Hospital facing five-day week?

SERVICES at Ennis hospital could be limited to just five days a week if a new blueprint for acute hospitals in the region is fully implemented, The Clare Champion can exclusively reveal.

According to a draft document dated September 29, which outlines the proposed introduction of a new national acute medicine programme, one of the more worrying aspects for Clare is the proposed closure of the Intensive Care Unit.
The blueprint suggests Clare patients would be assessed in a daytime Medical Assessment Unit (MAU) and tracked using the national ‘early warning score’ to determine if they are a high or low-risk case. If a patient is deemed high-risk, they will be transferred to the Mid-Western Regional Hospital, Limerick, who in turn will send low-risk patients back to Ennis if deemed appropriate.
GPs would also be able to refer low-risk patients and medical patients for assessment to the MAU during daytime hours.
If patients deteriorate after admission, they will be transferred to Limerick and if a patient is critically ill, the regional critical care retrieval team will ensure transfer.
The medical staffing at night would be a resident medical registrar and senior hour-officer, both certified in advanced cardiac life support with a consultant on-call.
Ennis hospital may also have a minor injury unit, while nurse staffing at night would include a nurse manager/supervisor.
The Mid-West HSE declined to comment on the draft document before going to press on Tuesday evening.
The Clare Champion has also learned that Ennis, Nenagh and St John’s Hospital, Limerick would be classified as a model two acute facility and St Joseph’s Hospital, Ennis as a model one facility, with the Mid-Western Regional Hospital, Limerick, a model four facility.
The newspaper is also informed from a reliable source that substantial changes have been made from the original document drafted last June compared with the September draft and that more alterations could be made before the final version is published.
The acute medicine programme is a clinician-led initiative between the Royal College of Physicians of Ireland (RCPI), the Irish Association of Directors of Nursing And Midwifery (IADNAM) and the Therapy Professionals Committee (TPC).
This is one of a number of clinical programmes jointly initiated by the RCPI and the directorate of Quality and Clinical Care of the HSE.
“The future growth in healthcare will be in the areas of ambulatory care, including chronic disease management and day surgery, diagnostics and rehabilitation, which will be based in model two hospitals. As a result of these emerging models of healthcare delivery and the ageing population, the total volume of activity of local hospitals will need to grow substantially for the successful implementation of this programme,” the document stated.
The chairman of the Irish College of General Practitioners, Dr Michael Harty, described the document as a “wish list” and claimed the HSE has not prioritised it for funding. He said he understood this is a blueprint for all hospitals in the country, which would be presented as a model for the Mid-West following the centralisation of all 24-hour emergency departments to the Mid-Western Regional Hospital, Limerick.
Raising the issue of staffing levels required to implement this strategy, the Kilmihil-based GP noted that five consultants would be needed to man the MAU in Ennis, which is double the existing whole time equivalent.
It is also noted that a proposal for the management of in-patient beds by GPs at Ennis hospital contained in the June draft, was omitted three months later. Another clause requiring a doctor to get consent from a patient prior to treatment that facilities may not be in place to provide the full spectrum of hospital resuscitation (IVR) was also excluded.
HSE Forum West member Councillor Brian Meaney has questioned the contents of the document and warned that Ennis hospital could become akin to a five-day week clinic if it is fully implemented.
He asked how medical staff would deal with chronically ill patients in Ennis if the Intensive Care Unit is withdrawn and with the centralisation of cardiology services next February.
He said he was assured by HSE personnel that Ennis would become a centre of excellence in endoscopy but feels this could not be achieved if the hospital is operating on a five-day week basis.
“Will there be a clear-out of wards at the weekends and what will happen to these patients? I am concerned these patients may have to be transferred into the Mid-Western Regional Hospital, Limerick to cater for their medical needs.
“I would like to see what is happening with reconfiguration in the rest of the country. I believe that the Mid-West could be seen as a ‘soft touch’ and as a result, this region is taking much of the worst hits in relation to this programme for political reasons,” he noted.