Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

The Government’s decision to establish hospital groups, where small and larger hospitals work together, was informed by two reports, the hospital groups report and the smaller hospitals framework.The hospital groups will provide an optimal configuration of services, with benefits relating to safety, quality, access and cost. Every hospital, large and small, will play a vital role in their group.

The smaller hospitals framework defines the role of the smaller hospitals and outlines the need for smaller hospitals and larger hospitals to operate in partnership as a single hospital group. It also defines the need for the smaller hospital to be supported within the group in terms of education and training, continuous professional development, recruitment of high quality clinical staff and safe management of deteriorating and complex patients.

The framework outlines in detail the wide range of services that can be provided in smaller hospitals, the services that can be transferred from larger to smaller hospitals and commits to the expansion of less complex services in these hospitals, such as day surgery, ambulatory care, minor injury units, medical assessment units, screening, other medical services and diagnostics. It is envisaged that smaller hospitals will provide more, rather than fewer, services, with more flexibility so that patients are the ultimate beneficiary of the reforms.

The initial focus is on getting the hospital groups up and running as single cohesive entities. In 2015, each hospital group will be asked to develop a strategic plan to describe how they will provide more efficient and effective patient services, reorganise these services to provide optimal care to the populations they serve and how they will achieve maximum integration with other groups and all other health services, particularly primary care and community care services. Alongside the work done at hospital group level, work will be done at a national level on the best configuration for certain national specialties.

Small hospitals have a bright and busy future providing a wide range of existing and new services, but it will not be possible for every hospital to be a centre of excellence or specialist centre for everything. We need to be honest with people about that. Separately, I foresee many services moving out of hospitals and into primary care in line with clinical programmes strategy.

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