Hospital Groups will secure future of smaller hospitals

A Major Trauma Network policy for Ireland was being developed,  a review of the future location of the Dublin maternity services was due to be completed in April and  an application for planning permission for the new Children’s Hospital, including its two satellite centres,  would be submitted to Bord Pleanála this summer, Ms. Fionnuala Duffy, Head of the Acute Hospital Policy Unit, Department of Health with responsibility for the establishment of Hospital Groups and the development of the new Children’s Hospital, told a HMI Forum in Beaumont Hospital, Dublin.  Maureen Browne reports.

Fionnula Duffy
Mr Liam Duffy, CEO, Beaumont Hospital, Ms Joan Regan, Department of Health, Ms Fionnula Duffy, Department of Health, Mr Derek Greene, HMI President and Ms Anne-Marie O’Grady, HMI Council 

The current reorganisation of Irish hospitals was not just about the larger hospitals but about providing an appropriate role for the smaller hospitals through reconfiguring services, Ms. Fionnuala Duffy, Head of the Acute Hospital Policy Unit, Department of Health with responsibility for the establishment of Hospital Groups and the development of the new Children’s Hospital, told a HMI Forum in Beaumont Hospital, Dublin.

“Hospital groups will secure the future of our smaller hospitals. Smaller and larger hospitals must work together in the provision of services. Services can be exchanged between sites. This will result in the maintenance of activity in smaller hospitals, but, will allow them to focus on the provision of care that is safe and appropriate.”

If you were planning a hospital service for this country you would not plan for 48 acute hospitals working in isolation and duplicating facilities.

She said no smaller hospitals were going to be closed, but a considerable amount work needed to be done on integrating services across hospitals in a group – effectively operating as a single service on a number of sites and re-directing patient flow to the most appropriate location If a hospital 24/7 ED was reconfigured to a minor injuries unit this meant that it would be expected to do a greater amount of other work- such as day case and ambulatory care.

Ms. Duffy, who was speaking on “What’s happening now and in the future,” said she believed legislation to establish the new Hospital Groups was three to five years away and in the meantime they would need to work on an administrative basis.

She also said that a Major Trauma Network policy for Ireland was being developed, a review of the future location of the Dublin maternity services was due to be completed in April and an application for planning permission for the new Children’s Hospital, including its two satellite centres, would be submitted to Bord Pleanála this summer.

Hospital Groups

She said the establishment of hospital groups was the most fundamental modernisation of our health system infrastructure in the history of the State.

The Department was going to put in place an overarching policy framework to guide the overall hospital services reorganisation.

“If you were planning a hospital service for this country you would not plan for 48 acute hospitals working in isolation and duplicating facilities. This is particularly a phenomenon of the Dublin hospitals. At present a large number and range of acute hospitals are operating in relative isolation. This has resulted in duplication and fragmentation of resources, difficulty in recruiting and retention of key clinical staff, non-compliance with EU directives and an inequitable distribution of workload and resources.”

She said public hospitals would be reorganised into more efficient and accountable hospital groups with increased independence and greater control at the local level. This represented a crucial step in delivering a more effective and efficient hospital service

“The formation of hospital groups will change how hospitals relate to each other and integrate with the academic sector, delivering higher quality services, more consistent standards of care, more consistent access to care, stronger leadership and greater integration between the healthcare agenda and the teaching, research and innovation agenda. The partnership with the academic sector has great potential and it is very important for us to harness it.”

The intention was that in time, the groups would qualify as independent hospital trusts as we progress to Universal Healthcare, but that would not happen for a few years.

The Government had approved the establishment of six hospital groups – Dublin North East-RCSI, Dublin Midlands, Dublin East – Ireland East, South/South West, West/North West –Saolta and Midwest – UL and also The Children’s Hospital Group.

Ms. Duffy said that each of the new Groups hadthe following characteristics – at least one major teaching hospital, an appropriate size for good governance and effective management, an existing link between hospitals and an academic partner.

The Groups were of sufficient scale to be able to deliver meaningful reform and were configured so as to facilitate the delivery of safe, high quality patient care in a cost effective manner.

We expect that the satellite centres will be opened well in advance of the main hospital so people will be used to going there.

Other key benefits included stronger governance and management structures, more cost efficient care with removal of duplicated services, concentration of complex services at particular hospitals to ensure quality, efficiencies through avoidance of duplication in areas such as HR and Finance and more effective use of staff .

There were challenges ahead. Voluntary hospitals had their own Boards and governance arrangements and we needed to work with them as we put in place group governance and group management teams   “We have a lot of work to do on ensuring accountability for use of public funding, while giving service providers greater autonomy to be innovative, to make decisions and take responsibility for them.”

She said the Department was going to put in place an overarching policy framework to guide the overall hospital services reorganisation. Health Minister, Dr. Leo Varadkar had appointed a National Strategic Advisory Group, chaired by Mr. Leo Kearns. This SAG would provide objective advice and expertise on the implementation of hospital groups. Its initial focus was on producing a guidance paper on the development of Hospital Group Strategic Plans. The final document, which incorporated input from a range of stakeholders, would be issued to Hospital Group Chairs and CEOs in early 2015.

The guidance paper would take the form of a blueprint to guide the hospitals through some of the major challenges in developing their Strategic Plans. It would be followed in time by additional national guidance from the SAG on configuration of key national specialist services across hospital groups, the definition of a Hospital Trust in an Irish context, and the criteria that would be used to assess readiness to transition to Trust status.

Trauma Network

Ms. Duffy said we needed a trauma network for Ireland which would provide the different hospitals with an appropriate role from stabilising trauma patients to specialising in major trauma to with improved service for rehabilitation in hospitals and the community

Consultant cardiac surgeon, Ms. Eilish McGovern was chairing the Trauma Network working group. This would build on work of the Trauma and Orthopaedic clinical programme and examine the international evidence base with regard to the most efficient and effective organisation of major trauma services for this country. It would describe and evaluate how major trauma was currently dealt with in an Irish context, engage in appropriate consultation with key stakeholders and recommend a policy for a major trauma network for Ireland to the Minister for Health. The new Children’s Hospital.

Ms. Duffy said that at a cost of €650 million this would be the single largest State building project.

“There is much work to be done here. We have three voluntary hospitals and we are going to have to create a single entity in advance of the move to the new hospital. They each have pride in their vision and legacy and we have to integrate them into a single entity that retains these visions and values. The Children’s Hospital Group CEO and the CHG Board have been working closely with the three existing hospitals on integration planning to bring together three independently governed organisations. We are committed to producing Heads of a Bill to establish a new statutory body for the new children’s hospital before the end of the year.

She said the CHGB was working closely with the HSE Systems Reform Group on the necessary project planning, and was now commencing the clinical integration, corporate integration and programme management workstreams.

“The National Paediatric Hospital Development Board aims to submit planning application to An Bórd Pleanála in the middle of this year for the hospital and its two associated satellite centre on the campuses of Connolly and Tallaght Hospitals, allowing six months timeframe for planning decision. The satellite centres will be under the branding of the Children’s Hospital, will look and feel the same as the main hospital and will be staffed from the main hospital. We expect that the satellite centres will be opened well in advance of the main hospital so people will be used to going there and the new hospital does not get clogged up attendances for more minor injuries when it opens in 2017.”

Dublin Maternity Hospitals Location

Ms. Duffy said work was on-going on a review of the locations for the Dublin maternity hospitals to identify their appropriate configuration, given that tri-location of adult, paediatric and maternity services must take place on the St James’s campus.

The review was expected to be completed by the end April. She said it had previously been anticipated that the Rotunda Hospital would be tri-located with the paediatric hospital on the Mater campus, and that the National Maternity Hospital and the Coombe should be co-located with St. Vincent’s and Tallaght Hospitals respectively.

Plans are well underway to relocate the National Maternity Hospital to St. Vincent’s campus. The   project is progressing very well with very good engagement with the Design Team from both hospitals. A review would be complete by the end of April on the future location of the Coombe and the Rotunda Hospitals. Maternity services would have to be located on the St. James’s campus to achieve tri-location of adult paediatric and maternity services and there had to be a decision on this before the planning application for the Children’s Hospital was submitted to An Bord Pleanála. The Department is also committed to the development of a National Maternity Strategy.