Review of Acute Hospital Services in HSE Mid-West An action plan for acute and community services Health Service Executive Review of Acute Hospital Services in HSE Mid-West An action plan for acute and community health services Horwath Consulting Ireland Teamwork Management Services Marine House Top Floor, Eagley House Clanwilliam Court Deakins Park Dublin 2 Egerton, BOLTON, BL7 9RP IRELAND UNITED KINGDOM Tel: +353 (0)1 6760951 Tel: +44 (0)1204 600660 Fax: +353 (0)1 662 5105 Fax: +44 (0)1204 600661 e-mail: [email protected] e-mail: [email protected] web: www.hbc.ie web: www.teamwork-ms.co.uk April 2008 HSE Mid-West Acute Hospital Services Review Review of Acute Hospital Services in HSE Mid-West An action plan for acute and community services Abbreviations used in this report ................................................1 Key messages............................................................................2 Setting the scene........................................................................7 The HSE approach.................................................................................................. 7 Review of acute hospital services in the Mid-West.................................................. 9 Review of PCCC and its interface with acute care .................................................. 9 Understanding the new clinical model of care..........................11 The global nature of the drivers for change........................................................... 11 What is ‘International Best Practice’? .................................................................... 12 The emerging clinical model of care in Ireland ...................................................... 12 The assumptions................................................................................................... 17 The ‘gap’ between today’s acute services and the emerging future model..............................................................................21 Patient benefits in the current acute service configuration .................................... 22 The current system for acute services generates substantial risks to patients and staff ....................................................................................................................... 23 General medicine .................................................................................................. 25 General surgery..................................................................................................... 27 Adult critical care................................................................................................... 31 April 2008 HSE Mid-West Acute Hospital Services Review Review of Acute Hospital Services in HSE Mid-West An action plan for acute and community services Accident & Emergency .......................................................................................... 33 Other specialty services ........................................................................................ 37 Clinical Governance .............................................................................................. 39 Developing safe, sustainable high quality acute and community services in the Mid-West ..........................................................41 Integrating PCCC services with the acute services............................................... 42 The Mid-West needs 3 local ‘centres of excellence’.............................................. 48 The Mid-West needs one regional ‘centre of excellence’ for acute care ............... 54 Understanding the impact of the new clinical model of acute care upon service capacities and configuration.................................................................................. 59 Understanding the functions of the clinical networks............................................. 60 Understanding how the model works in practice for patients ................................ 65 Developing the implementation plan ........................................70 Pre-conditions to delivering service reconfiguration .............................................. 70 Managing the implementation programme ............................................................ 72 Using best practice standards for clinical change management............................ 74 The implementation plan: details and timescales.................................................. 75 Resourcing the implementation plan ..................................................................... 83 The benefits for patients from this new system ........................86 For local (non-acute) care: .................................................................................... 86 For regional (acute) care: ...................................................................................... 87 Appendix 1 – Terms of Reference and Steering Group ...........88 April 2008 HSE Mid-West Acute Hospital Services Review Review of Acute Hospital Services in HSE Mid-West An action plan for acute and community services Appendix 2 – Site visits and interviews ....................................91 Appendix 3 – Documents provided ..........................................92 Appendix 4 – Current service delivery in the Mid-West............94 Resident population............................................................................................... 94 Health needs of the population.............................................................................. 95 Overview of local service profile............................................................................ 96 Current service delivery......................................................................................... 98 Primary, community and continuing care .............................................................106 Findings................................................................................................................107 Current governance arrangements for hospitals ..................................................107 Appendix 5 – The latest international best practice................109 Moving acute care near to or at the patient’s home..............................................109 Future clinical model of care ................................................................................110 Patient self care....................................................................................................110 The patient at home .............................................................................................111 The patient at the local ‘centre of excellence’.......................................................112 Key role of primary, community and social care in delivering care at or close to home ....................................................................................................................115 Centralising specialist acute services...................................................................116 Infrastructure to enable healthcare delivery .........................................................122 Clinical networks ..................................................................................................123 Assured quality.....................................................................................................127 April 2008 HSE Mid-West Acute Hospital Services Review Review of Acute Hospital Services in HSE Mid-West An action plan for acute and community services Tele-medicine.......................................................................................................128 Information, communication & technology............................................................129 Appendix 6 - Modelling assumptions......................................131 © Horwath Consulting Ireland Limited and Teamwork Management Services Limited 2008 This report has 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. April 2008 HSE Mid-West Acute Hospital Services Review Review of acute hospital services in HSE Mid-West An action plan for acute and community services Abbreviations used in this report A&E Accident & Emergency ALoS Average Length of Stay AMP Advanced Midwife Practitioner ANP Advanced Nurse Practitioner AP Advanced Paramedic CCU Coronary Care Unit CH Community Hospital CIT Community Intervention Team CMS Clinical Midwife Specialist CNS Clinical Nurse Specialist CNU Community Nursing Unit DRG Diagnostic-Related Group EL Elective inpatient activity GP General Practitioner HAI Healthcare Associated Infections HIPE Hospital In-Patient Enquiry HIQA Health Information and Quality Authority HSE Health Service Executive ITU Intensive Therapy Unit LHO Local Health Office LIMS Laboratory Information Management System NCHD Non-consultant Hospital Doctor NE Non-Elective inpatient activity NHO National Hospitals Office OT Occupational Therapy PACS Picture Archiving and Communication System PCCC Primary, Community & Continuing Care PCN Primary Care Network PCT Primary Care Team PHN Public Health Nurse PSCN Primary and Social Care Network UCC Urgent Care Centre UL University of Limerick Wte Whole Time Equivalent 1 Review of acute hospital services in HSE Mid-West An action plan for acute and community services Key messages The Health