Northern Ireland acute hospitals may be halved
The number of acute hospitals in Northern Ireland could be halved under the biggest health service shake-up in the region's history.
The 10 facilities providing acute care are set to be reduced to between five and seven over the next five years.
The major review of health and social care services commissioned by the devolved administration also recommended much more cooperation with providers in the Irish Republic, particularly in the border areas.
Calling for a reduction in acute hospitals, the review noted that a region of similar population size - 1.8 million - elsewhere in the UK would typically be served by four acute care facilities.
The 99 proposals in the document produced by review chair John Compton called for many more patient services to be taken out of a hospital setting, with GPs taking responsibility for a greater range of treatments and diagnostic duties.
Stormont Health Minister Edwin Poots outlined the findings of Transforming Your Care, A Review Of Health And Social Care, to the Northern Ireland Assembly.
He said: "The report contains a compelling set of proposals for the future of health and social care services in Northern Ireland.
"It proposes a model which puts the individual at the centre. Health and social care services will be increasingly accessible in local areas.
"Patients will have to deal with fewer professionals and will be at the centre of decision-making about their treatment.
"There will be a significant shift from provision of services in hospitals to provision of services in the community, in the GP surgery, closer to home, where it is safe and effective to do this."
The plan will require an additional £70 million in funding to implement and will see £83 million currently spent in hospitals transferred to GP and other services.
The review calls for older people to be cared for in their own homes as much as possible and said there would be "inevitable" closures of state-run residential homes.
Public nursing homes will be asked to provide more of the services currently offered to the elderly in hospitals.
The report said there was an "unassailable case for change" in the local health service.
Mr Compton, chief executive of the region's Health and Social Care Board, said: "Throughout our work in producing this report, our overriding desire was to describe and build a system of health and social care which would place the individual, family and community that use it at the heart of how things are done.
"The review is about change. The change is planned over the next five years and is based on evidence. These changes are designed to deliver better outcomes that individuals can reasonably expect in a modern system of care and treatment.
"Our proposals, which are wide-ranging, deal with quality and outcomes as the determining factors in shaping our services; the need for patients to be better informed and to have choice and control over their care, particularly in their later years.
"It also describes changes to services for children and those with a disability or mental health difficulties.
"It recommends, over time, fewer major hospitals providing acute services and a much greater role for GPs in an integrated approach to healthcare.
"These proposals set out a road map to take the changes in the service forward and take account of the significant issues around workforce planning and the development of skills and capacities among our healthcare professionals and the enhancements in our technology provision.
"The new model underpins a sustainable and resilient service which the current model cannot deliver, and it provides a timeframe within which change can happen in a structured, planned and thought-through way."
Local commissioning groups will now draw up proposals on how acute care can be provided on fewer sites.
Mr Poots said the current healthcare model was not sustainable and, if maintained, would not be able to provide effective patient care.
"We must stop doing what does not work, challenge out-of-date practices and acknowledge that some of our services are no longer fit for purpose," he said.
"The system needs to change. Our services need to be resilient, sustainable and safe."