A seismic change is underway in the structures of Dublin voluntary hospitals, with moves to establish Academic Health Centres (AHCs), new groupings and mergers between voluntary hospitals themselves and between voluntary hospitals and HSE hospitals in Dublin and in the wider eastern area.
This will be the first major re-structuring of Dublin hospitals for over 30 years and can be expected to have very far reaching effects. There are a number of drivers which include:
- The establishment of Academic Health Centres, including in some cases operational mergers
- The economic climate
- For some Catholic voluntary hospitals, the desire to preserve the voluntary ethos following the departure of the religious orders.
It can be expected to be fuelled by the moratorium on new appointments in the health services which means that a number of top management posts, vacated by the recent exit packages, can only now be filled on an acting basis. There is also a growing belief that, following the poor take up at the end of last year, yet another exit package will be offered sooner rather than later to health service staff.
Many senior health managers are split in their views on the planned changes, those who support it point to the efficiencies and savings which can be expected and the likelihood that, if they don’t move in this direction voluntarily, they will be pushed there by the State. On the other hand, many are concerned about the loss of identity, the loss of the voluntary ethos and concerns about the size of the new hospital centres. Big, they say, is not always beautiful.
There is also very real concern to ensure that, with a view to recruiting clinical staff into management, all management staff in any new arrangements would have appropriate management training and skills.
Following the departure of the religious orders, many hospitals such as the Mater and St. Vincent’s in Elm Park have formed limited companies and it is known that the National Rehabilitation Hospital in Dun Laoghaire and St. Vincent’s Hospital in Fairview are also considering going down this road. There are fears that the HSE could be in a position to put a lien on hospitals where it funds their capital programmes. It is understood that they wanted the site for the new paediatric hospital in the Mater to be turned over unencumbered.
There is little doubt that the process may well be expedited by the recent exit package for health service staff and the Department of Finance moratorium on the appointment of new staff to replace those who have left. This means that CEOs who have left the health service either through the Voluntary Early Retirement Scheme or the Voluntary Redundancy Scheme cannot be replaced. These include Aidan Gleeson, CEO of Cappagh National Orthopaedic Hospital, Dublin, Pat Smyth, CEO of Leopardstown Park Hospital, Dublin, Phil Shovlin, CEO of the Children’s University Hospital, Temple Street, Dublin and Teresa Ayres, CEO of the Incorporated Orthopaedic Hospital in Clontarf. These hospitals are now being run by Acting CEOs.
Moves are already under way on the north side of Dublin to establish two new groupings. One involves the Mater Hospital, the Children’s University Hospital, Temple Street, and Cappagh National Orthopaedic Hospital, all of which could eventually merge under one management. The second involves Beaumont Hospital, Connolly Hospital in Blanchardstown and possibly Our Lady of Lourdes Hospital in Drogheda.
These groupings would be facilitated by the fact that the Mater, Temple Street and Cappagh are now limited liability companies. Beaumont Hospital is established under the Health (Corporate Bodies) Act, 1961 and the Minister appoints its Board. Connolly and Our Lady of Lourdes Hospitals are both run by the HSE. Beaumont and Connolly Hospitals and the Royal College of Surgeons in Ireland are the initial partners in an Academic Health Centre which includes an operational merger of the hospitals as a component of the AHC. Other potential partners, both academic and service based, can be considered as part of the ongoing development of this AHC.
Academic Health Centres (also called Academic Medical Centres) comprise the three functions of research, education and clinical care and seek to integrate these to optimise patient care. They look to prioritise patient care across hospital and community settings within a research-intensive learning environment, guaranteeing improved outcomes and meeting the needs of the population they serve.
Different approaches are being taken by organisations in relation to progressing changes. Some initially envisage that the administrative functions such as finance, HR and risk management could be merged on one site and then that shared rosters could be introduced and other services merged. It is known that the Mater, Temple Street and St. Vincent’s Hospital in Fairview are already discussing shared medical rosters and of course most of the consultant orthopaedic appointments in the Mater and Cappagh are already joint appointments between the two hospitals.
At this stage, it seems likely that each of the hospitals would continue to maintain their own Boards and services on their existing sites.
The HSE would obviously like to provide these shared services to the voluntary hospitals but it is more likely that the voluntary hospitals will provide these shared services.
On the south side, St. Vincent’s University Hospital, St. Michael’s Hospital and Loughlinstown Hospital would make a natural grouping and, of course, St. Vincent’s and the Mater are in the process of establishing an Academic Medical Centre with University College, Dublin.
Some of the services of St. Luke’s Hospital are being transferred to St. James’s Hospital and Beaumont Hospital. The future of the maternity hospitals seems to be up in the air. An independent Review of Maternity and Gynaecology Services in the Greater Dublin Area by KPMG in 2008 recommended co-locating the three Dublin maternity hospitals on the site of large acute general hospitals, in keeping with international best practice. The report recommended moving the Rotunda Hospital to the Mater site, the Coombe Women’s and Infants’ University Hospital to AMNCH in Tallaght, and the National Maternity Hospital in Holles Street to St Vincent’s University Hospital, in Elm Park. However, the economic situation makes it unlikely this will happen in the short term.
The last major rationalisation of the Dublin hospitals started in the 70s and resulted in a significant reduction in the number of voluntary hospitals, with the closure of Dr. Steevens’ Hospital, Sir Patrick Dun’s Hospital, Mercer’s Hospital and the Royal City of Dublin Hospital, Baggot Street, the transfer of the Meath, Adelaide and the National Children’s Hospital in Harcourt Street to AMNCH, Tallaght and the transfer of St. Laurence’s and Jervis Street Hospitals to Beaumont.
