Main points of the report
• Working hours of non-consultant hospital doctors (NCHDs) must be reduced in line with the European Working Time Directive - this requires the average working week of NCHDs to be cut to 58 hours a week by August of next year.
• Health agencies should not attempt to meet the terms of the directive by employing more NCHDs.
• Substantially more hospital consultants should be appointed instead -- 1,300 more should be appointed by 2009, and 1,870 more by 2013.
• Consultants should be much more immediately accessible for clinical decision-making and treatment day and night - their contract should be renegotiated.
• The scope for enhancing the role of nurses and midwives should be explored.
• A new grade of operating department assistant should be created.
• The working day of hospitals should be extended to cover periods such as 7 a.m. to 9 p.m. -- outpatient clinics should open late into the evening, as should theatres for elective surgery.
• Radical reorganisation of acute hospital services will be required nationally.
• Hospital services should be reorganised in two pilot regions as a first step. The regions include the Mid Western and East Coast Area Health Boards, and in these hospital services should be organised into regional networks.
• In these regions, each with a population of 350,000, there should be one major hospital. It would provide the full range of A&E services for the region. All other hospitals, such as Nenagh General Hospital, to be reclassified as local hospitals, providing minor injury units, elective daycare procedures and other routine services. All the hospitals to be networked with one chief executive officer.
• Single-speciality hospitals in these regions should ultimately be relocated to the site of the major hospital.
• A national hospitals authority should be established.
• The current fragmentation in the co-ordination, management, regulation, inspection, control and funding of postgraduate medical training should be addressed by establishing a central, independent, statutory postgraduate training authority.
• The management structure of acute hospitals should be strengthened to establish clear lines of accountability - there should be considerably greater involvement of medical and other health professionals.
• Considerations about capacity, workload and a critical mass of patients must influence where hospital services can be safely provided.
• Regional specialities can be provided safely and effectively in a region with a population of 350,000 to 500,000 people.
• Supra-regional specialities such as radiation oncology can only be provided in a limited number of locations - areas with a catchment population of 750,000 to 1 million people.
• A national implementation group with power should be established to drive the changes.