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

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Review of acute hospital services in HSE Mid-West An action plan for acute and community services managing the more major emergencies, and with a consultant recruitment plan to eventually establish a team of A&E Consultants sufficient for the provision of a ‘consultant-led’ 24 hour, 7 day a week service and compliant with the European Working Time Directive; • Establish an Emergency Care Network for Adults and Children for the Mid-West, providing an integrated, seamless service, connecting all the professionals on emergency duty, whether General Practitioner, Advanced Nurse Practitioner, Community Nurse, the Advanced Paramedic and all the duty teams in the acute hospital specialties; • Develop Nenagh, Ennis, and St. John’s, and possibly other sites, into key elements of the Emergency Care Network. They need to both relieve and complement the regional A&E centre by providing all the services for minor injuries and illness (Urgent Care, with access 12 hours per day, 7 days per week) across the Mid-West. Each would be led by an Advanced Nurse Practitioner and professionally accountable, as part of the Network, to the regional A&E Consultant team; and • In the meantime, until implementation of the new service configuration is completed, put in place additional temporary medical staffing, to improve the levels of patient safety of current services at Nenagh and Ennis. Our overall recommendations: We have set out our recommendations for action in a practical, ‘patientcentred’ implementation plan, aligned with the HSE Transformation Programme and designed to achieve consultant-led, clinically safe, sustainable, high quality acute and related primary and community services. We have identified the risks and pre-conditions which the action plan needs to address, in particular, immediate actions to improve patient safety and transitional investments to maintain basic standards in the current acute core services, pending full implementation of the Transformation Programme. We estimate that such a programme would largely achieve its objectives within 3 to 4 years, once the detailed project planning has been completed and subject to major capital builds. In overall terms, providing high quality, safe and sustainable services, built upon a ‘best practice’ foundation, across the Mid-West means: • Each hospital and specialty taking prompt action to: remove excessive variations in clinical and organisational practices (by standardising clinical management according to Integrated Care Pathways); and improve their current levels of efficiency and effectiveness to avoid unnecessary hospital admissions and 5
educe the length of stay in hospital; Review of acute hospital services in HSE Mid-West An action plan for acute and community services • Reconfiguring services into clinical networks, operating across three local ‘centres of excellence’ providing a wide range of routine out-patient, diagnostic and treatment services, and one regional ‘centre of excellence’ in Limerick City providing all specialist acute care; • Identifying what additional acute and community resources are needed to ensure that no patient is admitted unnecessarily to the acute hospital, and that all patients have access to supported earlier discharge; • Undertaking detailed workforce planning, training, restructuring and development in line with future service objectives; • Revisiting the Mid-West acute and PCCC capital build programme to confirm that the buildings and design enable the delivery of the new clinical strategies; • Confirming that local ‘centres of excellence’ offer a fully integrated service profile and easy patient access to: primary care teams; out-patient clinics; urgent care; diagnostics; day surgery; endoscopy; rehabilitation; and therapy beds; • Ensuring the ambulance strategy to deploy the Advanced Paramedic emergency workforce is in place; • Introducing new, complementary clinical and corporate governance structures to support the concept of integrated working practices and clinical networks, which will also incorporate the university / academic organisations to ensure that service planning and delivery can benefit from academic leadership and clinical best practice; and • Persuading all HSE staff and other providers to engage in challenging the ‘status quo’ and committing to support implementation of the HSE Transformation Programme across the Mid-West for the benefit of all patients, carers, resident population and the staff themselves. The changes recommended in this report present major challenges, but, in terms of patient safety, the availability of high quality care and clinical sustainability, the continuation of the present configuration of services is not acceptable. The benefits will be profound: much better patient experience and interaction with health care services; patients accessing more care at home and in their community setting; fewer patients spending unnecessary time visiting or being an in-patient in hospital; and safe and sustainable local and regional hospital services for patients, the population of the Mid-West, and for staff. 6
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Developing the implementation plan
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Within three years Review of acute
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Appendix 3 - Documents provided Rev
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Current service delivery Regional s
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Consultant Medical Workforce Review
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Future clinical model of care Revie
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The patient at the local ‘centre
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Centralising specialist acute servi
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Specialty British Columbia 100 New
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Critical care network Review of acu
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Tele-medicine Review of acute hospi
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Review of acute hospital services in the Mid - Health Service Executive

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