A radical health service shake-up in Northern Ireland could see acute hospital numbers halved in a drive to provide more treatment outside the region’s wards.
The major review of health and social care also recommended more formal link-ups with providers in the Republic to maximise services across the island, particularly in the border areas.
The report by review chair John Compton will have implications for the care of the elderly as well, with more emphasis placed on enabling people to continue to live at home.
The Government-commissioned review said there would be “inevitable” closures of state-run residential homes, while public nursing homes will be asked to provide more of the services currently offered to the elderly in hospitals.
There are 10 hospitals providing acute care in Northern Ireland, nine of which currently offer accident and emergency treatment.
That number could be reduced to between five and seven over the next five years if recommendations contained in the report are accepted by the devolved administration.
Part of that reconfiguration may see the three major hospitals in Belfast city - the Mater, City and Royal Victoria - merge into one hospital that would continue to utilise the three sites, but for potentially different services.
In calling for a reduction in acute hospitals, the review noted that a region of similar population size to Northern Ireland - 1.8 million - elsewhere in the UK would typically be served by four acute care facilities.
Local commissioning groups will now draw up proposals on how acute care can be best provided into the future in Northern Ireland and report back to Stormont health minister Edwin Poots.
Outlining the review findings to the Assembly, Mr Poots said the current healthcare model was not sustainable and, if maintained, would not be able to provide effective patient care.
“We must stop doing what does not work, challenge out-of-date practices and acknowledge that some of our services are no longer fit for purpose,” he said.
“The system needs to change. Our services need to be resilient, sustainable and safe.”
Mr Poots insisted the potential reduction in acute hospitals was not the most significant element of the report.
“I think the significance of this report isn’t about acute hospitals, the significance of this report is about the shift from hospital secondary care to the primary community sector and the shift to producing the right packages to enable people to stay in their own homes and it’s about bringing healthcare closer to people’s homes as opposed to further away.”
He added: “The specialist services will probably be further away but there will be lots more of those day-to-day services that you need will actually be coming closer to your own home.”
PA