Reconfiguration of Services in the Mid West

1. Reconfiguration of Services in the Mid West Future Role of the Local Hospital

2. History FitzGerald ReportOutline of the future hospital system: report of the Consultative Council on the General Hospital ServicesDublin: Stationery Office, 1968

3. A Changing Ireland! • Patient expectation • Cancer strategy • HIQA • Doctors Expectations

5. TEAMWORK - background risk issues ! • 1 inpatient elective case per day • 105 surgical “emergencies” in one month • (Full theatre on call in 3 local hospitals) • 1 in 3 rota (78 rest days) half of all weekends covered by locum! • A/E: Weak clinical governance in local hospitals!

7. TEAMWORK Report Mid West- 2009 • Services are too fragmented ! • “Unable to sustain safe reliable levels of care on a continuous basis in Trauma, Acute Surgery, and ICU/High Dependency” • SAFETY ! • “These issues should be rectified immediately” !

8. Limerick: Junction of Mid west !“Hub and Spoke” 75% of population live within 25 miles of Limerickideal area for integrated health service !

9. Project group set up to develop local plan! • Clinical Lead – Chairman • Executive Lead – national profile • Senior Nurse – full time on project • HSE Transformation office - Project Manager and Nursing Development Officer • Senior Nurse (2) • Set up a Project Board, Project Team, then “Workstreams” in A&E and Surgery. • Lots of meetings between Project Group and relevant stakeholders

10. The Vision of the FutureTeamwork • Delivery of care is now being designed around what is best for the patient, not what satisfies the requirements of the service, or an organisation, or its staff. • Non-acute care is delivered in local “centres of excellence” ensuring easy access to a wide range of services for management of most ‘routine’ conditions; • Acute care is delivered in a single, regional centre responsible for managing the more complex conditions..

11. Mid West Regional hospital Tertiary Care Centre Major Trauma Unit Cancer Centre Academic/University Centre Ennis / Nenagh/St John Advanced diagnostics Day Surgery Local Emergency Centre Inpatient beds Therapies Primary Care Team Selling the Vision!Staff Public GP’s

12. Pre requisites for change Quick Wins ! • Emergency Theatre • Capacity to centralise intensive Care • Ambulance transport • New services in local hospitals - orthopaedics, new endoscopy units • Improved Access to Diagnostics (Nimis)

13. Trouble out West !

14. HIQA Report on Ennis Hospital (April’09) • “define clear role for the smaller hospital !” • “need structured relationship between hospitals” • Outreach Day Surgical Services • “Select Basket of medical conditions”

15. HIQA Report – implications ! Regionalise A&E Services immediately ! No ventilated patients to be kept in Ennis !

16. Local A&E Close at 8pm.Clinical Governance Established ! • More ambulances • Advanced Paramedics • Direct medical admission access • “Bypass Protocols” Trauma, Obstetrics, Paediatrics

17. Local Public and GPs not happy !

18. Ambulance Activity and Response time • Improvement in response times due to more ambulance availability

19. Capacity:New A&E attendances

20. Impact on Admissions from A&E 2 extra patients requiring admission per day

21. Medical inpatient Activity June 2009 vs 2010 • Ennis and Nenagh and St Johns continue to provide significant medical inpatient service

22. Reconfiguration of General Surgery All hands on Deck !

23. Theatre Schedule”All men are equal but some are-----------!!”

24. Hospitals in the Mid West“changing the way we work” ! • Emergency Services Regional A&E - clinical governance Acute surgery – centralised Trauma Centre – bypass protocol Anaesthesia/ ICU: centralise and expand ! • Regional Surgical Service Cancer Centre, Elective and Day surgery in 3 local hospitals • Medical Model in Local Hospital : next challenge !

25. Critical Care / Medicine • Centralise Critical Care • Anaesthetic Resource • Impact on Local Hospital?

26. Region wide Medical Model • Can local hospitals remain in their current mode? • Relationship of Medicine to Anaesthesia ? • Bed Capacity for medical patients in Region • Role of Acute Medical Assessment Unit

27. Medical inpatient Activity June 2009 vs 2010 • Ennis and Nenagh and St Johns continue to provide significant medical inpatient service

28. Shannondoc: 8PM to 8AM

29. Acute Medical Assessment Unit • The AMAU will provide a rapid assessment for GP referrals requiring an acute medical assessment • Can keep a significant number of patients out of hospital !

30. JEN – The Model Hospital Who will run ? GP or Community Geriatrician Pre-Assessment Clinic OPD Diagnostics Endoscopy Day Surgery NCHD Training Up skill clinical staff Inpatients in JEN AMAU rapid response team rapid retrieval Triage Sub-acute LOS < 5days Ambulance Service Post Major Surgery Acute LOS 21-28 days Rehab MWRH Elderly

31. Region WideDiagnostics • National Integrated Medical Imaging System (NIMIS) • Unified imaging system across all Mid West: Q3 2010 ????

32. Recession vs. Reconfiguration • Moratorium preventing the transfer of retired staff WTE ! • HSE being limited in its flexibility by Dept Of Finance ! • Meaningful reconfiguration is threatened !

33. Progress ! “Changing the order and bringing order to change !” The small hospital does have a vital role to play in a modern Irish health system!