Health, Place and Hanly: modelling accessibility to hospitals in Ireland

The Irish Government is currently engaged in considerations about a proposed reorganisation of acute hospital services. The proposals in the ‘Hanly’ Report recommend the creation of new classifications of Major, General and Local Hospitals. This paper looked at how these proposals might affect geographical accessibility to Irish acute hospitals and modelled it within a GIS framework. Spatial data in the form of hospital location and size, road network and demographic distribution of over 65’s were drawn together within the GIS. A weighted accessibility formula was applied to produce a measure of accessibility called a Spatial Accessibility Measure based on travel time, hospital size and population-weighting. This measures was then applied to produce three scenarios modelled on; a) the existing configuration of services, b) a partial roll-out and c) a full roll-out of the proposed changes in the ‘Hanly’ Report. The scenarios identified those parts of the country, which were potentially likely to have increased/decreased accessibility to acute hospital services based on the different scenarios. Residents in the central and western parts of the country were shown to be most vulnerable, while the impacts of a full roll-out of Hanly suggests additional potential impacts on some suburban hospitals in the Greater Dublin area. The work provides a valuable and previously underdeveloped set of policy-informed spatial outcomes which can be adjusted if or when more beds are introduced into the Irish health care system in the next five to ten years. Key index words: healthcare, accessibility, service planning, GIS, policy. Introduction The Irish Government is currently in the process of planning the strategic reformation of the existing structure of acute hospital services across the country. This process has been developed through a series of strategic government reports linked to wider health care reform and specific hospital reorganisation (Department of Health and Children, 2001, Department of Health and Children, 2002, Prospectus Strategy Consultants, 2003). For hospital services, a particularly relevant policy document is one that is widely referred to as the Hanly Report (Department of Health and Children, 2003). The essential thrust of the Hanly Report is to suggest planned efficiency changes in current acute hospital provision. While driven by a EU working-time directive on medical staffing, the report also took the opportunity to suggest changes in the configuration of acute hospital provision (European Union, 2000). The key changes suggested by the Hanly Report are based around expanding services in existing large regional centres (Major Hospitals) while downgrading services in sub-regional centres (Local Hospitals). This major shift in policy and service provision would seem to lend itself to areabased modelling to clarify the implications of the planned changes. To date, there has been limited GIS-based modelling carried out at a national level in Ireland with regard to the existing system of either acute or more general hospital provision. Irish Geography, Volume 39(1), 2006, 52-68. It is imperative therefore, that a number of area-based models of service provision are developed to identify the implications of current and proposed new structures (Teljeur, Barry and Kelly, 2004). From a policy perspective, this may prove especially valuable in the light of considerable local resistance to the proposed hospital changes, a factor common in most change environments (Brownell et al., 2001; Luo and Wang, 2003; MacNamara, 2004). As an exemplar of this process, this paper therefore aims to initially model existing access to acute hospital services. Additionally, to augment accessibility modelling for the population as a whole, the work will also look briefly at the elderly population as a sample group. The choice of people over the age of 65 is relevant in that the literature clearly identifies this group as being the main users of acute hospital services (Gatrell, 2002). The choice of the elderly also enables the modelling of specialist geriatric service provision as a contrast to the wider general provision. The second main aim of the paper is to use GIS to model a set of theoretical scenarios as to how the planned changes within Hanly may affect accessibility to acute services within the state as a whole.