Hospital faces downgrade

WHILE the HSE has made no decisions about hospital services in Laois from next month, a document seen by the Leinster Express could see Portlaoise hospital downgraded for good.

WHILE the HSE has made no decisions about hospital services in Laois from next month, a document seen by the Leinster Express could see Portlaoise hospital downgraded for good.

The HSE, driven by Government cuts appears to be down to two options which it is feared will have serious implications for the hospital’s future viability. The current problems are being blamed on a shortage of NCHDs (non consultant hospital doctors) at hospitals in Portlaoise, Tullamore and Mullingar. Portlaoise faces the worst problems. The hospital faces having acute surgery pulled and its A&E downgraded.

At the request of management Dr Sean O’Rourke, consultant in emergency medicine, wrote the document entitled ‘Proposed Contingency Plan for Emergency Medicine’. He has written the report due to what he says is the “impending NCHD crisis within emergency departments”. The doctor says it is assumed that the crisis “had left no alternative but to consolidate acute surgical services in the midlands”.

Option one is the “closure of Portlaoise to all acute surgical patients”. This would mean that no surgical patients being admitted to the A&E. There would be a surgical presence in the hospital and elective surgery would still be permitted. However the sting is that no junior doctors would be available to support a 24/7 Emergency Department.

The doctor presents three outcomes if surgical admissions are withdrawn from Portlaoise. He said a 24 hour A&E could be retained but the cost may be prohibitive. An 8am-8pm A&E is also considered which would see patients admitted directly to beds through their GPs out of hours. While this would allow for local treatment he says it would increase the pressures on other A&Es. The worst scenario is that Portlaoise’s A&E would become a minor injury clinic accepting no ambulances. The unit would open from 8am-8pm and GP referred medical cases would be accepted directly to the ward.

Option two would see the closure of acute surgical admissions at both Portlaoise and Mullingar hospitals. The consultant says this would be contingent on Tullamore being able to retain two doctors. If not he warns that Tullamore would also be in trouble and its A&E would have to close at night.

The doctor says there is an obligation to deliver care close to where people live but it must be safe and of the highest quality. He says hospitals without surgical services cannot receive trauma patients. He warns that it is “unsafe” to rely on locum doctors but funding is also an issue.

Dr O’Rourke concludes that the reorganisation of services in the midlands will have a significant impact on the delivery of care in the emergency departments. It assumes that Tulllamore will have enough NCHDs on July 11.