Dáil Éireann Debate, Tuesday - 22 June 2004
91 Mr. Gilmore asked the Minister for Health and Children if he has received the response to the Hanly report from the Ennis General Hospital Development Committee; his views on its recommendations; and if he will make a statement on the matter. [18362/04]
View answerI have examined the report commissioned by Ennis General Hospital Development Committee in response to the Hanly report. I am pleased that it supports a substantial number of the Hanly proposals and that it acknowledges that the report should not be rejected out of hand. This is in marked contrast to some of the comments offered about the report from other quarters.
However, the report reaches some incorrect conclusions regarding the implications of the Hanly report for the future of Ennis General Hospital. For example, it compares staffing ratios and costs per case between Ennis General Hospital and other hospitals without taking account of differences in case complexity between smaller and larger hospitals. Comparisons of costs and staffing levels are meaningless unless the relative complexity and intensity of patients' treatment needs are taken into account. It is not possible to reach valid conclusions about the relative efficiency of hospitals without this information.
The report incorrectly assumes all acute beds in Ennis would be closed and transferred to Limerick. The Hanly report does not propose the closure of any beds in local hospitals. Its recommendations are based on the provision of an additional 3,000 acute hospital beds as envisaged in the health strategy.
The report also appears to expect that all accident and emergency cases currently seen in Ennis will be transferred to Limerick, with the effective complete closure of accident and emergency in the smaller hospitals. This incorrect assumption leads to a projected 35% increase in Limerick's accident and emergency numbers. In fact, the Hanly report argues that the major hospital should treat the most serious accident and emergency cases, namely, those requiring multi-specialist care. The great majority of current accident and emergency work would continue to be provided in hospitals such as Ennis.
The report commissioned for the hospital committee analyses journey times to hospital in the context of the "golden hour". Unfortunately it seems to take no account of the approach set out in the Hanly report, which argues that the critical issue is speedy access to emergency treatment at the scene by first responders, such as trained ambulance personnel or general practitioners. This should be followed by rapid transfer to a hospital most able to meet their needs. The critical issue, therefore, is not journey time to the nearest hospital, but speed of access by trained personnel with onward transfer to the hospital most able to deal with serious cases. The critique later argues that reliance on ambulances would leave remote areas more vulnerable where an ambulance has been called away from that region; however this depends on the number of ambulances available and their positioning within the region.
Finally, the critique points to a "population explosion" brought about by tourism in the summer months in the west Clare region. Any additional workload for accident and emergency services brought about by this increase is already reflected in the accident and emergency activity recorded in Ennis General Hospital. It was therefore taken into account by the Hanly group when framing its recommendations.
Overall, I welcome the work commissioned by the Ennis General Hospital Development Committee in analysing the Hanly report. I am pleased it is very supportive of many aspects of the Hanly report but its key criticisms are based on a series of incorrect assumptions which need to be challenged.
