The country's hospitals are to be organised into six groups, while smaller hospitals are set to have some major services transferred to larger centres, following changes announced today by Health Minister James Reilly.

The changes, some of which are already being put in place, when completed will mark the biggest revamp of the hospital system for many decades. Work on implementing the revamp is to start immediately.

Health Minister James Reilly, launching the new plans, said patients would not notice an immediate change in care provision, but they would gradually see a greater range of services being provided, particularly in smaller hospitals. He said changes were already being seen in hospitals such as Mallow and Roscommon.

Under the plan, hospitals will be divided into six groups, which will eventually become independent, self-governing trusts as part of the planned overall reform of the system that involves the abolition of the HSE and the advent of universal health insurance (UHI)

The groups have been designated as Dublin North-East; Dublin Midlands; Dublin East; South/South-West; West/North-West and Mid-West. Each group will have between six and 11 hospitals and includes at least one major teaching hospital. All groups will be attached to university medical schools and services and staffing will be spread among hospitals within each group.

The biggest hospital in each group is Beaumont; St James's; the Mater; Cork University Hospital; University Hospital Galway and the Mid-Western Regional Hospital in Limerick. Each group will include a major cancer treatment centre.

Letterkenny and Sligo Hospitals are to be designated as a formal sub-unit within the new West/North-West group.

Hospital groups have already been operating in the west and the north-east.

Some hospitals that are currently linked for service provision will be split into separate groups.The Rotunda and the Mater are to be separated while Mullingar Hospital is to be separated from Portlaoise and Tullamore Hospitals.

Waterford Regional Hospital does not get to head up it own regional south-east group, but has been included in the new South/South West group. Its potential downgrading under the new plan led to local protests.

However, the plan says Waterford Hospital will continue to be a regional trauma and orthopaedic centre and to provide an expanded invasive cardiology service. It will have academic consultant appointments at UCC and will be renamed Waterford University Hospital.

Under plans announced for smaller hospitals, nine hospitals have been earmarked for a changed role - Navan; Dundalk; Loughlinstown; Mallow; Bantry; Ennis; Nenagh; St John's in Limerick and Roscommon County.

All except Navan and Loughlinstown have already had 24-hour emergency departments removed, and Loughlinstown and Navan are expected to lose their major A&E services shortly. Smaller hospitals are, however, retaining many services and getting expanded services under the plan, including day surgery and diagnostics.

All nine hospitals, under the plan, will have local injury units, instead of full A&Es, and these units will operate from 8am to 8pm. Some already have these injury units as well as other new services up and running.

The smaller hospitals plan provides for some of these hospitals to still carry out some more complex planned surgery in certain cases. Otherwise, the smaller hospitals would mostly carry out day surgery.

Under the plan, none of the smaller hospitals - designated 'model 2 hospitals'- can provide major acute surgery or critical care. These can only be carried out in the larger Model 3 and Model 4 hospitals.

Model 3 hospitals will have 24/7 EDs, acute surgery, acute medicine and critical care, while Model 4 hospitals will have these services plus specialist, supra-regional care. The smaller model 2 hospitals will continue to provide some acute medical care.

The plan stresses that the traditional practice of providing as many services as possible in every hospital is neither sustainable nor safe and the system is being reformed to meet these challenges.

Minister Reilly said while we had some of the best doctors and nurses in the world, we did not have the best health system, and that needed to change.

The plan says hospitals such as Letterkenny, Wexford and Kerry General, because of their location, will retain their full range of ED services, as well as surgical, maternity and paediatric services.

The chair of the expert team that drew up the report on hospital groups, Prof John Higgins, said no hospitals would get any surprises in the recommendations of the report. A separate report recommended the changes in the role of smaller hospitals.

Minister Reilly, asked about the splitting up of closely-located hospitals in both Dublin and the Midlands into different groups, said existing clinical care pathways would not be disrupted.

He said the addition of some new services to smaller hospitals would free up the larger hospitals to do more appropriate work.

The Minister said over a period of time, people would see that more services are available to them locally and that these services would be safe. He said there would be no downgrading of Waterford Hospital under the plan.

Dr Reilly said there had been predictions that there would be 'winners and losers' under the hospital plans, but this was not the case. No hospital would be closed under the new plan.

He said the reorganisation would benefit hospitals and patients, who would in the future have more services available locally and these would be safe services.

Work on the roll-out of the hospital groups is to start immediately, according to the Minister, with group chairpersons and CEOs (who will be appointed from within the HSE system) to be put in place as soon as possible.

Each group must develop a strategic plan for their future services in the first year of their operation. These plans must describe how they will reorganise these services to provide optimal care to the populations they serve. They must also show how they plan to link their services effectively with GP and primary care services in the community.

The hospital groups will be converted into independent trusts in 2015 - the CEO positions for these trusts will be advertised internationally.

The new hospital system will eventually operate under a 'money follows the patient' basis under UHI, which means they will be not receive fixed budgets but will be funded according to the level of services they provide and the number of patients they treat, thereby incentivising staff to work more effectively.

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