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
• There are patently unsatisfactory A&E staffing arrangements at Ennis and Nenagh. The
service is provided by external, non-HSE, non-consultant doctors, recruited from
overseas on contract to a commercial medical recruitment agency. Concerns have been
expressed in relation to the fact that although there is some consultant input to the
services at Ennis, they operate independently, and there appears to be no measure of
their quality of service delivery; and
• Overall, there are not enough consultants, and they are spread too thinly across too
many sites to provide a satisfactory level of consultant supervision anywhere in the
present system.
The bottom line is that the current services in the Mid-West have major practical difficulties in
meeting basic standards, let alone international best practice standards.
Recommendations
We strongly recommend that the HSE takes prompt action to develop a specific programme
to address these unsatisfactory arrangements, including:
• It would be prudent for the HSE to direct the affected units and their staff to sensibly limit
the unfiltered emergencies that presently come to these small A&E units by:
- Informing the public of the safety issues and announcing new access criteria and
levels of treatment available;
- Insisting that the ambulance service comply with current by-pass protocols to avoid
these small A&E units, and to update the protocols as necessary according to the
new access criteria;
• Announcing a programme of immediate, short and medium term actions to improve
current services, pending full service reconfiguration;
• Confirm one regional A&E ‘centre of excellence’ at Dooradoyle, focused on 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;
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