The creation of clusters of hospitals in 12 regional centres around the State is to be proposed in the next phase of the Government's health reform package, to be published next month. Arthur Beesley, Political Reporter, reports.
The Hanly report, which is to be considered by the Cabinet shortly, proposes that major treatments will be available in only one hospital in each regional centre.
The Hanly proposals were not part of the package of health reforms unveiled in fanfare style in Government Buildings yesterday in the presence of the Taoiseach, the Tánaiste, and the Ministers for Health and Finance.
Yesterday's radical reform plan proposes the abolition of the State's 10 health boards and the Eastern Regional Health Authority, and their replacement with a single Health Service Executive.
The reform will affect "every element of the health system", the Minister for Health, Mr Martin, and the Minister for Finance, Mr McCreevy, said at yesterday's launch.
The Hanly report on medical manpower, which has just been finalised, proposes clusters of hospitals, generally comprising one major and three minor hospitals in each of 12 regions.
The Government anticipates a major political backlash from this proposal which, it is feared, will lead to the downgrading of hospitals in many constituencies.
A major battle within Fianna Fáil over the plans is expected.
Government sources said the location of these hospitals would prove the most contentious part of the initiative.
Yesterday's reform package was based on the findings of two highly critical reports into health funding and the structure of the health system, the Brennan report and the Prospectus report.
The location of hospitals - under the command of the new National Hospitals Office, proposed in the Prospectus report - will not be decided until the Hanly report is published.
Government sources expect that the issue of location will be more politically sensitivite thathe controversy over the withdrawal of health board membership from local councillors.
"There'll be an awful lot of fighting about that," said one senior Government source.
It is expected that Government TDs will fight among themselves to have major centres of excellence located in their own constituencies.
It is also feared that the Government will face an external threat from Independent "hospital" candidates in the next general election.
The reform plan published yesterday also pits the Government against hospital consultants and pharmacists.
Hospital consultants will resist proposals in the Brennan report that newly appointed consultants work only in the public sector.
Mr Martin said yesterday he wanted to "review" all aspects of the consultants' contract.
The Government also wants to significantly reduce the 50 per cent mark-up that chemists receive on prescriptions for public patients, and to increase radically the use of generic medicines.
However, the Irish Pharmaceutical Union said the proposals could lead to the collapse of the General Medical Services Scheme.
The Minister for Health said initial legislation to implement the reform might take 18 months to prepare.
The Minister for Finance, Mr McCreevy, refused to discuss the funding of the plan, which he said was an issue for Budget preparations.
Yesterday's package also proposes the establishment of the a National Hospitals Office answerable to the new Health Service Executive.
The Department of Health and Children will also be reorganised and a Primary, Community and Continuing Care Directorate with four regional health bodies and 32 local health offices delivering regional and local non-hospital services.
The Minister for Health brifed Fianna Fail TD's and Senators on the plan yesterday.
Members of the Eastern Regional Health Authority were last night briefed on the legal advice sought on their behalf in regard to the proposal to dissolve the ERHA.
It is understood they were told that there was nothing to stop the Minister going ahead with his proposals.
The Opposition parties said last night that the plan failed to address the deficiencies that have led to a string of bed closures this year.
Fine Gael's health spokeswoman, Ms Olivia Mitchell, said , however, that she ageed it was absolutely necessary to streamline management of the health sector and introduce a clearer chain of command.
The Labour spokeswoman, Ms Liz McManus, said her party supported the establishment of a single hospitals authority but added: "We do not oppose, in principle a reduction in the number of health boards."