A NUMBER of smaller maternity units in hospitals across the State could be forced to close as a result of plans by the Health Service Executive (HSE) to re-examine the numbers of births in each unit next year to determine if the numbers of babies being born in each warrants keeping them open.
That's according to the HSE's service plan for 2009 which states that "reconfiguration plans" will be developed next year for existing maternity units "where the minimum number of births is less than that required for comprehensive safe services".
While the service plan states that births are projected to rise by a further 4.3 per cent next year from around 73,000 this year to 76,000 in 2009, the current delivery model in maternity units nationally needs to be examined in light of emerging trends and best practice both nationally and internationally.
The health service plan states that plans to reconfigure maternity services in the midwest will be advanced next year.
There will be some provision made for extra investment in the three Dublin maternity hospitals, pending their relocation to the site of acute hospitals in line with the recommendations of a recent review by KPMG.
The service plan, which has been approved by Minister for Health Mary Harney, also states that consideration will be given to "rationalisation of emergency department services across hospitals" next year in line with best practice.
It says the HSE will next year review current arrangements whereby eight hospitals in Dublin and three hospitals in Cork city provide adult emergency departments around the clock seven days a week.
There will also be a review of the need for the three children's hospitals in Dublin to provide 24-hour emergency services.
And it says that following a review of acute hospital services in the midwest and northeast, emergency departments in these will be reconfigured to ensure they meet needs "whilst reducing the risk of poor clinical outcomes".
There is also to be an analysis undertaken next year of acute hospital services in the midlands and a framework developed for "reconfiguration of all services" in the southeast hospital network.
The service plan also states that paediatric services outside Dublin will also be reorganised.
Furthermore, the plan states that the private co-located hospitals on a number of public hospital sites will be progressed to construction phase next year "subject to satisfactory banking arrangements".
There has been speculation recently about whether banks will provide money to build these hospitals in the current economic climate.
The document points out that next year will be a tough one financially for the HSE and there will be additional demands on it by those losing their jobs who will be applying for medical cards.
The report states that provision is being made for an extra 81,000 medical cards next year but if more people than that need them and if HSE income from private beds drops as a result of people letting their health insurance lapse, the HSE may have to cut services elsewhere to cover these costs.
"If any of these risks materialise the HSE will have to review our abilities to deliver on the overall service levels set out in this plan," the report states.
In a foreword to the service plan, the chief executive of the HSE, Prof Brendan Drumm, states that 2009 will be "financially very demanding".
Maintaining 2008 service levels will be a major challenge "with no scope to fund any unanticipated escalation in demand for service level activity".
He also states that while the HSE had to save €280 million this year, it will have to repeat this next year and also save a further €250 million.
The report said these savings will be achieved partly by a 3 per cent reduction in management/administrative payroll costs in the HSE and the voluntary hospitals.
A reduction in expenditure by about 3,000 whole-time equivalent staff in pay costs, which it says will be achieved "through actual staff reductions, staff redeployment and pay related savings as a result of changing how some services are provided" is envisaged in the health service plan.
There are also plans to reduce spending on overtime and agency staff and to employ an extra 1,000 healthcare assistants to free up nurses to do other duties.
In relation to hospital activity levels next year, the plan states that more procedures will be done on a day-case basis and thus there will be reduced dependence on inpatient beds.
It also proposes reducing the length of time patients spend in hospital, controlling elective work, and seeing more new patients in outpatients by reducing the number of patients returning for check-ups.
There are also plans to finally measure the length of time patients have to wait to see a consultant in outpatients once referred by their GP.
A target of a 6 per cent reduction in MRSA infections has also been set.