HSE Dublin and Northeast on Reconfiguration savings

Response to HSE DNE Forum on savings as a result of reconfiguration

The purpose of the North East Transformation programme is to design
and build a health system that is in line with the model of care
emerging internationally. The benefits of reconfiguration cannot be
judged solely in terms of financial savings. The enhanced patient
safety and better clinical outcomes that result from reconfiguration
must also be considered.

This is achieved by centralising acute and
complex care, so that clinical skill levels are safeguarded by
ensuring access to a sufficient throughput of cases. This was
highlighted, along with identified patient safety and quality of care
issues, in the 2006 Teamwork Report to the HSE – “Improving Safety and
Achieving Better Standards – An Action Plan for Health Services in the
North East”.

It is difficult to quantify the financial implications of
reconfiguration due to the extensive changes that have occurred in the
health economy over this period. For example, since 22nd July 2009
services have been centralised from Monaghan to Cavan, and a number of
staff have been redeployed to support the enhanced services in Cavan
General – MAU, ICU, addition ambulance personnel. There have been
marginal savings and we can state that the actual spend in Monaghan
Hospital has reduced by €8.2m between 2008 and 2011. However, it is
important to emphasise that this figure is not solely based on
reconfiguration. Other factors such as the overall reduction in
public sector salaries, the early retirement and voluntary redundancy
schemes, and savings from procurement and other cost containment
measures will have contributed to this decreased spend.

Additionally in relation to the Cavan Monahan Hospital Group there are
increased costs to support the transfer of services from Monaghan to
Cavan such as the MAU, additional impacts on laboratories, radiology,
catering and other support services as well as increased costs with
Ambulance, Primary care and costs transferred to Our Lady of Lourdes
in Drogheda as patients from the South Monaghan area are now receiving

From July 2010 services have been centralised from Louth County
Hospital Dundalk to Drogheda and a number of staff have been
redeployed to support the enhanced services in Our Lady of Lourdes
Hospital – MAU, ICU, staffing for additional beds. Much of the cost
which has come out of Dundalk has transferred to Drogheda along with
the transfer of work. Following reconfiguration Louth County Hospital
continues to play an important and expanding role in the provision of
health services in the North East region with a particular
focus on diagnostic and day services.

The following services are presently provided in Louth County Hospital:

  • Day Medical Services (The Elderly Day Assessment service has transferred from OLOL to LCH. This is a direct access service with a Consultant Geriatrician provided enabling a one stop assessment for elderly GP referrals who require access to comprehensive assessment by both Medical, Allied Health professionals and specialist nursing services).
  • Day & 5 Day Surgical Services.
  • Elective Endoscopy – LCH has been successfully selected as a candidate site for National Colorectal Screening.
  • Minor Injury Unit – This unit provides for patients presenting with less serious injuries and for those patients who do not require hospital admission. The average attendance is 19 patients daily and average turnaround time is less than 1 hour.
  • Outpatient Services including Medical, Surgical, Orthopaedic and Antenatal clinics.
  • Radiology Services including CT and Ultrasonography.
  • Laboratory Services.
  • Physiotherapy Outpatient Services.
  • Dental Day Services.
  • Gynaecology Day Services.
  • National Colposcopy Service.
  • Catering, laundry, stores, maintenance and a mortuary facility are also available.