More unknowns than knowns in two hospital reports
The announcement of the hospital groups merely separates our healthcare facilities into geographical regions with no detail on what services will be provided where, see here for my Medical Independent column of the launch of two long awaited reports on hospital groups.The release of the Framework for Development – Securing the Future of Smaller Hospitals and The Establishment of Hospital Groups as a Transition to Independent Hospital Trusts reports in mid-May was a pretty dull affair. Well over 18 months after the reports were expected, and were persistently and strategically leaked and media managed, the powers that be did not leave much to tell.
News headlines were not achieved as neither report named what services would be provided where. All the reports do is name the six hospital groups and set the parameters of what can and cannot be provided in hospitals of different scales.
The hospital groups report gives the poisoned chalice to the, yet to be appointed, hospital group CEO who shall “within one year of appointment, present to his/her board a strategic plan for service configuration and integration consistent with national objectives for the delivery of patient services”.
In simple words, the hospital group CEO, who crucially will be appointed independently and through open national and international competition, will, in cooperation with their board, decide which services will be where.
That said, many potential landmines have either already exploded or been carefully detonated. Former health minister Mary Harney successfully oversaw the rationalisation of cancer treatment from 30 hospitals to eight, while many of the smaller hospital A&Es (and they were A&Es not emergency departments) have already been shut under the guise of patient safety.
There will be some small incendiary responses to the closures of A&Es in Navan, Loughlinstown, Mallow, Bantry and Ennis, but it is unlikely to take the form of previous ‘Save Our Hospital’ campaigns. It would be interesting to survey hospital doctors and GPs in these areas and ask them if given a choice to go to their local hospital or a longer distance to a ‘model 3’ hospital (which provides 24/7 acute surgery, medicine and critical care), which one would they choose.
That said, it is essential that critically ill people requiring emergency care are able to get to that care. Recent response times by ambulances do nothing to reassure an already worried public.
Interestingly, the usual public, political or medical hoo-ha about the make-up of the groups was absent. Prof John Higgins, who oversaw the report, had done the groundwork, holding more than 100 meetings with staff and representatives from different hospitals and hospitals were generally grouped where they wanted to be. It was the areas where there was no consensus that proved the more contentious. Waterford wanted to stay as the big hospital in a south eastern group instead of being subsumed into the southern group, but the other hospitals in the south east wanted to be with Cork or Dublin.
One could query the size and/or the make-up of the groups; is Dublin East manageable with 11 hospitals and two big teaching hospitals or will Dublin Midlands just be about St James’s and the new national paediatric hospital, if that ever gets built?
An issue that did not go above the radar is the fact that there will be seven, not six hospital groups as the three current childrens’ hospitals and the new one, will form one group.
Another critical issue is ensuring quality and consistency of care across the groups’ hospitals. This was the very rationale for the HSE. Yet by 2015, when these groups will come into existence, the HSE, under the Minister’s grand plan, will be abolished. The hospital group report details how licensing will be a central mechanism to ensure safety and quality standards. However, there is not a chance that any, let alone all hospitals, will be licensed by 2015.
In order for hospitals to be licensed, legislation needs to be passed to give HIQA the relevant powers. This is not even on the legislative list for 2013. If legislated for in 2014, it will take years to actually happen.
Another unknown is how the groups will link with primary and social care. Again the report references the importance of this, but with no HSE post-2015, and a fragmented, skeleton of primary care services, how will these services link with the new hospital groups?
Perhaps most significantly, to whom will the new hospital groups be accountable? With no HSE and no clear structure post-2015, this is hard to fathom. Of course, no one has the answers to these questions. But with no clear accountability structures, we raise the risk of creating six new independent, hospital fiefdoms accountable to no one.
The only reassurance is that with James Reilly’s track record of not meeting any deadline he sets himself, nothing will happen quickly, so there is plenty of time to work this out.