It is wrong of the Hanly report to assert there is "convincing evidence" that large hospitals achieve better outcomes for patients, according to a health economist who has written a critique of the report.
Ms Catherine McNamara presented her findings to the new Health Services Action Group in Kill, Co Kildare, yesterday. She said the latest and most comprehensive study reviewing the relationship between hospital size and patient outcome looked at evidence available from all research undertaken over the last 20 years. It found good reasons for centralising services for only five procedures which would include cardiac surgery, paediatrics and surgery for pancreatic cancer.
"There is no good evidence at all to support Hanly's extreme centralisation proposals."
She said bigger hospitals were not more cost effective. "Hanly spent very little time discussing costs but they do assert that their proposals to centralise acute inpatient care in just a few hospitals will be cost effective and will cut down unnecessary duplication of services. They are quite wrong in these assertions.
"They completely ignore the vast body of international evidence which shows that, allowing for case-mix, large hospitals (more than 500 beds) are always high cost and inefficient, while the best size for economic efficiency is a hospital of 100-400 beds.
This would include most of the existing network of hospitals around the country," she said.
Hanly has recommended that hospitals be grouped in regional networks, with one centre of excellence providing major surgery and A&E services, backed up by local hospitals doing elective surgery.
The Minister for Health, Mr Martin, said last evening he was baffled by Ms McNamara's claims. He said her theories were "fundamentally wrong" and he accused her of deliberately misrepresenting what Hanly proposed.
The implementation of Hanly would result in a doubling of hospital consultant numbers and a greater range of services in each region. Patient care would be improved, he said.