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
Precondition 1: There must be a critical mass of medical workforce and workload in
order to deliver an assured quality of acute care
All strategic developments have centred on the need to maximise access to local services for
as many people as possible while at the same time providing assured, high quality care to
the much smaller number of patients who need more expert, complex management.
Providing the infrastructure for this more complex management means bringing together a
critical mass of medical workforce teams for the acute core services and providing them with
a matching critical mass of appropriate, complex workload to foster a combination of job
satisfaction, high quality care and continued development of these skills and expertise.
Critical mass is only achieved by delivering these services on a centralised, ‘regional’ basis.
In practice, a balance is reached between workforce and workload when the ‘region’ refers to
a minimum catchment population of 350,000 to 500,000.
These clinical expert teams must be able to provide continuous, assured, high quality, ‘round
the clock’ acute care i.e. must be able to offer immediate access to an available, alert, duty
consultant whenever necessary. This means there needs to be at least eight full time
members on the team, to share out the workload and the time commitment in a manner that
is equitable, appropriate and compliant with the European Working Time Directive. The
minimum of eight also applies to the least number needed on each layer of the medical
staffing shifts and rotas.
It is a fundamental assumption, therefore, that it is the matching of medical workforce
numbers and expertise with the workload demand, supported by an optimal physical and
functional configuration, that paves the way for that service to be able to deliver an assured
quality of acute care ‘as the norm’ and in line with international best practice standards.
In turn, this assumption for acute care is based upon the second fundamental assumption
that all elements of the new strategies for maximising access to local services through prehospital
services e.g. Ambulance, AP, ANP, have first been fully implemented.
The critical mass relationship is of course applicable to all services, not just the acute
services.
Precondition 2: A fully effective pre-hospital service must be in place
An essential element of improving services and safety, and ultimately of securing the optimal
configuration for the regional ‘centre of excellence’, is to have a fully effective pre-hospital
system in place, one that inspires confidence in all potential users of the service, knowing
that they will be safely protected from unnecessary referral, admission, or from staying too
long in the acute hospital, except for clear and compelling acute clinical problems needing
active consultant specialist management.
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