Sunday 17 December 2017

Priscilla Lynch: Are we about to see Dublin emergency units downgraded?

People on trolleys in Beaumount Hospital accident and emergency ward
People on trolleys in Beaumount Hospital accident and emergency ward

We're used to Health Minister's Leo Varadkar's forthrightness and have-a-go approach by now.

He hasn't shirked away from budget overruns or trolley lists. His emergency department (ED) task force, despite fears it might be just a talking shop, recently published a well-received report and Leo secured a package with increased funding for nursing home beds, as well as new step down beds.

Now many observers are wondering if Leo could have the bottle for the most radical suggestion in this area - rationalising the EDs (once known as A&E units) in the capital. It's long been seen as a 'no no' politically but now the whispers are gathering pace that it may come to pass.

On the face of it, this sounds like a mad suggestion. We are just emerging from the worst ED crisis in the HSE's history, with record-breaking numbers of patients on trolleys and delayed discharges.

Furthermore, yesterday it was revealed that the HSE overspent its budget by almost €25m in January, with EDs exceptionally busy during the month.

In excess of 3,500 patients spent more than 24 hours in EDs during January. St Vincent's, Beaumont, Naas and Connolly hospitals were the worst for such delays.

Sure how could we consider downgrading any of Dublin's EDs when they cannot cope currently?

Quite the opposite. Many feel that restructuring Dublin's EDs to play on each hospital's strengths - some would be major trauma centres or specialise in certain treatments, while others could have daytime only services - would mean patients spend less time on trolleys and experience less surgery cancellations.

This would, it's argued, lead to a more efficient, and cheaper, ED service in the long term.

The first CEO of the HSE, Prof Brendan Drumm, was in favour of rationalising Dublin's EDs. He told me, after he left his post, that it was a hot potato politically despite Dublin being out of step with other similar sized EU cities in terms of the number of EDs we have operating round-the-clock.

Back in 2009 it was reported that the HSE was reviewing the need for 24-hour cover in its adult and three paediatric EDs in Dublin and three adult EDs in Cork city.

Cork has since seen its EDs successfully reconfigured, but Dublin was left alone.

Last year again it was reported Dublin's EDs were being examined but there have been no published reports or plans to date. There has been no appetite to embark on a war around the issue of downgrading some Dublin EDs but there is a realisation now that things need to change.

If Dublin's EDs are to be "reconfigured" (as the HSE likes to put it), this needs to be done in a very careful, well planned way. This should not be the way reconfiguration usually happens in the HSE - for example Limerick has become overburdened after taking on overnight ED services from Nenagh and Ennis.

One would assume that one of the city centre located EDs would be likely to have its opening hours reduced.

Geographically Tallaght, Beaumont and Blanchardstown serve large populations outside of the city limits and in adjoining counties. However, Beaumont Hospital's long-running ED problems have been well publicised, so would it fare better to have the pressure of a 24-hour ED removed?

Plus it was announced last week that the Rotunda Maternity Hospital will now likely move to Connolly, which would be a sweetener if some services were to be downgraded at the latter, particularly as Connolly is in the Health Minister's and Tanaiste's constituency, with an election nearing.

Of course, all this is just speculation at this point. However, I recently spoke to former Minister of Health Mary Harney, who it turns out is a big fan of the current Minister. She described him as tough and courageous and believes he is doing a good job.

High praise indeed from a former General of Angola. Does it mean Leo might be the one to finally dig out the reports on downgrading some Dublin EDs, make the recommendations public and maybe even implement them?

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