Smaller hospitals play vital role

Sir, – Newton Emerson in “Forget Sinn Féin’s ‘Irish NHS’. We may all be headed for a British HSE” (Opinion & Analysis, October 5th) refers to tax-based and insurance-based health systems and muses as to which system is better at closing small general hospitals, which he refers to as “the obsolete blockage in every system”. Some believe that rural smaller hospitals are obsolete and are only kept open for political reasons. But what does your columnist mean by a small hospital? Is it one with 50 beds or 250 beds? Let us assume that a “small hospital” is, say, 175 beds and a decision is made to close all accident and emergency services at small general hospitals, then the following A&E departments would have to close: the Blackrock Clinic in Dublin (170 beds), the Hermitage Clinic (112 beds), the Galway Clinic (146 beds) and the Mater Private Cork (75 beds).

Would he argue vociferously for closure of these “obsolete” small private hospital A&E departments?

Can small hospitals provide quality care? Research by John Posnett, former professor of health economics, and Prof Luigi Siciliani of York University, has found no evidence of a beneficial effect of the general concentration of services in larger hospitals and advise hospital services should be local and easily accessible and do not support closure of small hospitals to achieve quality gains. Prof David Urbach of the Institute of Health Policy, Management and Evaluation in Toronto has indicated that more efficient use of resources may be gained by improving the quality of care at smaller hospitals through investment in development of care processes at those institutions rather than concentrating resources in larger ones.

Sadly, despite international research, media and certain medical communities continue to call for closure of smaller hospitals in rural Ireland where access to care is most important but on the other hand don’t call for closure of small city hospitals. – Yours, etc,