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
However, the present service configuration can no longer deliver today’s quality standards
and needs to change fundamentally in order to be able to deliver international best practice.
In other words, the present health system as delivered today is itself a key source of
increased patient risks. These risk factors are not new, they are not subtle, and are already
well known. They create circumstances that:
• Leave patients exposed to an environment where there is an increased risk of something
going wrong 14 ;
• Leave staff exposed to lack of consultant supervision; and
• Leave the quality of clinical performance unchallenged, in the absence of any system of
regular audit, peer review and clinical governance.
In essence, acute emergency care in the Mid-West is too fragmented, such that the clinical
resources, consultants, nurses and on-call staff, probably sufficient if grouped together on
one site, are too diluted and overstretched across the four sites to provide safe, continuous,
sustainable, high quality care to international standards.
Consultants and hospital managers, individually working hard to deliver a satisfactory quality
of acute care, are exposed by this fragmentation, as are the patients, who rightly expect to
receive high quality care in hospital. Consultants are routinely working in very small teams, or
even single-handedly, patently inadequate to sustain an acute 24/7 service. There is not
enough workload within and between the four sites to justify more consultants. These
circumstances place excessive stress upon the staff, and expose patients to an
unacceptable level of clinical risk.
We now assess the sustainability of today’s core acute services across the Mid-West,
focusing on the high impact specialties of general / elderly medicine, general surgery,
orthopaedics, obstetrics and paediatrics.
14 There was a specific area of heightened patient risk highlighted during our fact finding interviews. Although there is a
designated regional trauma centre for the Mid-West, this does not mean that trauma patients are automatically referred there
directly. The ambulance service still continues with the old habit and practice of taking trauma patients to the nearest ‘A&E’
department, even when it is known that only the Dooradoyle site operates a trauma service. This has been identified as an
avoidable high risk to trauma patients by the regional trauma consultants, in that definitive trauma management is often
significantly delayed, with endangerment to the patient’s life.
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