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Health Service Executive Securing Securing clinically safe and sustainable acute hospital services: a review of acute services in HSE South and a five year action plan for Cork and Kerry Item Type Report Authors Horwath Consulting Ireland, Teamwork Management Services Publisher Horwath Consulting Ireland Limited and Teamwork Management Services Limited 2008 Download date 27/09/2021 18:46:36 Link to Item http://hdl.handle.net/10147/70013 Find this and similar works at - http://www.lenus.ie/hse Securing clinically safe and sustainable acute hospital services The next steps for Cork and Kerry Health Service Executive Securing clinically safe and sustainable acute hospital services: A review of acute services in HSE South and a five year action plan for Cork and Kerry FINAL REPORT Horwath Consulting Ireland Teamwork Management Services Marine House Top Floor, Eagley House Clanwilliam Court Deakins Park Dublin 2 Egerton, BOLTON, BL7 9RP Tel: 353 1 6760951 Tel: 44 1204 600660 Fax: 353 1 662 5105 Fax: 44 1204 600661 e-mail: [email protected] e-mail: [email protected] web: www.hbc.ie web: www.teamwork-ms.co.uk 15 May 2008 Securing clinically safe and sustainable acute hospital services The next steps for Cork and Kerry Version control: Securing clinically safe and sustainable acute Title: hospital services Horwath Consulting Ireland Limited Author: Teamwork Management Services Limited Target Audience: HSE South Project Steering Group Circulation List: HSE South Project Steering Group Circulation Status: Restricted to HSE South Project Steering Group Version: 5.7 Date of Issue: 15 May 2008 Document Status: Final Description: Final Report for HSE Board ISO Status (Document No: 22) V3.0 Document History: Date Version Author Notes Horwath / 3rd draft presented to Project Steering 04/06/07 2.3 Teamwork Group meeting on 5 June 2007 Horwath / 4th draft presented to Project Steering 09/07/07 2.9 Teamwork Group meeting on 10 July 2007 Horwath / Revised draft following Project Steering 15/08/07 3.6 Teamwork Group meeting on 10 July 2007 presented to sub-group meeting of Project Steering 15 May 2008 Securing clinically safe and sustainable acute hospital services The next steps for Cork and Kerry Group on 15 August 2007 Revised draft following sub group Horwath / meeting of on 15 August 2007 presented 04/09/07 3.9 Teamwork to a further sub-group meeting of Project Steering Group on 5 September 2007 Revised final draft for consideration at Horwath / 24/09/07 4.3 final Project Steering Group meeting on Teamwork 27 September 2007 Final Report (for final comment by sub- Horwath/ 24/10/07 4.6 group meeting of Project Steering Group Teamwork on 25 October Horwath / 01/11/07 4.8 Final Report Teamwork Horwath / Final report to incorporate comments 15/05/08 5.7 Teamwork following HSE feedback 15 May 2008 Securing clinically safe and sustainable acute hospital services The next steps for Cork and Kerry THE KEY MESSAGES.................................................. 2 A world class service for Cork City ................................................ 2 The importance of critical mass in the systematic delivery of high quality clinical outcomes....................................................... 2 The objectives of reconfiguration ................................................. 3 Implementing the Transformation ................................................. 3 Phase One – Cork City, Bantry and Mallow ................................. 4 Phase Two – Acute services in Kerry.............................................. 5 Current services need to be more efficient ................................. 5 Services in the South East of HSE South need further study ........ 5 The anticipated patient and staff benefits .................................. 6 Definitions & Abbreviations.................................... 7 The key terms................................................................................... 7 The key abbreviations .................................................................... 8 Setting the scene.................................................... 9 The transformation of healthcare delivery in Ireland .................. 9 Review of acute hospital services in HSE South ......................... 11 Review of the PCCC interface with acute care ....................... 11 Our approach ............................................................................... 12 The best practice process............................................................ 13 15 May 2008 Securing clinically safe and sustainable acute hospital services The next steps for Cork and Kerry The international trends in clinical practice ...... 14 The emerging clinical model of acute and community care .15 Impact of changes on acute hospital activity, size and workforce....................................................................................... 20 Benefits and risks in current services ................... 22 Understanding the importance of critical mass ........................ 22 The consequences of small catchment populations generating small workloads ............................................................................. 28 Hospitalisation rates ...................................................................... 41 Inadequacy of existing governance arrangements................. 42 Primary, Community and Continuing Care services ................. 44 Our overall conclusions about current services......................... 48 The optimal configuration of acute and community services in HSE South ........................ 50 Service profiling across care settings .......................................... 51 The HSE South needs two regional ‘centres of excellence’ ..... 53 The HSE South needs around ten local ‘centres of excellence’ ........................................................................................................ 54 The optimal model of care for the Cork and Kerry area .......... 54 The current acute hospital services in the South East require further study................................................................................... 65 15 May 2008 Securing clinically safe and sustainable acute hospital services The next steps for Cork and Kerry Understanding how the optimal configuration will improve services and practice ..................... 66 Optimising patient flows and activities....................................... 66 Seamless care through the clinical networks............................. 74 Delivering better care in practice............................................... 79 Dealing with the risks to successful transformation ................................................................................ 85 Implementing the transformation plan for Cork and Kerry ............................................................... 89 In relation to implementation planning, this section addresses: ........................................................................................................ 89 High level site feasibility for local ‘centres of excellence’ ........ 89 High level site feasibility for regional ‘centre of excellence’.... 92 Resourcing the plan for Cork and Kerry ..................................... 94 Managing the implementation programme ............................. 97 The benefits for patients from this new system 108 Appendix 1 – Terms of reference and Steering Group................................................................... 109 Appendix 2 – Site visits and interviews.............. 112 Appendix 3 – International best practice........ 114 15 May 2008 Securing clinically safe and sustainable acute hospital services The next steps for Cork and Kerry Moving acute care near to or at the patient’s home ............ 114 Centralising specialist acute services at regional and tertiary ‘centres of excellence’ .............................................................. 121 Infrastructure to enable healthcare delivery........................... 127 Appendix 4 – Current acute services in HSE South .............................................................................. 134 Appendix 5: PCCC Transformation Programme .............................................................................. 156 © Horwath Consulting Ireland Limited and Teamwork Management Services Limited 2008 This report contains sensitive information on clinical services at some sites. The report is produced for the purposes of the Chief Executive of the Health Service Executive and no liability or responsibility is given to any director, member or officer in their individual capacity, or to any third party. 15 May 2008 Securing clinically safe and sustainable services across HSE South THE KEY MESSAGES THE KEY MESSAGES We recognise the importance of the recent amalgamation of the two Cork City voluntary hospital providers in This independent report identifies the enabling further exploration of the optimum configuration of hospital based opportunity for the City to take the lead services for HSE South, in accordance in health developments in Ireland and with the HSE’s strategies, transformation internationally. priorities and the international trends in healthcare delivery. The importance of critical mass We address the impact of the new configuration on the interface and in the systematic delivery of high relationship between the acute hospital quality clinical outcomes and the primary, community and continuing care (PCCC) service and International evidence highlights that propose practical next steps, set out in there is a critical
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