Statement by Dr. James Kiely, Chief Medical Officer, Department of Health and Children on the Report of the National Task Force on Medical Staffing (Hanly Report)
The publication of the Report of the National Task Force on Medical Staffing (Hanly Report) has to be seen as part of the wider reform package decided upon by the Government and is a significant step towards a safe, equitable and patient centred acute hospital service.
“Hanly” is the latest in a series of reports dealing with hospital medical staffing and the acute hospital system published over the last three decades. The same key point recurs: that service provision in the Irish hospital system is overly dependent on doctors in training providing 24-hour, 7-day a week medical care. Patients have limited access to appropriate levels of senior clinical decision making and this has serious implications for both their diagnosis and treatment
The report identifies a clear and pressing need to reform existing service provision, improve working arrangements for medical staff and develop medical education and training. These reforms must take account of the facilities, volumes of activity and medical expertise needed to provide the best possible service for patients.
The Hanly Report has set out a series of principles regarding the future organisation of acute hospital services. It emphasises the need to provide a full range of specialist services appropriate to a region and to designate suitable roles for each type of hospital, whether major, general or local.
The Hanly Report deals with this central issue in an honest and explicit way. It addresses all the elements involved, the need to improve patient care, to reform medical education and training and to support the provision of safe, high quality acute hospital care 24 hours a day, 7 days a week while at the same time, identifying the critical linkages between hospitals and other parts of the system which allow for fully integrated personal and family care. No other analysis of these issues has been as fundamental and thorough, no other analysis has been based on such a wide and intense consultation and certainly no viable alternative has been advanced. This has not been done in such a comprehensive way before and is to be welcomed
The other major service reform proposed is the Primary Care Strategy, A New Direction. Primary Care, including family doctor and local nursing services, is the most appropriate point of first contact for people with the health services. This strategy provides for the development of the Primary Care Team, which can cater for the vast majority of health needs, including acute episodes of care. The publication of the Hanly report identifies a number of opportunities for the further development of particular services in primary care such as minor injury clinics, community based diagnostic centres and Emergency Medical Technician (EMT) services which are of particular importance to the effective functioning of the proposed hospital configuration.
Implementation of the Hanly Report, paralleled by development of acute bed capacity, appropriate resourcing and reform of ambulance services, development of important elements of primary care and effective management of the critical linkages between all these services, will mean that throughout the health system people receive the care most appropriate to their needs, delivered by doctors best qualified to provide that care. It will ensure that patients, wherever they live and wherever they come into contact with the health system, have equitable and rapid access to high quality emergency and elective care.