Portlaoise hospital protest in 2017.
The options considered by Dublin Midlands Hospital Group CEO Dr Susan O'Reilly and her advisory team were:
1 Sustaining the Midlands Regional Hospital Portlaoise as a Model 3 acute general hospital.
2 Continuation of 24/7 obstetrics and paediatrics in a Model 2 acute general hospital.
3 Coversion to Model 2 hospital necessitating relocation of acute paediatric services and obstetrical deliveries to other hospitals in the region.
The consensus view for all National Clinical Programme Leaders is that the Midland Regional Hospital Portlaoise will become a Model 2 hospital.
Model 2 hospitals deliver ambulatory (outpatients) care, which includes chronic disease management and day surgery, diagnostics and rehab.
There will be a 12/7 GP referral Medical Assessment Unit with the 'intent' to progress to a 24/7 service and a 12/7 local injuries unit. The focus will be on developing integrated care with GP and Community Health.
The plan outlines an end to 24/7 Emergency Department (ED A&E).
Emergency Department to be transferred to other Dublin Midlands Hospital Group hospitals and that all ambulance calls be triaged to the the most appropriate setting.
This cut will be contingent on developing the Medical Assessment and Local Injury Units.
All maternity deliveries and neonatal services will be delivered by the Coombe Women and Infants Hospital in Dublin or nearest unit. This would be subject to substantial theatre and delivery capacity development at the Coombe. Outpatient care will still be provided in Portlaoise.
As for children the report says paediatric emergency and inpatient services cannot be safely provided in a Model 2 hospital. So, when Portlaoise is downgraded, all patients aged 5 or older will be seen at the the Midland Regional Hospital Tullamore except for patients aged five years or older who will attend the local injuries unit.
A new Paediatric Emergency Department will be established in Tullamore. The Offaly hospital will also provide both urgent and elective paediatric mdicine and surgery services.
Anesthetics in Portlaoise will be refocused on day-case elective surgery which will go up in volume once phase two has been developed and implemented.
As for ICU and critical care, the report says that the very low volume at Portlaoise is not sustainable and will be discontinued. If a patient needs critical care, he or she will be stablised and transferred according to the plan.
In surgery, the plan finds that there is a low volume and low complexity of cases at present. It says it would be 'preferable' for all surgical presentations except minor injuries to attend hospitals with higher volumes of surgical services.
As to the related health care planning considerations, the plan says the National Ambulance Services estimate that it will take two years to have sufficient sat trained to support 'growth in capacity'. It is admitted that the required training of staff and investment must be achieved prior to change to model 2 status.
On mental health, the plan will ensure appropriate support and clinical pathways between Tullamore and St Fintan's Mental Health Services in Portlaoise.
As for Prisons with more than 1,000 inmates, the report says mental health, addiction and chronic disease management are the dominant health care needs. The plan says Portlaoise hospital will continue to provide services to the prisoners and the low volume of ambulance deliveries will go to other hospitals in the group.
As for implementation and investment, the plan says that health services transformation requires capacity developments to provide appropriate facilities and staff. It says a high level plan describes the proposed capital developments.
It is claimed that €20 million would have to be invested into Portlaoise to expand outpatients and other departments. The Coombe requires €20 million while Tallaght and Naas require €15 and 1.8 million respectively. Up to €40 million is projected to be needed in Tullamore.
The cost of extra staffing and ambulance services is not outlined in the summary.
The plan says staffing will not fall in Portlaoise and patient numbers will increase.
The report says it will take a minimum of four years to implement the plan subject to capital funding. It says the time frame is realistic.