Legend. Louth. Area 6. Meath DNW DNC. Area 5 DSW DL DSC DSW. Kildare/W Wicklow. Wicklow. Area 4. Wexford Tipperary SR

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1 6.4.1 Optin 1 - Based n Hspital Grups This ptin sets ut a prpsal which suggests six successr Cmmunity Healthcare Organisatins t the existing ISAs (frm heren this shall be referred t as Optin 1 ). These areas are based n an amalgamatin f frmer LHO areas which are gruped tgether based n the new Hspital Grups, as far as pssible given the cnstraints arund the Hspital Grup cnfiguratin. The map belw illustrates same and a descriptin f each area in terms f ppulatin and lcalities cntained within, is prvided. Ppulatin & Descriptin Table Opti W DW DSW C C DSC DSE DL Dnegal Optin 1 bundary ptin_1 Area 1 - pp 704,977 Area 2 - pp 379,327 Area 3 - pp 886,476 - pp 640,099 - pp 956,481 - pp 1,020,891 Area Ttal , ,327 Descriptin Dnegal LHO, Slig/Leitrim/We Cavan LHO, Galway, Rscmm and May LHOs Clare LHO, Limerick LHO and N Tipperary/East Limerick LHO Kerry May Area 1 Galway Clare Limerick Nrth Crk Area 3 Nrth Lee Slig/Leitrim Cavan/Mnaghan Area 2 Rscmmn Lngfrd/Westmeath Lais/Offaly Nrth Tipp/East Limerick Carlw/Kilkenny Luth Wexfrd Tipperary SR Waterfrd WC DW DSEDSC DSW DL 3 886, , , ,020,891 Average 764,709 Kerry LHO, Nrth Crk LHO, N Lee LHO, Suth Lee LH, West C LHO, Tipperary Suth LHO and Waterfrd LHO Carlw/Kilkenny LHO, Wexfrd LHO, Dún Laghaire L and Dublin Suth East LHO Kildare/West LHO, Dub West LHO, Dublin Suth City LH and Dublin Suth West LHO, Lais/Offaly LHO, Lngfrd/Westmeath LHO Luth LHO and LHO, Ca Mnaghan LHO, Dublin Nrth L Dublin Nrth Central LHO and D Nrth West LHO West Crk Suth Lee SRG Prjects Office, Limerick Prduced Under OSI License Max 1,102,891 Min 379,327 The Hspital Grups d nt cver catchment areas as such. In areas such as the Mid West the gegraphical area cvered by the Hspital Grup is clear, hwever in ther areas particularly in the eastern half f the cuntry there are verlaps in the areas that the Hspital Grups cver. This is due t the high density f the hspitals in that half f the cuntry and agreed academic alliances between the majr teaching hspitals. As such it is very difficult t crrelate frmer LHO areas t all Hspital Grups. This ptin maximises c-terminsity between the Hspital Grups and new areas, with fur f the six Hspital Grups nly having t link with ne new prpsed Area (a table is prvided after the analysis f each criterin t illustrate same). 51

2 The fllwing table details the advantages and disadvantages f this ptin against each criterin. ASSESSMENT AGAINST CRITERIA Optin 1 Criteria Advantages Disadvantages Internal Integratin Demgraphics / Deprivatin Self Sustaining /Manageability Factrs Gegraphical / Physical /Cultural External Integratin Issues This ptin maximises in s far as pssible the c-terminsity with the new Hspital Grups which wuld clearly supprt maximising the integratin agenda between hspital trusts and Cmmunity Healthcare Organisatins Frmer LHO bundaries are maintained by this ptin and they are the key building blcks fr these areas The key primary care secndary care linkages are bradly maintained Each area has sufficient ppulatin size t be self -sustaining The Suth/Suth West Hspital Grup is in Area 3 in this ptin with the exceptin f Lurdes Orthpaedic Hspital which is in The Dublin East Hspital Grup is in Areas 4, 5 and 6 Existing ISA Bundaries (Suth East) are nt maintained Reginal bundaries are nt maintained. Mental Health areas are nt maintained in all areas, i.e. Suth East The average ppulatin size fr these areas is 764,709, with a large range between 379,327 and 1,102,891 As cmmunity services are very gegraphically spread, sme f the larger areas wuld require a number f layers f management in rder t cluster services Due t the cnfiguratin f the Dublin East Hspital Grup it is nt pssible t frm a cmmunity area which is cterminus with it as cntiguity is a prerequisite fr same. In this ptin the frmer Suth East area is divided between tw new areas, this may be a significant change frm a public perspective, hwever rad netwrks indicate that this shuld nt be a prblem This ptin des nt ffer any advantage fr imprving crss brder cnnectivity beynd what currently exists Given that it was nt pssible t match Optin 1 with the current Hspital Grup cnfiguratin the table belw assciated each prpsed area and their relevant hspitals and Hspital Grups. The table als highlights the tw Hspital Grups which are split between fur areas in this ptin. In practice given the specialised nature f the hspitals in questin (with the exceptin f Midland Reginal Hspital, Mullingar) the impact f this wuld be that and 6 wuld have t deal with tw Hspital Grups. Similar tables are prvided fr the ther ptins in Appendix H.1 fr cmparisn purpses. 52

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4 6.4.2 Optin 2 Based n Maximising Primary and Secndary Care Activity, Pathways and Relatinships Optin 2A This ptin sets ut a prpsal which suggests nine successr Cmmunity Healthcare Organisatins t the existing ISAs (frm heren this shall be referred t as Optin 2A ). These areas are based n previus wrk which identified seventeen ISAs based n ptential catchments t maximise primary/secndary care pathways (Appendix H.2). This ptin was based n Primary Care Teams, and while the riginal prpsal fr seventeen ISAs which was recmmended in 2011 brke LHO bundaries, the ptin belw, thrugh amalgamatins, rejins many f these. The map belw illustrates same. Ppulatin & Descriptin Table Optin 2A DW W DSW C C DSC DSE DL Kerry May Area 2 Galway Clare Limerick Nrth Crk Slig/Leitrim Rscmmn Area 3 Nrth Lee Dnegal Tipperary SR Area 1 Lais/Offaly Waterfrd Cavan/Mnaghan Lngfrd/Westmeath Nrth Tipp/East Limerick Carlw/Kilkenny Optin 2A v2 Optin_2A Area 1 - pp 389,048 Area 2 - pp 445,356 Area 3 - pp 379,327 - pp 664,533 - pp 497,578 - pp 364,464 - pp 674,071 - pp 592,388 - pp 581,486 Luth Wexfrd WC DW DSEDSC DSW DL Area Ttal , , , , , , , , ,486 Average 509,806 Descriptin Dnegal LHO, Slig/Leitrim/We Cavan LHO and Cavan/Mnagh LHO. Galway, Rscmmn and May LHOs Clare LHO, Limerick LHO and N Tipperary/East Limerick LHO. Kerry LHO, Nrth Crk LHO, N Lee LHO, Suth Lee LHO and W Crk LHO Suth Tipperary LHO, Carlw/Kilkenny LHO, Waterfr and Wexfrd LHO LHO, Dún Laghaire L and Dublin Suth East LHO Kildare/West LHO, Dub West LHO, Dublin Suth City LH and Dublin Suth West LHO Lais/Offaly LHO, Lngfrd/Westmeath LHO, Lut LHO and LHO Dublin Nrth LHO, Dublin Nrth Central LHO and Dublin Nrth W LHO West Crk Suth Lee SRG Prjects Office, Limerick Prduced Under OSI License Max 674,071 Min 364,464 The emphasis f Optin 2A is t align cmmunity catchments with lcal secndary care pathways. Based n this wrk nine new areas have been identified, taking cgnisance f the fllwing key influencing factrs: PCT bundaries were the building blcks t achieve maximum c-terminsity between primary and secndary care and this has been maintained; Crss brder cperatin culd ptentially be further develped using this cnfiguratin; Maximising c-terminsity with lcal authrities A minimum ppulatin in excess f 350,000 was determined as being a critical mass fr a selfsustaining Cmmunity Healthcare Organisatin. 54

5 The fllwing map illustrates a mre detailed view f the Dublin area fr ptin 2A SRG Prjects Office, Limerick Prduced Under OSI License 55