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
The current system for acute services generates substantial risks
to patients and staff
In essence, the present system means that the resources for four of the core acute
specialties in the Mid-West - A&E, general medicine, general surgery and critical
care, are too fragmented.
Presently, the resources are too diluted, dispersed across four hospitals and
providing four small independent services. This circumstance is not satisfactory for
staff and exposes patients to unnecessarily increased levels of clinical risk.
By and large, and with the specific exception of A&E, there are already enough
consultants in the system. If grouped together on one site, they could provide
systematic, safe, continuous, sustainable, high quality care to recognised
international standards.
In relation to assessing clinical performance and checking upon the quality of
patient care, there is presently no system of peer review or monitoring or reporting
upon performance through clinical audit and clinical governance.
Particular concern was expressed about increased risks to trauma patients due to
unnecessary delays in ambulance transfers to the regional trauma centre.
We recommend that consultants are invited to conduct regular peer review within
their specialty and that the HSE develops a Clinical Governance strategy to openly
and transparently assess the degree of compliance of service quality and patient
outcomes against international standards and practice.
The present system has grown up around the concept that delivering acute care across
several separate hospital sites serving small populations provides a satisfactory quality of
patient care. In the Mid-West, therefore, acute general hospital services are presently
provided across four stand-alone hospital sites, all within reasonable travelling distance of
each other, namely:
• The Mid-Western Regional Hospital Dooradoyle;
• The Mid-Western Regional Hospital Ennis;
• The Mid-Western Regional Hospital Nenagh; and
• St. John’s Hospital, Limerick.
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