Paving the way for Trust hospitals

Following months of consultations, discussions, wrangling, compromises and concessions, involving politicians, managers, clinicians and academics, the Cabinet has agreed to the establishment of six new public hospital groups. Maureen Browne reports.

Following months of consultations, discussions, wrangling, compromises and concessions, involving politicians, managers, clinicians and academics, the Cabinet has agreed to the establishment of six new public hospital groups – each with an academic partner – as a transition to independent hospital trusts in two years time.

Maureen Browne
Maureen Browne

Each of the six groups will consist of between six and eleven hospitals and will include at least one major teaching hospital. Each grouping will include a primary academic partner “in order to stimulate a culture of learning and openness to change within the hospital group.”

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While it was widely expected that the Minister would direct prescriptive groupings for Ireland’s 49 acute hospitals, the Department of Health statement said that the composition of the new groups, which it laid out was “recommended,” which obviously still leaves some wriggle room.

There were little surprises in the recommended composition of the groups, which had been leaked extensively in recent times.

Interestingly the recommended new groups cut across geographical areas. In Dublin East, the group will include the Mater Hospital on Dublin’s northside and St. Vincent’s University Hospital on Dublin’s southside, which are of course already linked by an academic medical centre.

The Department of Health statement said that the composition of the new groups, which it laid out was “recommended,” which obviously still leaves some wriggle room.

The Rotunda Hospital becomes part of the Dublin North East Group, splitting it from its traditional partner, the Mater Hospital, but the two hospitals will be allowed joint consultant appointments.

The south east hospitals have been split between the Dublin East Group, which includes St. Luke’s General Hospital in Kilkenny and Wexford General Hospital and the South/South West Group which includes Waterford Regional Hospital.

Waterford will retain its role as a major cancer, cardiology and trauma centre for the southeast and the hospital will be upgraded to university hospital status, with academic posts, including two professorships provided for consultant staff.

Hospitals in Wexford, Kerry and Letterkenny will retain emergency services because of their location but St. Columcille’s Hospital Loughlinstown Co. Dublin will lose its ED.

No. Recommended Composition of Hospital Groups
i Dublin North East: Beaumont Hospital; Our Lady of Lourdes Hospital, Drogheda; Connolly Hospital; Cavan General Hospital; Rotunda Hospital; Louth County Hospital; Monaghan Hospital. (Academic Partner: RCSI).
ii Dublin Midlands: St James’s Hospital; The Adelaide and Meath Hospital, Dublin, including the National Children’s Hospital; Midlands Regional Hospital, Tullamore; Naas General Hospital; Midlands Regional Hospital Portlaoise; the Coombe Women and Infant University Hospital. (Academic Partner: TCD).
iii Dublin East: Mater Misericordiae University Hospital; St Vincent’s University Hospital; Midland Regional Hospital Mullingar; St Luke’s General Hospital, Kilkenny; Wexford General Hospital; National Maternity Hospital; Our Lady’s Hospital, Navan; St Columcille’s Hospital; St Michael’s Hospital, Dun Laoghaire; Cappagh National Orthopaedic Hospital; Royal Victoria Eye and Ear Hospital. (Academic Partner: UCD).
iv South/South West: Cork University Hospital/CUMH; Waterford Regional Hospital; Kerry General Hospital; Mercy University Hospital; South Tipperary General Hospital; South Infirmary Victoria University Hospital; Bantry General Hospital; Mallow General Hospital, Lourdes Orthopaedic Hospital, Kilcreene. (Academic Partner: UCC).
v West/North West: University Hospital Galway and Merlin Park University Hospital; Sligo Regional Hospital; Letterkenny General Hospital; Mayo General Hospital; Portiuncula Hospital; Roscommon County Hospital. (Academic Partner: NUIG).
vi Midwest: Mid-Western Regional Hospital, Limerick; Ennis General Hospital; Nenagh General Hospital; St John’s Hospital Limerick; Mid-Western Regional Maternity Hospital; Mid- Western Regional Orthopaedic. (Academic Partner: UL)…
The acute paediatric services in Dublin; Our Lady’s Children’s Hospital – Crumlin, Children’s University Hospital Temple Street, and the paediatric service in AMNCH – Tallaght should also function as a single cohesive entity with appropriate governance arrangements (in line with hospital group proposals).

The Minister said the hospital groups represented the most fundamental reform of the Irish acute hospital system in decades and the reorganisation of public hospitals “into more efficient and accountable hospital groups” would deliver improved outcomes for patients. He emphasised that no acute hospital would close and it was envisaged that smaller hospitals would provide a greater amount of routine services such as day surgery and diagnostics.

Each group of hospitals will work together as single cohesive entities managed as one, to provide acute care for patients in their area, integrating with community and primary care. The Minister said this would maximise the amount of care delivered locally while ensuring complex care was safely provided in larger hospitals.

Each of the six new hospital groups will be led by a group Chief Executive Officer, who will be the accountable officer for the group.

Each of the six new hospital groups will be led by a group Chief Executive Officer, who will be the accountable officer for the group.

The Minister said the requirement for individual hospital management teams will be determined by the size of the hospital and the range of services provide at each site. However, the management teams of hospital groups must include a Group Chief Executive Officer, a Chief Clinical Director, a Chief Academic Officer, a Chief Director of Nursing, a Chief Finance Officer and a Chief Operations Officer.

The hospital groups will each establish an interim group board to which the management team will report. The Chair of the Interim Board will be appointed by the Minister. The Chair will then nominate the board membership for Ministerial approval. The Minister said that the interim group board will “comprise the necessary skills, competencies and experience to enable them to contribute to and challenge the performance of the group.”  Their experience and expertise will include clinical business, social, legal, medical academic and patient advocacy. Group Chairs and CEOs are to be appointed as soon as possible.

In its first year of operation, each group must develop a strategic plan for its future service configuration. These plans must describe how they will provide more efficient and effective patient services, how they will reorganise these services to provide optimal care to the population they serve and how they will achieve maximum integration and synergy with other groups and all other health services, particularly primary care and community care services.

Legislation is to be put in place in 2015 to enable Independent Hospital Trusts to be established, taking account of any changes to groups which may emerge from the review process.

Work on the roll-out of hospital groups is to begin immediately and will be overseen by a National Strategic Advisory Group.  This will provide guidance and on-going direction in relation to implementation of both the Hospital Groups report and the Smaller Hospitals Framework. The Department said it would also provide a forum to resolve issues and assist in the development of specific implementation guidelines on the steps required for full implementation.

The Department said that the Government’s decision on the hospital groups was informed by two reports “The Establishment of Hospital Groups as a Transition to Independent Hospital Trusts”, produced by an expert group led by Prof. John Higgins following consultation with stakeholders and the “Framework for Development – Securing the future of smaller Hospitals”