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Health service reform: Hospital closures plans prevalent in previous reviews

The former Chief Medical Officer of England, Sir Liam Donaldson published a review into the Northern Ireland health system in 2014. Pictured with then Health Minister Jim Wells. Picture by Kelvin Boyes/ Press Eye
Analysis by Gareth McKeown

HEALTH reviews are nothing new and the Bengoa report is now the fourth commissioned in the north since devolution in 1999.

The three preceding reviews have each contained various proposals aimed at making the health system more effective and efficient, but at the heart of all of them has been a call for a more streamlined hospital service in Northern Ireland.

This is very a much a continuation of policy, as even before devolution the Department of Health said they wanted to close seven existing acute hospitals, centralising acute services to six main hospitals.

In 2001 the Hayes report, compiled by the chairman of the Acute Hospitals Review Group and former ombudsman Dr Maurice Hayes, proposed the removal of accident and emergency services from five smaller acute hospitals.

He also recommended the rationalisation of hospital administration by replacing the four health boards with one "strategic commissioning authority" and merging the 18 hospitals trusts into three integrated health systems.

A new acute hospital to be built in County Fermanagh to serve the south west region was another significant recommendation.

Fast-forward ten years and 'Transforming Your Care', a report commissioned by then chief executive of the Health and Social Care Board Dr John Compton, detailed a total of 99 proposals designed to “put the individual at the centre” of the healthcare system.

The report recommended a significant reduction in the number of hospitals providing acute care from 10 to between five and seven, noting that similar sized population areas in the UK would typically be served by four acute care facilities.

The report also stated that £83 million would eventually be transferred from hospitals to GP and other services.

Continuing in the same vein 'The Right Time, The Right Place' report of 2104, commissioned by former Chief Medical Officer of England, Professor Sir Liam Donaldson, further referenced the need to reduce the number of hospitals in the north.

One of the ten recommendations was to "close local hospitals that cannot provide level of care needed 24/7," with the report stating that having too many hospitals meant the public did not receive the best healthcare and medical expertise was too thinly spread.

The report was also critical of its predecessor, saying Transforming Your Care required a "rocket buster" to implement it.

Tuesday's report 'Systems, Not Structures' commissioned by a panel headed by Professor Rafael Bengoa does not directly mention hospital closures, but services will have to meet criteria to prove they are viable according to the Health Minister Michelle O'Neill.

A 'reform of hospital services' is also outlined as one the priorities in the minister's 10 year roadmap for the future of healthcare in the north.

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