A detailed critique of the Hanly report on hospitals reform, written by a consultant physician and a health economist, has described it as being "intellectually dishonest". It claims its authors have "failed dismally to fulfil their terms of reference".
The critique by Dr John Barton, a consultant physician at Portiuncula Hospital, in Ballinasloe, Co Galway, and Catherine McNamara, a health economist, was presented in summary to a meeting of the Health Service Action Group in Co Kildare at the weekend.
The full document , seen by The IrishTimes, accuses Hanly of "not putting the patient at the centre of our health service" and says that "if Government had read and reviewed some of the literature, it would in the first instance be doing its best to try and preserve as much of our acute rural hospital services as possible".
Dr Barton and Ms McNamara acknowledge, none the less, positive aspects of the report of the National Task Force on Medical Staffing (the Hanly group). These include a move to appoint more consultants; the provision of health services on a regional basis; and the delivery of specialist out-patient services locally. However, it is scathing in its criticism of what it terms the expert group's "misuse of volumes and outcomes research to support centralisation [of the health service\]".
The authors also criticise the Hanly group for extrapolating better outcomes for certain surgical procedures in hospitals with larger patient volumes to medicine as a whole.
The Department of Health responded, saying: "The Minister for Health and Children, Mr Martin, strongly rejects these claims" and has issued a point-by-point response to The Irish Times. It described the claim that some of the task force's conclusions were based on a limited number of sources and that it misinterpreted its findings as "entirely inaccurate".
There is a significant difference of opinion between the critique and the Department's response on the introduction of 3,000 additional acute hospital beds into the system.
The critique claims Hanly's proposals "illicitly" take the 3,000 additional hospital beds which the National Health Strategy has identified the system already needs by using them to fulfil the proposed bed changes inherent in the move to a smaller number of larger hospitals. The Department rejected this, noting that "nowhere does Hanly recommend transferring beds from one acute general hospital to another".
The two sides also disagree about the interpretation put on a key National Health Service document, Keeping the NHS Local - a new direction of travel.
Barton and McNamara said it acknowledges that a centralisation policy has not resulted in a better hospital service in Britain.
The Department said the UK report supports the thrust of Hanly analysis. "There is little difference between Keeping the NHS Local recommendations on smaller hospitals and the Hanly recommendations on local hospitals," it said. In response to the "large volume hospitals produce better patient outcomes" element of the Barton/McNamara critique, the Department stated: "Nowhere does the Hanly report assert that larger volume hospitals produce better outcomes."
Political fallout over the implementation of Hanly has continued. The weekend promise that medical cover would be provided "is designed to give the impression that the Government is backtracking on the downgrading of A&E services in two thirds of the country's hospitals", claimed Fine Gael spokeswoman on Health Ms Olivia Mitchell. "In Hanly speak, 'medical cover' means having a nurse on duty and a doctor at the end of a telephone. This is another blatant example of how far Fianna Fáil will go to deceive the public when their own electoral interests are at stake," she added.