W2E-004 Mixed Ulster editorials-3.txt
Critical list

THE consultation process continues, but the future of hospital reorganisation in the Eastern Board area is much clearer from today. The Belfast Telegraph's exclusive revelations on the future purchasing plans of the board provide the fullest picture yet of how the existing hospitals will expand or contract in the years to come.

A previous consultation document set out the Board's criteria for evaluating hospital services, from which hospitals like Downe concluded that they would lose patients. Now they know the worst, and it appears that the biggest losers are the Royal, City and Downe hospitals, while the Mater, Lagan Valley and Ulster hospitals all attain a higher status.

The Board's reasoning is that since it becomes a purchaser of services from April 1, it must spend its money where the population will get the maximum benefit. As it has lost out financially, because of changes in funding, it would say there is no alternative to rationalisation of expensive services, while not wanting patients to have to travel too far.

The result is that the Board will be relying less on the Royal and City and more on outlying hospitals like the Lagan Valley in Lisburn and Ulster in Dundonald, which are easily accessible to people who have moved out of Belfast. It will be up to the two Belfast-based hospitals, which will get self-governing trust status from April, to consider how best they will meet this challenge. Less duplication and perhaps and eventual merger may be on the cards, but their teaching hospital status must be preserved.

There is no easy answer to the problems facing the hospital service, as medical technology develops new means of treatment at the same time as patients'expectations grow and funding, in real terms, declines. The Eastern Board is about to put its proposals on the table, which must be anathema for those hospitals and communities which see their services down-graded.

The protests will continue, and adjustments may still be possible. But the Government's reform laid down the ground rules, with their concept of a free market in medicine, and it will be difficult to upset them.
