HSE to have four hospital networks

ishmael whale

The Irish Times subscription section seems to be the only paper covering this, but reviewing PPARS isn’t the only thing happening at the HSE board tomorrow. It looks like the new management plans to actually do something to bring sense and order to the delivery of hospital services, rather than simply replicating the inefficiencies of the old health board structure under a different name. IMHO this will be their real test, and its outcome will determine whether we actually ever get to see any return for the money invested in health.
Seeing as how their source for this story was a HSE board member, I think we can take it that the politics have started already.

http://www.ireland.com/newspaper/ireland/2005/1005/395785805HM9HOSPITALS.html
Hospitals across the State are to be grouped into four networks under new plans to be finalised by the board of the Health Service Executive (HSE) when it meets tomorrow. The move, which is likely to prove controversial, will see hospitals in Limerick, Galway and Donegal, for example, being managed as one network.
…. In June an HSE newsletter set out to "introduce" its "newly appointed senior managers" including the managers of 10 hospital networks who had recently been appointed. ….The HSE, when asked about the change of direction yesterday, said its chief executive Prof Brendan Drumm planned to make the HSE's management structures more responsive to the needs of patients and frontline staff……
The Western region stretches from Limerick to the Inishowen peninsula; the Southern region covers the entire south of the country from Kerry to Wexford; the Dublin/Mid-Leinster area covers the midlands, Wicklow and parts of south and west Dublin; and the Dublin/North-East region covers from north Dublin to Cavan and Monaghan.
The idea is to make each region self-sufficient in the provision of health services.
The roles of up to 12 smaller hospitals in these networks are being clarified.
The HSE said the changes were designed to accelerate the pace of the reform programme; to involve clinical practitioners and patients in the development, execution and monitoring of health care strategies; and to ensure full integration between the main service delivery units in the HSE.

murphaph

To be honest, whenever the health service bit comes up on the news I have always tended to switch off. So now I'm pretty ignorant as to what's wrong with it (cos I know this much-billions have been pumped into it and we still have poor feckers on trolleys in A&E waiting on admission to the wards). So can someone enlighten me as to what's wrong with the thing? Too many managers? Not enough 'real' staff? Cheers.

ishmael whale

No one link or article will cover the full gamut of health service related issues, but the link below gives some kind of an overview.

http://www.ireland.com/focus/localelection2004/mainissues4.htm

Briefly, the Hanly Report recommended that major acute hospitals should have populations of 350,000 to 500,000 and that only major hospitals should have the full range of emergency services available. Major hospitals would be networked to local hospitals which would provide more limited supportive services, including outpatient services and long stay care. The main impetus to the report was the European working time Directive, which limits the hours that non consultant hospital doctors and hence impacts on how medical staff can be rostered.

The intention behind the Hanly plan was to provide hospital services in an efficient manner, in the (perfectly reasonable) belief that staff in large hospitals built up specialist expertise because they handled large caseloads, and this in turn leads to better patient outcomes (health service speak for curing people.) Local hospital campaigners contested this on the grounds that smaller hospitals were more likely to have nurses called Brigid who went to school with your sister or maybe even were your sister, and this was proven to lead to an even better patient outcome, or even if it didn’t at least local large farmers had a pool of decent respectable women from which to take a wife.

Alright, they didn’t say that, but I find the local hospital campaigns so self serving that I can’t give an objective summary of their views. If you want, try this link for a flavour. http://www.saveourhospital.com/. If you can figure out how the statement “ Monaghan General Hospital, a hospital paid for and developed by the people of County Monaghan” can be reconciled with the fact that the CSO report that Monaghan households pay 159 million in tax but receive 177 million in social transfers, making them next beneficiaries of state funds before you even lay a scrap of tarmac on a road, let me know. Please.

http://www.cso.ie/releasespublications/documents/economy/current/regincome.pdf

Hanly ended because a lot of people got exercised about the loss of local A&E services in particular and, in fairness, because the A&E services to which they would be referred on to aren’t exactly dripping with resources at the moment. However, that sort of leaves the ball hanging in mid air. One way or the other, most county areas are simply too small a catchment area for many hospital services. A&E is a great issue to mobilise opposition, because it has that air of immediate crisis about it. How could anyone be caught saying your emergency can wait until you’ve driven up the road? But, in truth, by and large hospital are not dealing with car accidents. But they are dealing with cancer patients. Because the cancer patients aren’t lying on the road in a pool of blood the issue doesn’t have the same photogenic appeal, hence local interests are able to use A&E as an effect barrier to reform.

murphaph

Cheers ishmael,
It seems local interests are always the ruination of progress. "for the greater good" is an expression completely lost on them. This country will always be like this.

ishmael whale

I can’t help feeling the Monaghan Hospital issue will be a defining moment for the development of the health services. Will the HSE be left to manage the issue, or will local politics be allowed in?

http://www.online.ie/news/viewer.adp?article=3286480

Patient's death 'not a political issue'
online.ie
2005-10-19 10:50:01+01
The death of a 75-year-old Monaghan man in hospital is the responsibility of the Health Service Executive, not a blame game for politicians, HSE chief executive Brendan Drumm said today. Prof Drumm said his organisation must be allowed to provide the best care possible, regardless of the local political concerns of public representatives.

He spoke out after the Government came under heavy criticism in the Dáil following the death of Patrick Walsh from a bleeding ulcer last Friday in Monaghan General Hospital. Medics had scoured hospitals in Cavan, Drogheda and Dublin but failed to find a bed for Mr Walsh, despite two being available, according to Prof Drumm.

Prof Drumm said it was not possible to have five acute hospitals catering for a population of only 300,000 people, as demanded by local politicians. "I have very significant concerns about our ability to provide a quality of service to people like Mr Walsh in a situation where we divide our resources, which are provided at great expense by the taxpayer, across a number of sites, that's unjustifiable," he told RTÉ Radio."It's not good enough for me and I don't think it's good enough for those who pay for it."

Prof Drumm insisted resources must be consolidated rather than spread over too wide an area.”I would challenge anybody in the political or health system to produce any group of experts on an international level, who are not tied down by the local politics of this issue, to state that we should be maintaining five acute services across a population of 300,000," he said. ”If people are asking for that, I'm saying that that is not in the best interests of patients."

Cork

ishmael whale wrote:

Will the HSE be left to manage the issue, or will local politics be allowed in?

Mixing politics and health created a mess. Was it not 11 health boards with various County Councillers?

It is about time that the HSE is left run the system delivering a good service without the interference of politicians or lobby groups.