Report queries need for new kids' hospital

A Department of Finance report has questioned the need to build a new children's hospital at the Mater site in Dublin.

The report says the rationale for the continued development of the children's hospital and some other major planned hospital building projects is unclear.

The document also stresses that alternative community services must be up and running and working before existing hospital services are discontinued as part of the hospital reorganisation process.

The report, by the Department's Health Vote Units, Sectoral Policy Division, was submitted to An Bord Snip, and many of its recommendations were adopted in some shape or form in the controversial public service cutbacks report.

The Bord Snip report, however, published in July, did not make any specific recommendations on cancelling or postponing the children's hospital development.

However, the Department of Finance report lists four major planned developments and queries whether they are necessary.

These are: the redevelopment of the main Mater Hospital, the new national children's hospital, also at the Mater, a new National Rehabilitation Hospital and the North East regional hospital in Navan.

While plans for the new north-east hospital have recently been long-fingered due to the current economic crisis, planning on the children's hospital development has been continuing.

The development, which has been surrounded in controversy over its site location, had been costed at €800 million and is due to be completed around 2014-15.

The Department of Finance report states that the rationale for the continued development of the four projects is unclear given:

* The delays to date in progressing them.

* The PA consulting report conclusion that there are already sufficient acute beds in the system.

* The reduction in HSE capital allocation to reflect the new economic reality.

* The fact that the provision of step-down community nursing beds, primary care team facilities and medical assessment units are an essential prerequisite to breaking the logjam in acute hospitals and the delivery of integrated care.

The report also states there are substantial unmet needs in the health system with regard to emergency department developments, new facilities for primary care teams and residential care beds for the elderly.

The submission points out that there were (at the time of writing the document) 100 primary care teams (PCTs) in operation, which was one-fifth of the original target set for 2011. The development of these teams is designed to take pressure off and provide alternative care to the hard-pressed hospital service.

The Finance report says the delivery of PCTs and health and social care networks is essential to the delivery of integrated healthcare and is an essential prerequisite to freeing up resources in the hospital sector.

It says primary care and the delivery of care in the community are generally regarded as more cost-effective and efficient than having people with non-urgent medical needs clogging up A&Es and occupying expensive beds.

"It is considered, therefore, that it would be a false economy to seek to make savings on the roll-out of PCTs."

The report says the focus here should be on the optimum configuration of services to make the best use of available resources in developing the service.

It stresses that alternative primary and community services must, at a minimum, be put in place and be seen to be working before existing hospital services are discontinued.

It notes that with the exception of cancer services, the progress of reconfiguration of hospital services has been slow.

The Department of Finance report also propses changes in medical card eligibility similar to those proposed by Bord Snip and also proposes a charge for medical card presctiptions, also proposed in the Snip report.

The Finance submission, however, proposes 4,000 job cuts in the health sector, while Bord Snip proposed 6,000 job cuts.

On the National Tretment Purchase Fund (NTPF), the Finance report says there are concerns that the system
is an expensive way of purchasing procedures privately that could or should be delivered by better use of public system capacity.

It points out that the same consultant whose public patients have failed to obtain treatment in the public system is now likely to be providing that treatment for a fee in the private system.

View the full report here

[Posted: Mon 07/09/2009]