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Review of acute hospital services in the Mid - Health Service Executive

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Key messages<br />

<strong>Review</strong> <strong>of</strong> <strong>acute</strong> <strong>hospital</strong> <strong>services</strong> <strong>in</strong> HSE <strong>Mid</strong>-West<br />

An action plan for <strong>acute</strong> and community <strong>services</strong><br />

The <strong>Health</strong> <strong>Service</strong> <strong>Executive</strong> has already laid out its strategies for <strong>the</strong> future<br />

delivery <strong>of</strong> both <strong>acute</strong> and primary, community and cont<strong>in</strong>u<strong>in</strong>g care <strong>services</strong>.<br />

These strategies are designed to align health <strong>services</strong> <strong>in</strong> Ireland with<br />

<strong>in</strong>ternational best practice, reflect<strong>in</strong>g a global trend towards implement<strong>in</strong>g<br />

new health systems that ensure:<br />

• The majority <strong>of</strong> patients, those who require only a rout<strong>in</strong>e, straightforward level <strong>of</strong><br />

urgent or planned care, will be safely managed locally, with treatment be<strong>in</strong>g<br />

delivered ‘at home or as close to home as possible’; and<br />

• The m<strong>in</strong>ority <strong>of</strong> patients, who require true emergency or more complex planned<br />

care, will be safely managed <strong>in</strong> designated <strong>acute</strong> regional centres <strong>of</strong> excellence,<br />

where all <strong>the</strong> relevant cl<strong>in</strong>ical expertise is concentrated so that consultant led,<br />

high quality care is available round <strong>the</strong> clock.<br />

International evidence highlights that <strong>the</strong>re is a critical mass relationship<br />

between medical workforce and workload for <strong>the</strong> systematic delivery <strong>of</strong> high<br />

quality 24/7 <strong>acute</strong> <strong>hospital</strong> care. This means match<strong>in</strong>g <strong>the</strong> size <strong>of</strong> <strong>the</strong><br />

consultant team with <strong>the</strong> size <strong>of</strong> <strong>the</strong> catchment population, i.e. hav<strong>in</strong>g <strong>the</strong> right<br />

numbers on <strong>the</strong> team to ensure senior supervision <strong>of</strong> patient management at<br />

all times and <strong>the</strong> right size <strong>of</strong> cl<strong>in</strong>ical workload to produce <strong>the</strong> best cl<strong>in</strong>ical<br />

outcomes.<br />

Our f<strong>in</strong>d<strong>in</strong>gs <strong>in</strong> relation to critical mass:<br />

Although <strong>the</strong>re has been good progress <strong>in</strong> some areas, <strong>the</strong>re are still clear<br />

and substantial shortcom<strong>in</strong>gs <strong>in</strong> <strong>the</strong> way core <strong>acute</strong> <strong>hospital</strong> <strong>services</strong> are<br />

presently planned and provided, compared to <strong>in</strong>ternational best practice.<br />

Substantial reconfiguration is required to move <strong>the</strong> <strong>acute</strong> <strong>services</strong> <strong>in</strong> HSE <strong>Mid</strong>-<br />

West towards <strong>the</strong> systematic delivery <strong>of</strong> safe, high quality patient care. This<br />

service reconfiguration is about reallocat<strong>in</strong>g exist<strong>in</strong>g HSE resources. The<br />

consultant resources for <strong>acute</strong> care are already largely sufficient but <strong>the</strong>y are<br />

presently too dispersed across units that are too small to meet <strong>the</strong> critical<br />

mass criteria <strong>of</strong> workforce and population, such that it is not possible for staff<br />

to systematically deliver consistent high quality <strong>acute</strong> care.<br />

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