organisation (INO) said. The HSE said the figure was 230.
Prof Drumm said Ms Harney's €70 million A&E action plan had impacted on numbers of patients inappropriately accommodated in acute hospitals.
The INO expressed concern that it could take another two years to improve the A&E situation and claimed Ms Harney's plan was not working. It also demanded the immediate opening of up to 480 beds it claimed were closed. The HSE said only 90 acute hospital beds were closed, and this was for reasons such as refurbishment.
Meanwhile, Prof Drumm said he would be speaking to all political parties about their responsibility to come up with a policy for caring for the elderly.
"Either you are going to have to create nursing-home beds that are subsequently paid for out of people's estates, which is a big issue, which is done in other countries, or it becomes a demand on the taxpayer," he said.
If sufficient care for elderly people was provided, up to 500 beds in acute hospitals could be freed up.
He confirmed that the HSE faced an €80 million deficit this year, much of it incurred by hospitals, but he promised there would be no cutbacks in clinical services. "The savings have to be made in areas that aren't clinically relevant," he said.
The deficit was "not bad" in the context of the HSE's €11 billion annual budget.
He has asked for all new posts to be brought to his attention so he can decide if they are of benefit to patients. If they are not, they will not be approved.
The health service faced a big challenge, he said, trying to minimise hospital-acquired infections such as MRSA. "It's a major problem for our society and for other societies". One of the biggest things that needed to be done was to get infection control nurses into all hospitals.
Furthermore, he said, there was significant demoralisation among health service staff, including hospital consultants, with whom he wanted to get into talks on a new contract shortly.