Harty calls for reconfiguration forum

A NEW reconfiguration forum with an independent chairman, including all disciplines of healthcare in the Mid-West, should be established to plan for the future of acute hospital services in the region.

That’s according to the chairman of Clare College of General Practitioners, Dr Michael Harty, who believes this would allow all interested parties to have an influence on the future provision of a sustainable, safe and dynamic health service.
Dr Harty claimed the Mid-Western Regional Hospital, Limerick is being forced to function over its capacity due to the increased volume of patients, as a result of the centralisation of services.
“Patients who require admission to hospital are experiencing unacceptable difficulties in being admitted to inpatient beds and may be sent home without admission, due to an overall reduction in bed capacity in the region. There is a lack of compensatory additional beds in Limerick, following the closure of beds in Ennis and Nenagh,” he said.
Dr Harty said if the Mid-West reconfiguration is to be used as a model for other regions, then it should provide a better template for service delivery.
“It must first recognise and then accommodate the fact that centralising some disciplines of care fundamentally alters the delivery of all other services. You can’t change the structure on one service in isolation without planning change in all services, as they are interdependent,” he told The Clare Champion.
He noted the essential problem is that of capacity; the capacity to provide a consultant opinion or a diagnostic test in a timely fashion and the capacity to provide a hospital bed when needed.
Dr Harty claimed it is more difficult for Clare patients to access inpatient and outpatient services in Limerick hospital since the reconfiguration and warned the decision to reduce the average length of stay from 5.1 to 3.7 days is a high-risk strategy.
He claimed some patients are being prematurely discharged or being refused admission, even with a GP referral, because the hospital is too busy.
He also claimed that a number of Clare people who have health insurance or can afford to pay are going to private hospitals. “This, in turn, is creating a problem for the public health service because it is losing out on the income these insured patients would have provided.
“The only patient who will opt to go to a public hospital are those who don’t have insurance and those who can’t get a particular type of treatment in a private hospital.
“We have no idea where reconfiguration is going or what will be the final outcome of the process in the Mid-West,” he claimed.
He alleged the commitment to developing services in Ennis hospital could be gauged by the experience with the CAT scanner service that started last May but was stopped after six weeks when a radiologist left the service.
“Why put in a new CAT scanner without providing a permanent radiologist who could run the service?” he asked.
Dr Harty’s concerns are shared by Dr Tom Nolan, who claimed it is harder for public patients to access acute hospital services in the Mid-West today compared to the situation prior to reconfiguration.
The Kilkee-based GP warned that patients who have voluntary health insurance are “voting with their feet” and going to private hospitals because they are not prepared to wait for hours in the emergency department at Limerick.
“I don’t think the people driving the reconfiguration programme would be prepared to wait for hours on a hospital trolley for treatment. It is an inhumane and degrading way of treating people. It isn’t right to have seriously ill patients cooped up in cramped conditions in hospital.
“I have had a number of patients over the last three months who had injuries such as fractures and they were put off being admitted into Limerick regional hospital for up to two weeks because the hospital was too busy to deal with them.
“Other patients have been sent home early and told to come back in a week’s time. What is happening is nothing more than you could expect when you put more and more patients into a system with less beds,” he said.
However, the medical director of the reconfiguration plan, consultant surgeon Paul Burke, said the region has set a headline for the rest of the country in putting the patient first and ending outdated and inefficient practices.
“There is always a certain reluctance to claim that we have met all our targets but we can say that delivery of acute care is now being delivered around what is best for the patient, not what satisfies the requirements of individual hospitals, their staff or vested interests.
“This may sometimes mean an inconvenience for the patient but it is definitely safer,” he said.
“Significantly, while reconfiguration initially encountered much opposition at local level, including politicians and GPs, there is now an emerging consensus of medical opinion that the changes to surgery and A&E were necessary and that the new model is working. Local political opinion is slower to change but that’s something we have to accept,” he added.