Ms Colette Cowan:

I thank the Chairman and committee members for the invitation to attend today. I am joined by my colleague, Mr. Paul Burke, chief clinical director of UL Hospitals Group. I will confine my opening remarks to the following themes: positives of groups; governance and organisational reform; vision; the integrated model of care; quality and safety; and the future of health.

UL Hospitals Group was one of the only two hospital groups to be put in place with a functioning board. We support the concept of a network of hospitals working together as one virtual delivery model for the population of the mid-west, an arrangement that has worked with increasing success. We have robust governance structures and a defined policy on safe care in the correct settings, underpinned by the smaller hospitals framework. We also have close and strong links with the University of Limerick driving medical, nursing and health and social care education as well as a fertile research agenda which will be further enhanced by our new clinical education research centre on the University Hospital Limerick site.

For four years we have worked closely with our board which has brought valuable and enthusiastic expertise, oversight, vision and advice on the UL hospitals development and plans. We are coterminous with our community health organisation, CHO, and engage continually with the CHO to improve patient care and outcomes. The fact that the geographical area covered by the CHO and UL Hospitals Group is identical provides an ideal basis for implementing policy and procedure.

The future of health care requires a governance model and leadership approach to deliver collectively on organisational reform. The fundamental question in the hospital service is the optimal numbers and configuration required to develop an efficient and effective service. The smaller hospitals framework has clearly defined model 2 services, but model 3 hospitals would benefit from a similar framework to ensure the range of services for acutely presenting patients is defined and supported.

The governance structure at UL Hospitals Group is unique and is based on a small management team in four directorates responsible for all sites rather than hospital specific managers. This single clinical governance across all sites is key to providing operational expertise and guidance on service delivery and has been shown to be highly satisfactory in terms of increasing efficiency, improving services to individual patients and reducing delays. Performance measured against quality, access, finance and resources is driven via directorate structures managing vertically across six sites. Our structure fits neatly with the Department of Health and the HSE’s accountability framework.

Our vision for future health is articulated in our submission paper but I will outline some priority areas now. We must define funding models to develop CHO areas to create hospital avoidance strategies because community delivered care is more beneficial to patients who do not require expensive hi-tech, high speciality hospital settings.

We must extend clinical care programmes and tight communication systems to include formal dialogue with general practitioners, GPs, on opportunities and protocols. We must progress the commissioner provider model and base decisions on service delivery relating to demographics and population health. We must continue to increase IT funding to address the gap currently in the HSE service. We must also establish bed capacity to inform ten year development plans.

The hub and spoke structure of the UL hospitals network, along with an identical catchment area for community health services, means that the UL Hospitals Group is in a unique position to provide an integrated model of care between our acute service and the community. That parallels the continual improvement of our specialist and emergency services at our model 4 hospital, University Hospital Limerick, UHL.

Clearly, the relationship with GPs is critical in determining how this integrated model of care continues to develop. We believe our model 2 hospitals in Limerick city, Ennis and Nenagh must provide support to our GPs at a local level, while helping to avoid admissions to UHL for less complex conditions. Increasing professional dialogue and communications with our GPs are among our top priorities. We are trying to ensure that GPs would have easy access to diagnostics and specialist outpatient department, OPD, services in the local hospital, which would link closely with the specialist supports in the community. In this co-ordinated way, people can receive the care they need in the most appropriate place, be it at home, in the community, at the local model 2 hospital and, hopefully, less often at the model 4 hospital. This is consistent with the HSE’s policy on prevention and management of chronic disease within an integrated care programme.

In using this local model, we are not only avoiding prolonged travel and access difficulties to our larger hospital but we are also reducing the burden on relatives and others, entrusted with the care of elderly patients. This model has huge social and economic benefits to the community. Additional medical specialty development at UHL in areas such as dermatology, rheumatology and neurology has meant more of these services being provided at the local hospitals, something that many would not have envisaged ten years ago.

Quality and safety was the driving force behind the centralisation of acute surgery, critical care and cardiology services six years ago, and all our clinical data is now processed through NOCA, the National Office of Clinical Audit. Our model of care for acute surgery was one of the first recommended by the national clinical programmes. Our cardiology service provides one sixth of the national PCI service for acute heart attack and we are also providing an acute stroke service through a newly built stroke unit, developed incidentally with the support of a number of voluntary agencies in the region.

Looking to the future, we envisage that with centralisation of our maternity services onto the main university hospital campus and with our favourable road infrastructure the UL Hospitals Group is likely to find itself serving more of the surrounding north Munster region. We undoubtedly need urgent expansion of our hospital bed capacity to cope not only with current demand, but with the change in hospital demographics that will inevitably evolve in the surrounding regions over the next decade

Our close relationship with the University of Limerick is of huge importance in improving standards of care, fostering education, clinical research and innovation so that the hospital complex is rapidly developing to become a major national centre for high quality as well as a major educational resource for the people of the region that we serve. That concludes my opening statement.