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

Review of acute hospital services in HSE Mid-West
An action plan for acute and community services
Planned care will be streamed separately from unscheduled care. This reduces
cancellations, achieves a systematic and predictable workflow, and improves the quality of
service to patients. However, patient safety needs to be at the forefront of any proposal that
involves elective care being delivered at a distance from critical care. An analysis undertaken
by the Department of Health in the UK, identified that 98 per cent of elective care by volume
requires a critical care stay in fewer than 1 per cent of cases 93 . Therefore, there is an
argument that regional centre inpatient based services can be separated into those which
are critical care dependent and those which are not, and both need not necessarily need to
be located on the same site.
The European Working Time Directive is dictating the minimum number of consultants in a
team needed to deliver a continuous 24/7 commitment that complies with the regulations,
and the minimum workload required to justify a team of that size being grouped together in
that manner.
Therefore, the acute teams in the regional centres of the future, for A&E, medicine, surgery,
trauma, etc., will be based upon this consultant profile of 8 or more in the specialty grouping.
The critical mass argument will be considered next when we come to consider regional
centres and the evidence surrounding what size of catchment population they need in order
to deliver best acute healthcare.
In turn, the regional centre may provide, or be supported by, tertiary, highly specialised
services, with individual services including neurosurgery, cardiac surgery, transplantation
surgery, plastic surgery and certain children’s services.
Catchment populations for acute regional services
Catchment populations provide a proxy for ensuring a sufficient critical mass of patient
volumes to provide safe and viable services staffed by specialist and sub-specialist
consultants and medical staff working in sustainable rotas.
The Royal College of Surgeons in Ireland has identified that the minimum number of general
surgeons required within a unit is 12 allowing for sub-specialty interests and suitable rota
cover. Assuming a ratio of 1 general surgeon per 25,000 of the population, this derives a
catchment population of 300,000 for a regional centre 94 . A review of medical staffing
workforce undertaken by a national task force in Ireland modelled consultant numbers on a
catchment population of between 350,000 and 500,000 95 .
93 Building a Health Service Fit for the Future, A National Framework for Service Change in the NHS in Scotland, 2005.
94 The Future of Surgical Specialties in Ireland, Royal College of Surgeons in Ireland, April 2004.
95 Report of the National Task Force on Medical Staffing, June 2003.
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