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October 30, 2014

HSE plan at ‘halfway house’

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Brian Geoghan, Dr Gerard Crotty, Haematologist, Tullamore; Dr Fintan Wallace, Radiologist, Mid-Western Regional Hospital, Limerick, Mr Peter Murchan, Surgeon, Clonmel; and Dr Alexander Fraser, Rheumatologist, Mid-West Regional Hospital, Limerick, pictured at the Irish Hospital Consultants Association Annual Conference in Adare, Co Limerick

Gary Culliton hears of concerns that the reconfiguration plan is stuck due to the recruitment embargo

Hospitals in the Mid-West are under “huge strain” because of the moratorium on recruitment and have been reconfigured through “scarification of our resource”, the region’s Clinical Lead for Reconfiguration Mr Paul Burke conceded at last weekend’s IHCA Annual Conference.

Speaking to delegates in Adare, Mr Burke added that some discretionary programmes might need to be stopped at some hospitals to maintain levels of emergency care at other hospitals.

“There does come a point at which you can say ‘no more unless you are prepared to help us’. We are at a point where we have made the leap. We have brought in acute surgery. We cannot go back on that,” he stated.

Dr Patrick Dillon, an anaesthetist in Limerick Regional, commented: “Paul Burke has said that we can’t go back from the reconfiguration of general surgical services and yet we can’t go forward. This is what those of us who had reservations were worried about. We are stuck in a halfway house,” he suggested.

“We have nine anaesthetists in three Mid-West hospitals who are not going to reconfigure. There does not seem to be any prospect that they are likely to join the rota to help with the increased workload at the major hospital. The acute medical scheme would appear to support their decision to stay in their local hospitals.”

Mr Dermot O’Farrell, consultant orthopaedic surgeon at the Mid-Western Regional Hospital, Limerick, added: “Part of the reconfiguration deal, as I understood it, was that on-call night-time and weekend theatre nurse whole time equivalents (WTEs) would be transferred from Nenagh and Ennis to the Limerick Regional, where we do significant trauma lists during the day. This work continues at night-time and weekends. That did not happen because many nurses — who were approaching the ends of their careers — retired.”

He said not one single nurse has moved his or her on-call workload into the Limerick Regional – nor have any WTEs been supplied. “That’s a part of the original deal that did not happen.”

Existing resources
This, according to Mr Burke, has been one of the major impediments to bringing about the changes quickly. “When we went to put in our proposal for the new critical care block, we had over 100 nurses proposed in relation to it. The HSE said ‘you have to find that from existing resources’. We calculated all of the WTEs in Nenagh and Ennis who had retired and whose WTEs didn’t come in to us because they got sucked into the moratorium. The HSE said that’s where those jobs are.”

Over the past year, as a result of closing 25 surgical beds in Ennis and 25 in Nenagh, the HSE has saved €5.5 million. “This happened because of people who retired — because they didn’t want to come to Limerick — and yet all their WTEs were taken from us,” explained Mr Burke.

Level of safety
Everyone, from the smallest hospital up, has to ensure that their level of safety is the same as the level of safety in other hospitals, Mr Burke added. “When you have a really serious crisis, you change your levels of expectation. The issue at the moment is that our standards and our expectations are extraordinarily different to what they were at the time of the last crisis in the mid 1980s.”

Mr Joe McGrath from Navan claimed there was an “unsafe reconfiguration” in the North East, which has been precipitated overnight. “There has been no consultation, certainly in relation to Navan surgery. We are being locked out of the situation,” Mr McGrath said.

Cherry pick items
“Since the Hanly report my fear was that the HSE would cherry pick the items that would save money and forget about the quid pro quo, which was to ensure efficient delivery of services without exploitation of doctors,” commented Dr Peter Kelly from Dublin’s Mater Hospital.

“There is no evidence I can find that any of the reconfiguration projects, including in the Mid-West or the North East, have saved a dime. All the evidence from the UK suggests that costs go up by between 15 and 20 per cent,” said one of the platform speakers, Mr Peter Murchan, a surgeon from South Tipperary General Hospital, Clonmel.

An overall reduction
In the first 12 months of a single region-wide department of emergency medicine, there has been an overall reduction of 9 per cent in the number of people attending EDs across the region, due mainly to the closure of Ennis and Nenagh at 8pm daily, said Mr Burke. Advanced nurse practitioners and permanently appointed doctors are likely to have a greater role in the running of the local emergency centres in Ennis and Nenagh in the near future. “This should develop into a more sustainable service that will be less dependent on recruiting junior doctors,” said Mr Burke.

The impact of these changes on the smaller and regional hospital is now being looked at in terms of patient movement across the hospital network, the Clinical Lead for Reconfiguration added. “The removal of inpatient surgery has brought some changes to the clinical practices of Ennis, Nenagh and St John’s hospitals, all of which would typify the small local hospital type that may be seen to be endangered as a result of reconfiguration.”