Madam, – With reference to your Editorial on hospital reform (January 17th,) I would like to reaffirm that the Royal College of Surgeons in Ireland (RCSI) is convinced that the reforms should continue in the Mid-West and elsewhere – where these changes are necessary and in many cases long overdue.
RCSI’s motive is first and foremost to achieve better and safer patient care. We want critically ill surgical patients to be brought to centres that are appropriately equipped and staffed and where there is a sufficient volume of this kind of activity to sustain the necessary levels of skills to manage these patients. Timing is often an issue and therefore patient transfer from hospital to hospital should be kept to a minimum.
Some might argue that a fiscal downturn is a bad time for such reforms to take place but we do not agree. It is precisely at these times that changes can be made with sensible costing rather than with over-exuberant plans and unrealistic budgeting.
Reconfiguration will probably make savings but, even if not, it will lead to the better use of available funds. Adequate investment to support these reforms must now be prioritised so as to create medium and long-term efficiencies.
Clarity needs to be established at a number of levels, for example, any change in the existing roles of hospital doctors and general practitioners so that they better understand each other’s position. The college remains extremely concerned about the AE overcrowding issue and this must be re-addressed. There is a shortage of hospital beds, and elective surgical practice is regularly being stymied although this will probably be helped by hospital reconfiguration in some areas.
While some of the bed capacity issues were due to be addressed by the development of co-located hospitals, there now seems to be a question mark hanging over these. We must recognise and face these problems.
The public quite correctly wants to participate in the debate and does realise that there is no health system in the world that is perfect. We cannot give a perfect service to every citizen at their doorstep.
We have to allocate services so that we deliver the best care to the greatest number. This issue is going to become more and more apparent as, for example, several new anti-cancer drugs are about to become available which if used unchecked would quickly bankrupt even the richest of countries.
If ever there was a time for patience, tolerance and a concerted national effort this must be it. We in RCSI are ready, willing and able to play our part. – Yours, etc,