Written Answers. - Hospital Services.
John Bruton
Question:
111
Mr. J. Bruton
asked the
Minister for Health and Children
if he will request the authors of the Hanly report to publish, in greater detail, the assumptions, data and conclusions of the research cited in their report as to the reason critically ill patients have better survival prospects in bigger centralised hospitals than in local hospitals.
[29613/03]
The national task force on medical staffing carried out an extensive review of the literature regarding the safe provision of acute hospital services. Details are included in the bibliography of its report. Much of the research highlights a relationship between the volume of procedures performed by individual hospitals or specialists and the outcome of that treatment for the patient. It noted that the volume of patients or procedures required to maintain skill and safe consultant practice are set out in guidelines from the royal colleges, training bodies, expert groups and in national and international literature. It also noted that these figures have significant implications for the organisation and staffing of acute hospitals.
On the basis of its review, the task force concluded in Section 3.5.5 of its report:
There is convincing evidence that the best results in treatment are achieved when patients are treated by staff working as part of a multi-disciplinary specialist team and that better clinical outcomes are achieved in units with appropriate numbers of specialist staff with relevant skills and experience, high volumes of activity and access to appropriate diagnostic and treatment facilities.
On hospital population catchments and hospital size, Section 3.5.8 of the task force's report refers to international literature that indicates:
. . . populations of 200,000-250,000 are needed to support a hospital with the minimum range of acute services required to deal with emergency and acute patients. The literature indicates that hospitals providing the full range of regional services require even larger catchment populations (350,000-500,000) to ensure safe and effective patient care, support training and allow staff maintain expertise.
The literature referred to by the task force relates to hospital services in the UK and other EU member states as well as Australia, New Zealand, Canada and the United States. A key example includes the joint report by the British Medical Association, the Royal College of Physicians of London and the Royal College of Surgeons of England, Provision of Acute General Hospital Services, 1998. This report concludes that high-quality comprehensive medical and surgical care "requires the concentration of resources and skills into larger organisational units".
Similarly, the reports by the Department of Health, Social Services and Public Safety in Belfast and by the Scottish Executive, entitled "Developing Better Services – Modernising Hospitals" and "Future Practice", respectively, both of which were published in 2002, conclude that the specialist teams and technology required to treat acutely ill patients and those with complex conditions can only be maintained in hospitals that serve substantial numbers of patients.
A report published in 2003 by the Department of Health in London, Keeping the NHS Local – A new Direction of Travel, argues that patient choice and patient needs are powerful reasons to build configurations around patients. It states that for highly specialised services, this may lead to a tension between the convenience of care close to home and the need to access very specialised care in a more distant centre of excellence.
The report asserts that improving quality of care will always be an important factor in developing new configurations, with patient safety coming first, underpinned by research evidence and professional opinion. Noting the link between volume and outcome, it states that outcomes may equally be linked to the organisation and approach of the service. For example, outcomes for patients are greatly improved if they are admitted promptly to a hospital and receive care from a specialist multidisciplinary team.
Contrary to some recent media reports, the recommendations of Keeping the NHS Local – A New Direction of Travel correspond to the principles set out in the task force report and, in particular, to the detailed recommendations in the task force report on the kind of acute or emergency services that can safely be provided in smaller hospitals. It should be noted that Keeping the NHS Local – A New Direction of Travel defines as "smaller hospitals" hospitals we in Ireland regard as medium-sized hospitals, that is, hospitals with five or more consultant general surgeons.
