'180 hospital beds' to close in NI health shake-up
One hundred and eighty hospital beds are to close in major changes to the health service in Northern Ireland, the BBC understands.
The number of statutory residential care homes will be cut by half to 27.
Greater emphasis will be placed on providing care at home and on nurses working in the community.
Addressing the Assembly, Health Minister Edwin Poots outlined how health services would change over the next three to five years.
He said the health service would be divided into five area networks, reflecting the five trusts.
Each network will have one main hospital or hub. While no hospitals are to close, each area will house one main emergency department.
In Belfast, the Royal Victoria Hospital will be the main hospital with clinical services divided between the others. Although this is still out to consultation, it is thought the Royal will house the main emergency site including operating one of two regional coronary intervention services.
Antrim Area Hospital will be the main hub in the northern network. It will deliver all the core services including emergency, maternity and renal. The Whiteabbey and Mid Ulster Hospitals will remain. However, people will be expected to travel to Belfast more.
The Causeway Hospital, Coleraine, will change. Doctors will provide emergency care and cater for other, fewer, specialities. But the major question is whether the Causeway will remain with the Northern Trust.
It is most likely to move to the western area, forming closer links with Altnagelvin. The Londonderry site will specialise in emergency care, orthopaedics, cancer services. The Derry hospital will house the second regional coronary service.
The new South West Acute Hospital in Enniskillen is self-contained and will form stronger links with Altnagelvin.
In the South Eastern area, the central emergency department will be at the Ulster Hospital with out-of-hours service operating at the Downe Hospital, Downpatrick and, eventually, Lagan Valley Hospital, Lisburn.
In the southern board area, Craigavon Area Hospital and Daisy Hill Hospital in Newry already provide a network system sharing staff and specialist units.
The minister said new integrated care partnerships would bring together doctors and other health workers alongside care providers and charities.
Their job will be to plan care and provide support in their area. There will be 17 of them across Northern Ireland operating from community health centres.
They will initially be focused on the elderly and people with long-term conditions like diabetes.
Mr Poots said the health service would focus on providing better targeted care for older people closer to home. About 50% of statutory residential homes will close over the next three to five years.
He said £3.2m would be invested in social care reform with plans for an extra 470 supported living places.
£1m will be invested in training staff in nursing homes to support people at the end of their lives.
The health minister said that for hospitals, the plan was to move from an "individual- institution based" approach to a "networked" approach. He referred to the use of a telepresence robot, which enabled doctors at Craigavon Hospital to support patients in another hospital, a story that made national news headlines.
"It is this 'without walls' approach that I want to see replicated across Northern Ireland as we work together, not as individual institutions but as networked services which respond flexibly to our patients and service users' needs," he said.
Janice Smyth, from the Royal College of Nursing, said nurses would want to know on what basis decisions about closing homes were made and what criteria were used.
"If it is about putting better models of care into the community to support people and their families in their own homes, then no-one will argue. But in the past, that has not always been the case," she said.
"What happens when people go looking for that 24-hour support? Will it be there for those who need it? That will be the test of this."
Ms Smyth said Mr Poots stressed this was not about the closure of homes, but about alternative provision of better models of care in the community.
"The question that nurses are asking has anyone costed these models. Are they affordable and will they provide a better quality of care," she said.