ICU critical for Ennis hospital

THE proposed removal of the intensive care unit from the Mid-Western Regional Hospital, Ennis and the possible withdrawal of associated full anaesthetic cover next July has prompted renewed concern about the future of the acute facility.
Clare doctors and medical staff at the Ennis hospital are becoming increasingly worried about the retention of acute medical services in smaller hospitals in the Mid-West, if Health Service Executive plans are fully implemented.
Accident and emergency services were removed from Ennis and Nenagh hospitals on April 6, 2009, and all surgical procedures were subsequently centralised to the Mid-Western Regional Hospital, Limerick.
However, Clare GPs could still refer medical patients with non-life threatening illnesses to Ennis hospital after 8pm where they would be seen by a doctor under the current arrangements.
The Clare chairman of the Irish College of General Practitioners, Dr Michael Harty, has warned the centralisation of all in-patient surgical services and the changes in accident and emergency services in Ennis and Nenagh have resulted in a number of knock-on effects on other disciplines of medical care in the Mid-West.
“The delivery of medical services and surgical services are not mutually exclusive. Their inter-dependence has become obvious in the Mid-West, as acute services have been removed from Ennis and Nenagh without adequate planning of how replacement services would be provided and how the altered dynamic between all other services would be managed.
“The viability of standalone acute medical services in Ennis and Nenagh will be further undermined when anaesthetic services are withdrawn from these hospitals in July 2010, resulting in an additional reduction in the range of medical patients which can be safely managed in these peripheral hospitals,” he explained.
Irish Nurses and Midwives’ Organisation representative, Mary Fogarty, said staff, including nursing and medical employees are  concerned that Ennis hospital would effectively become a geriatric facility or a fully functioning day hospital with acute medical services.
Ms Fogarty said staff are also concerned as to whether a doctor would be retained at night.
“A wide range of day surgery was planned for Ennis hospital but that hasn’t taken place and as a result, staff had to be redeployed from theatre throughout the hospital. Staff are concerned about what model of care will be provided in Ennis hospital,” she said. 
National HSE director, John O’Brien, said at a HSE Forum meeting on Tuesday that the authority has not made a definite decision about what medical services would remain in Ennis and Nenagh hospitals.
Mr O’Brien explained that the authority has started a process to examine which medical procedures will continue at the Mid-Western Regional Hospital, Limerick and which ones could be transferred out as day procedures to the smaller hospitals.
Acknowledging this is a key issue, which would be addressed, he revealed that the HSE had also sought help as part of this process from the clinical director in Beaumont hospital and another senior consultant in the South-East.
Deputy Timmy Dooley has claimed a planned €14 million upgrading of infrastructure and equipment at Ennis hospital copperfastened its retention as an acute medical hospital in the future.
It is expected that Health Minister Mary Harney will officially announce a new refurbishment project delivering 50 replacement in-patient beds in the near future.
While the Mid-West Health Service has declined to confirm the cost of this project before it goes to tender, it is understood it will be in the region of €10 million.
This is in addition to the expenditure of €1.2 million accommodating the new CAT scanner at the hospital, €2.5 million on a new endoscopy project, €250,000 on orthopaedic equipment, €100,000 for urology equipment and a proposal for €250,000 to support additional orthopaedic day surgical services.
A contractor has been selected to design and build the upgrading project and the design is undergoing final review prior to award.
The unit will fulfil the HSE requirements for community nursing facilities providing modern high-specification public healthcare facilities for elderly and high care dependency patients. 
Over the past number of months, new services have started in Ennis hospital theatre suite and out-patients department. 
The HSE anticipates that ear, nose and throat surgery, additional general surgery and orthopaedic surgery will be in place in coming months with a strong commitment from local and regional management to continue to develop day surgery at Ennis hospital in coming years.