THE long-awaited and controversial review of small hospitals, which will centralise certain acute emergency services across the State, is supposedly in the best interests of "delivering a safer health service".
In summary, it is proposed that up to nine hospitals across the Republic will permanently lose their emergency departments and intensive care units. Some locations, such as Roscommon and Ennis, have already been downgraded. Others, like Navan and Loughlinstown, are targeted for similar treatment in the future.
As exercises in spin and public relations go, this document is truly world-class. Even the proposed title – 'Securing The Future Of Smaller Hospitals: A Framework For Development' – gives the misleading impression that closing an A&E is an act of generosity, kindness and progress.
I am afraid the truth is somewhat different. I believe our current health infrastructure cannot cope with these proposals. In my opinion, to implement this plan, without the construction of new hospital facilities across Ireland, would be madness.
As a medical professional, I am well aware that in some cases centralised expertise does lead to better outcomes. Major trauma, complex surgery and specialist cancer care are good examples of this.
However, the vast majority of people who attend smaller hospitals are not suffering from diseases that require 'centres of excellence'. In reality, they are typically middle-aged and elderly people with common illnesses, such as pneumonia and other infections.
These patients need to be admitted to a bed on a clean hospital ward, to be treated with intravenous medication and to have appropriate 24-hour medical and nursing supervision with immediate access to an intensive care unit should their condition deteriorate.
As I write, these services are being provided across the State, by small hospitals, to a very high standard. Despite years of effort, the HSE has never once provided any compelling evidence to suggest that the care administered to these typical patients in these facilities is in any way inferior to that provided in major urban centres.
The reason for this is simple – no such evidence exists. Indeed, given that smaller hospitals suffer far less overcrowding and associated infection risk than their larger urban counterparts, it could easily be argued that most patients will actually enjoy better outcomes locally than on a trolley 40 miles away.
Naturally, these inconvenient facts are completely ignored by some of those promoting widespread downgrading. Thus, they cleverly move the goalposts by referencing patients who are 'complex cases' and then use such unusual clinical scenarios to justify the closure of a rural emergency department.
The sheer cynicism of this approach is truly breathtaking.
Worse still, I am afraid it is eagerly lapped up by the majority of Dublin-based media and medical commentators, many of whom have no experience of working or living in rural Ireland.
Local hospital campaigners are therefore outrageously portrayed as ignorant rednecks, more interested in preserving local jobs than in 'patient safety'.
MEANWHILE, in a disturbing development, the organisation that is the official 'watchdog' over our health service – 'the Health Information and Quality Authority' – appears to be supporting this downgrading agenda.
Thanks to this apparent 'a la carte' approach to patient safety, coupled with the sterling efforts of the HSE spin department, any objection to the closure of a rural emergency department is loftily dismissed as 'parish-pump politics'.
The current situation is not ideal. But the harsh reality is that for now, Ireland needs its small hospitals, backed up with intensive care units and 24-hour acute medical support.
Until new regional 'centres of excellence' are constructed, any downgrading would quite simply be dangerous, as the necessary additional acute bed capacity does not exist.
In conclusion, although it has some positive aspects, I fear the 'Small Hospital Review' is not in the best interests of patients or their safety. I believe it must be rejected.
Dr Ruairi Hanley is a GP and a medical columnist