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29 acute care hospitals too many for a small country like Ireland

patslatt

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Apr 11, 2007
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13,637
That was a key criticism of the Irish system by retired hospital medical consultant Prof Keane in an interesting Newstalk interview yesterday.

There has been talk about consolidating the large number of acute hospitals for twenty years or more, with little progress. Given the high costs of increasingly high tech hospital care,massive savings from consolidation would likely result. That would help the hospital system stay within budgets for a change instead of begging for more taxpayer money. While substantial savings were achieved by consolidating acute care for Clare, South Tipperary and Limerick in Limerick University hospital, going by the large number of patients on trolleys it looks like Limerick hasn't been given enough resources to cope with the increased patient volume.

Local politics,not real health care requirements, determines the number of hospitals,with politicians fearful of intense local opposition to cuts or restructurings in hospital services. Often, locals value acute hospitals as a source of highly paid employment rather than a medical necessity.

Given the low volume of patients in many of the small hospitals,their medical specialists are getting a low level of practice compared to specialists in large acute hospitals. The locals would often get better and safer medical services by travelling a fair distance to attend the latter.

Plans for consolidation don't necessarily have to close acute care hospitals but the services could be restructured to meet real medical needs, such as group medical practices.

Prof Keane was also highly critical of the HSE, past governments,hospital inefficiencies and vested interests such as unions and professional associations.

The HSE management is bureaucratic and too top down. Instead of focusing on assisting front line staff,line managers focus on obeying orders from the top by implementing directives and targets that are more bureaucratic than useful.

Past governments are too influenced by the election cycles in their attitude to health care. This hobbles good planning. The government should avoid getting involved in operational matters and confine its role to broad issues of policy and strategies.
 
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Hans Von Horn

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Sep 4, 2015
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1,594
That was a key criticism of the Irish system by retired hospital medical consultant Prof Keane in an interesting Newstalk interview yesterday.

There has been talk about consolidating the large number of acute hospitals for twenty years or more, with little progress. Given the high costs of increasingly high tech hospital care,massive savings from consolidation would likely result. That would help the hospital system stay within budgets for a change instead of begging for more taxpayer money. While substantial savings were achieved by consolidating acute care for Clare, South Tipperary and Limerick in Limerick University hospital, going by the large number of patients on trolleys, it looks like Limerick hasn't been given enough resources to cope with the increased patient volume.

Local politics,not real health care requirements, determines the number of hospitals,with politicians fearful of intense local opposition to cuts or restructurings in hospital services. Often, locals value acute hospitals as a source of highly paid employment rather than a medical necessity.

Given the low volume of patients in many of the small hospitals,their medical specialists are getting a low level of practice compared to specialists in large acute hospitals. The locals would often get better and safer medical services by travelling a fair distance to attend the latter.

Plans for consolidation don't necessarily have to close acute care hospitals but the services could be restructured to meet real medical needs, such as group medical practices.

Prof Keane was also highly critical of the HSE and past governments. The HSE management is bureaucratic and too top down. Instead of focusing on assisting front line staff,line managers focus on obeying orders from the top by implementing directives and targets that are more bureaucratic than useful.

Past governments are too influenced by the election cycles in their attitude to health care. This hobbles good planning. The government should avoid getting involved in operational matters and confine their role to broad issues of policy and strategies.
An incapable Hospital at every Crossroad, a Hospital in name only, where too little work is done to build skill, or maintain skill.
Scaremongering Politicians who demand local services are damning people to mediocrity in terms of Health Care.
 

Schuhart

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While substantial savings were achieved by consolidating acute care for Clare, South Tipperary and Limerick in Limerick University hospital, going by the large number of patients on trolleys, it looks like Limerick hasn't been given enough resources to cope with the increased patient volume.
Where is the evidence that savings were achieved?

How many extra inpatients did LUH see? How much more funding did they get?
 

Hans Von Horn

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It is not just about savings. Small Hospitals cannot properly recruit staff, train staff or maintain skills.
 

patslatt

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Where is the evidence that savings were achieved?

How many extra inpatients did LUH see? How much more funding did they get?
Closing down acute care in Ennis and Nenagh must have resulted in savings surely?

Limerick has the worst record on patients on trolleys, suggesting insufficient funding. Anecdotally, I heard of a case where a nurse in LUH was pressuring an Irish woman on a brief visit from Australia to take a recuperating relative out of the hospital, even though the woman needed to return to her family abroad.
 

Harmonica

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Savings are surely minimal in terms of the overall HSE budget. I presume the problem with small hospitals is lack of critical mass of medical experts but maybe the Trust model helps that. Haven't most of the medical scandals been at small hospitals? Do Port Laoise & Drogheda qualify as small?

Health reform is pretty much impossible anyway due to competing special interests.
 

Hans Von Horn

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Savings are surely minimal in terms of the overall HSE budget. I presume the problem with small hospitals is lack of critical mass of medical experts but maybe the Trust model helps that. Haven't most of the medical scandals been at small hospitals? Do Port Laoise & Drogheda qualify as small?

Health reform is pretty much impossible anyway due to competing special interests.
Time spent at a small Hospital does not look good on the CV.
 

Hans Von Horn

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Which hospitals employed the "doctor" from Sudan who couldn't tell an elbow on X rays?
Doctors from Sudan and such places need to sit Irish Exams to work in an Irish Hospital
 

farnaby

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Coming from a logistics background, I've often wondered if the principles of logistics network optimisation could be applied to the hospital network.

General principles for locating warehouses include:
1. Centre of gravity - locating so as to minimise distance between the warehouse and demand points
2. Centralising as much as your service levels allow, to minimise cost (i.e. fewer warehouses)
3. Using forward stocking locations (warehouses with less capacity/capabilities) to address urgent, short lead time demand

Applied to hospitals, this means full-service hospitals will inevitably end up close to major urban centres - probably less than 10. Most operations, technical procedures and specialised diagnostics would only be done in these hospitals.

People falling outside of these catchment areas (say <1-2 hour drive) will rightly be concerned about lack of emergency services, and having to get to e.g. Dublin for operations, diagnostics and multiple post-procedural reviews. For these people, "forward hospital locations" would be set up to provide initial A&E and non-specialist services. The new set-up would include a transport service (paid out of savings made by consolidation) to take people in comfort from the FHL to the full-service hospital and back.

Just a thought, throwing it out there.
 

Old Mr Grouser

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Old Mr Grouser

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Joined
Aug 29, 2009
Messages
6,341
Coming from a logistics background, I've often wondered if the principles of logistics network optimisation could be applied to the hospital network.

General principles for locating warehouses include:
1. Centre of gravity - locating so as to minimise distance between the warehouse and demand points
2. Centralising as much as your service levels allow, to minimise cost (i.e. fewer warehouses)
3. Using forward stocking locations (warehouses with less capacity/capabilities) to address urgent, short lead time demand

Applied to hospitals, this means full-service hospitals will inevitably end up close to major urban centres - probably less than 10. Most operations, technical procedures and specialised diagnostics would only be done in these hospitals.

People falling outside of these catchment areas (say <1-2 hour drive) will rightly be concerned about lack of emergency services, and having to get to e.g. Dublin for operations, diagnostics and multiple post-procedural reviews. For these people, "forward hospital locations" would be set up to provide initial A&E and non-specialist services. The new set-up would include a transport service (paid out of savings made by consolidation) to take people in comfort from the FHL to the full-service hospital and back.

Just a thought, throwing it out there.
From what I've seen of it, as a patient in London, even the big hospitals need to be 'clustered' into groups of three. That's so that particular hospitals can specialise, and it also provides 'security' if a team at one hospital is unavailable or if there's an emergency.

So Ireland would need at least fifteen acute-care hospitals. Three in Dublin, three in Cork, and another three groups of three elsewhere in the country.

It's the only way to provide what's considered today to be a proper standard of care.
 

wombat

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Past governments are too influenced by the election cycles in their attitude to health care. This hobbles good planning. The government should avoid getting involved in operational matters and confine its role to broad issues of policy and strategies.
People wrongly believe that the drive to keep local hospitals open is based on the needs of patients. This is a mistaken view, the real driver is economic, local jobs, local suppliers of goods and services. When someone is seriously ill, they want the best outcome which means being seen by experienced specialists and they will be found in the larger city hospitals as was explained when the cancer centres were being promoted. Patients die because of local gombeen politics.
 

patslatt

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From what I've seen of it, as a patient in London, even the big hospitals need to be 'clustered' into groups of three. That's so that particular hospitals can specialise, and it also provides 'security' if a team at one hospital is unavailable or if there's an emergency.

So Ireland would need at least fifteen acute-care hospitals. Three in Dublin, three in Cork, and another three groups of three elsewhere in the country.

It's the only way to provide what's considered today to be a proper standard of care.[/QUOTE
--------------------------------------------------------------------------------------------------------
OVERHOSPITALISED DUBLIN

Dublin has about double the acute care hospital capacity per head as the combined area of Limerick, Clare and South Tipperary served by LUH. Generally, doctors prefer to live and work in capital cities.
 
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4horsemen

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Joined
Mar 10, 2010
Messages
2,969
[Q

From what I've seen of it, as a patient in London, even the big hospitals need to be 'clustered' into groups of three. That's so that particular hospitals can specialise, and it also provides 'security' if a team at one hospital is unavailable or if there's an emergency.

So Ireland would need at least fifteen acute-care hospitals. Three in Dublin, three in Cork, and another three groups of three elsewhere in the country.

It's the only way to provide what's considered today to be a proper standard of care.[/QUOTE

OVERHOSPITALISED DUBLIN

Dublin has about double the acute care hospital capacity per head as the combined area of Limerick, Clare and South Tipperary served by LUH.
On Newstalk yesterday Prof Keane was asked by Ivan Yates whether we had too many acute hospitals because we have too many medical schools but he was not willing to address that question!
 

nakatomi

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Joined
Apr 10, 2010
Messages
3,709
That was a key criticism of the Irish system by retired hospital medical consultant Prof Keane in an interesting Newstalk interview yesterday.

There has been talk about consolidating the large number of acute hospitals for twenty years or more, with little progress. Given the high costs of increasingly high tech hospital care,massive savings from consolidation would likely result. That would help the hospital system stay within budgets for a change instead of begging for more taxpayer money. While substantial savings were achieved by consolidating acute care for Clare, South Tipperary and Limerick in Limerick University hospital, going by the large number of patients on trolleys it looks like Limerick hasn't been given enough resources to cope with the increased patient volume.

Local politics,not real health care requirements, determines the number of hospitals,with politicians fearful of intense local opposition to cuts or restructurings in hospital services. Often, locals value acute hospitals as a source of highly paid employment rather than a medical necessity.

Given the low volume of patients in many of the small hospitals,their medical specialists are getting a low level of practice compared to specialists in large acute hospitals. The locals would often get better and safer medical services by travelling a fair distance to attend the latter.

Plans for consolidation don't necessarily have to close acute care hospitals but the services could be restructured to meet real medical needs, such as group medical practices.

Prof Keane was also highly critical of the HSE, past governments,hospital inefficiencies and vested interests such as unions and professional associations.

The HSE management is bureaucratic and too top down. Instead of focusing on assisting front line staff,line managers focus on obeying orders from the top by implementing directives and targets that are more bureaucratic than useful.

Past governments are too influenced by the election cycles in their attitude to health care. This hobbles good planning. The government should avoid getting involved in operational matters and confine its role to broad issues of policy and strategies.
Pat reconfiguration actually pushes up costs , and increasingly it has been found that lack of beds increases mortality, it is estimated that one in 50 deaths in Ireland are due to lack of beds.

Over the last few years it has been said that smaller hospitals are dangerous and should be closed, while at the same time several smaller private hospitals with emergency departments have been opened without a word of concern?

Why? Is it that we don't care about the rich and its ok to send them to smaller hospitals?
Or is it that really the danger of smaller hospitals is a myth ?

There is no financial saving in closing bigger hospitals , overcrowding with increased mortality as a result is the outcome


Fact or Fiction: service reconfiguration | The Nuffield Trust
 

nakatomi

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Closing down acute care in Ennis and Nenagh must have resulted in savings surely?

Limerick has the worst record on patients on trolleys, suggesting insufficient funding. Anecdotally, I heard of a case where a nurse in LUH was pressuring an Irish woman on a brief visit from Australia to take a recuperating relative out of the hospital, even though the woman needed to return to her family abroad.
No savings , these hospitals have become dangerous.
Mid-West calls for reconfiguration halt | Irish Medical Times


They cannot attract staff, either nursing or medical.
 

gleeful

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Feb 7, 2016
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Technology is moving and soon there will be less advantage to pooling resources in ever larger regional hospitals. It made great sense 20 years ago but if we start now, by the the time its done the advantage will be gone.
 


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