Minister Announces Hospital Groups and Publishes The Framework for Smaller Hospitals

14th May, 2013

The Minister for Health, Dr. James Reilly TD today (Tuesday, 14 May, 2013) announced a reorganisation of public hospitals into more efficient and accountable hospital groups that will deliver improved outcomes for patients.  This represents the most fundamental reform of the Irish acute hospital system in decades.

The Government’s decision regarding the establishment and operation of the new hospital groups was informed by two reports – ‘The Establishment of Hospital Groups as a Transition to Independent Hospital Trusts’, produced by an expert group led by Professor John Higgins following consultation with stakeholders, and ‘The Framework for Development – Securing the Future of Smaller Hospitals’.  Both reports were published today.  These reports fulfil important commitments in Future Health, the strategic framework for reform of the health service which was published last November.

Hospital Groups
By working in groups, hospital services will be provided by the hospitals in each group, based on the evidence based needs of their populations.  Each group of hospitals will work together as single cohesive entities managed as one, to provide acute care for patients in their area, integrating with community and primary care.  This will maximise the amount of care delivered locally, whilst ensuring complex care is safely provided in larger hospitals. Six hospital groups will be established as follows:
·        Dublin North East;
·        Dublin Midlands;
·        Dublin East;
·        South/South West;
·        West/North West;
·        Midwest.

Each group will comprise between six and eleven hospitals and will include at least one major teaching hospital.  Each grouping will also include a primary academic partner in order to stimulate a culture of learning and openness to change within the hospital group.  Robust governance and management structures will be put in place at group level.

Benefits for Patients
The objectives of the groups are to:
·        achieve the highest standard of quality and uniformity in hospital care across the group;
·        deliver cost effective hospital care in a timely and sustainable manner;
·        encourage and support clinical and managerial leaders;
·        ensure high standards of governance, both clinical and corporate and recruit and retain high quality nurses, NCHDs, consultants, allied health professionals and administrators in all our hospitals.

The introduction of groups will provide for organisational change in the first instance, giving more autonomy and better enabling the reorganisation of services in a well-planned manner.  Over time, this will help to improve services and deliver better outcomes for patients.

Speaking at the launch, Minister Reilly said: “The establishment of hospital groups signals a fundamental modernisation of our health system organisation in line with best international practice.  The new hospital groups, each with their own governance and management, have been designed so as to provide the optimal configuration for hospitals to deliver high-quality, safe patient care which is cost effective and guarantees better outcomes for patients.”

Framework for Smaller Hospitals
The Framework for Smaller Hospitals outlines the need for smaller hospitals and larger hospitals to operate together and is therefore intrinsically linked to the formation of sustainable hospital groups.  Better co-operation between hospitals will help to maximise the amount of care delivered locally.

Speaking on this issue, the Minister said:  “Hospital groups will secure the future of our smaller hospitals.  When the new groups are established, services can be exchanged between sites.  This will result in the maintenance of activity in smaller hospitals and will allow them to focus on the provision of care that is safe and appropriate”.

Next Steps – Implementation
To complement implementation of the Report’s recommendations, the Department of Health will now put in place an overarching policy framework to guide overall hospital services  reorganisation from a national standpoint.  Work on the roll-out of hospital groups will commence immediately and will be overseen by a National Strategic Advisory Group and driven by the HSE.  Group Chairpersons and CEOs will be appointed as soon as possible and preliminary governance arrangements will be put in place.

Initially the groups will be established on a non-statutory administrative basis.  Each group must develop a strategic plan for their future service configuration in the first year of their operation.  These plans must describe how they will provide more efficient and effective patient services; how they will reorganise these services to provide optimal care to the populations they serve; and how they will achieve maximum integration and synergy with other groups and all other health services, particularly primary care and community care services.

Following a rigorous evaluation of each group to ensure it is fit for purpose to function as a Hospital Trust, legislation will be put in place in 2015 to enable Independent Hospital Trusts to be established, taking account of any changes to groups which may emerge from the review process.

The Minister said: “I am very pleased that Professor Higgins has agreed to stay on until the end of June to work on the initial implementation phase in the establishment of the groups.  He will return to his work in Cork but will continue to play a part in overseeing implementation as a member of the National Strategic Advisory Group.  Today represents a major milestone in the Government’s health reform programme.  I would like to thank Professor Higgins, the Strategic Board and the Project Team as well as those who participated in consultations.  I look forward to working with all of the stakeholders to implement hospital groups so that we can deliver the best possible service for patients.”

Professor Higgins said: “We have a wonderful opportunity to make a step change within the Irish hospital system.  We need to draw down the enthusiasm, the expertise and the experience of our all our staff.  Working together we can deliver real change.”

Tony O’Brien, HSE Director General Designate said: “Today’s announcement is the most significant development in the organisation of our hospital services since the development of the cancer centres.  This is an ambitious and well considered step towards ensuring that Ireland has a high quality, well organised and cost effective framework for the provision of acute hospital services to meet the changing needs of our population.  Today marks the beginning of a journey towards a new way of governing and organising our hospital services and the HSE is committed to ensuring that this transition is managed as effectively, safely and swiftly as possible.  The HSE will ensure the greatest degree of support is provided to each of the hospitals within the planned groups to ensure that they can each participate in the development of appropriate shared governance arrangements which will maximise the benefit to the communities that they serve.  I look forward to supporting these hospital groups as they become established on an administrative basis on their journey towards full trust status.”


Report on Hospital Groups and Consultation with Stakeholders
The proposals on hospital groups are based on the recommendations of a report on the subject, produced by a panel of national and international experts led by Professor John Higgins.  The report was informed by consultation with: management and senior clinicians from hospitals; patient advocates; health agencies; and the clinical programmes among others.  Detailed data analysis also informed the report recommendations.

Number and Composition of Hospital Groups No.  Recommended Composition of Hospital Groups
i  Dublin North East: Beaumont Hospital; Our Lady of Lourdes Hospital, Drogheda;  Connolly Hospital; Cavan General Hospital; Rotunda Hospital; Louth County Hospital; Monaghan Hospital. (Academic Partner: RCSI).
ii  Dublin Midlands: St James’s Hospital; The Adelaide & Meath Hospital, Dublin, including the National Children’s Hospital; Midlands Regional Hospital, Tullamore; Naas General Hospital; Midlands Regional Hospital Portlaoise; the Coombe Women & Infant University Hospital. (Academic Partner: TCD).
iii  Dublin East:  Mater Misericordiae University Hospital; St Vincent’s University Hospital; Midland Regional Hospital Mullingar; St Luke’s General Hospital, Kilkenny; Wexford General Hospital; National Maternity Hospital; Our Lady’s Hospital, Navan; St Columcille’s Hospital; St Michael’s Hospital, Dun Laoghaire; Cappagh National Orthopaedic Hospital; Royal Victoria Eye and Ear Hospital. (Academic Partner: UCD).
iv  South/South West: Cork University Hospital/CUMH; Waterford Regional Hospital; Kerry General Hospital; Mercy University Hospital; South Tipperary General Hospital; South Infirmary Victoria University Hospital; Bantry General Hospital; Mallow General Hospital, Lourdes Orthopaedic Hospital, Kilcreene. (Academic Partner: UCC).
v  West/North West: University Hospital Galway and Merlin Park University Hospital; Sligo Regional Hospital; Letterkenny General Hospital; Mayo General Hospital; Portiuncula Hospital; Roscommon County Hospital.  (Academic Partner: NUIG).
vi  Midwest: Mid-Western Regional Hospital, Limerick; Ennis General Hospital; Nenagh General Hospital; St John’s Hospital Limerick; Mid-Western Regional Maternity Hospital; Mid- Western Regional Orthopaedic.  (Academic Partner: UL).
Note: The acute paediatric services in Dublin; Our Lady’s Children’s Hospital – Crumlin, Children’s University Hospital Temple Street, and the paediatric service in AMNCH – Tallaght should also function as a single cohesive entity with appropriate governance arrangements (in line with hospital group proposals).
National Strategic Advisory Group
The National Strategic Advisory Group will provide guidance and on-going direction in relation to implementation of both the Hospital Groups Report and the Smaller Hospitals Framework.  It will also provide a forum to resolve issues and assist in the development of specific implementation guidelines on the steps required for full implementation.

Governance and Management of Hospital Groups
The Hospital Group Report makes recommendations in relation to governance, key leadership posts within the management teams, and key management functions of hospital groups.

Each hospital will be established on an administrative basis during an interim period.  The hospital groups will each establish an interim group board to which the management team will report.  The Chair of the interim board will be appointed by the Minister.  The Chair will then nominate the board membership for Ministerial approval.  The interim group board will comprise the necessary skills, competencies and experience to enable them to contribute to and challenge the performance of the hospital group.  This experience and expertise will include clinical, business, social, legal, medical academic and patient advocacy.

Each of the groups will be led by a group Chief Executive Officer who will be the accountable officer for the group.  The requirement for individual hospital management teams will be determined by the size of the hospital and the range of services provided at each site.  However, the management teams of hospital groups must comprise the following key posts: Group Chief Executive Officer; Chief Clinical Director; Chief Academic Officer; Chief Director of Nursing; Chief Finance Officer; and Chief Operations Officer.