The publication last week of the North of Ireland Acute Hospitals Review Group Report has significant cross-border implications. The most obvious are the opportunities for North/South health service co-operation which the report identifies. With a combined population of five million people, services such as transplant surgery and the treatment of childhood cancer could be enhanced. The provision of coordinated emergency medical services would bring about immediate benefits to people living on either side of the border.
However, the potential significance of this report runs deeper than cross-border co-operation. With Health Strategy 2001 due for publication next month in the Republic, the North's hospitals report contains a number of recommendations which are likely to be replicated in the findings. Of the North's 14 accident and emergency units, five are to be downgraded to "nurse-led emergency units". Several hospitals are set to lose in-patient maternity services and at least one major hospital will become a specialist centre for elective treatment.
That such changes can be traumatic, has been amply demonstrated in the Republic. The North Eastern Health Board's downgrading of maternity services in both Dundalk and Monaghan has been met with strong protests. Its recent decision to reject professional advice and to locate the region's specialist breast cancer services in Navan, rather than Drogheda, could be seen as a political reaction to the furore over its earlier maternity initiative.
Several reports on the reformation of health systems in both jurisdictions have been produced in recent years. Dr Maurice Hayes, the chairman of the Acute Hospitals Review Group, pointed out that radical change is needed to prevent the health system in the North from collapsing. His comment that, by doing nothing "the whole service will gradually run down and eventually implode", is already applicable in the Republic.
The North is to get a new hospital in Enniskillen, Co Fermanagh. Judging by last week's demographic predictions from the Central Statistics Office, the Republic also needs an extra acute hospital based in the greater Dublin region. With the population set to increase by 50 per cent by 2030, the already stretched Dublin hospitals could not expect to cope with a demand of this magnitude.
Dr Hayes has said the crucial issue for the North's hospitals is not a lack of bed space but delays in tests and treatment which keep beds occupied unnecessarily. While there is an identified and accepted need for extra beds in the Republic's health service, this does not preclude a major investment in increasing the existing system's efficiency. Having theatres and laboratories which cease routine work at 6 p.m. is not a luxury the health of the State can readily afford.
Last week's report recommended a doubling of hospital consultants and an increase in the number of GPs and nurses of 20 to 25 per cent in the North. The Republic also needs extra medical and nursing staff, but with the specialist to generalist ratio reversed. Primary care represents the particular key to unlocking the long-standing inequalities in accessing health care in the State. Nothing less than a Bevan-like reformation of health services in both jurisdictions is urgently required.