The ‘nuclear option’ of centralising all acute health services in the South East at Waterford Regional Hospital is ‘not on’ insists Kilkenny government TD Bobby Aylward.

The HSE is looking at bringing surgeries currently undertaken at the general hospitals at St Luke’s (Kilkenny), South Tipperary (Clonmel) and Wexford under one roof at Ardkeen.

However, while the likes of Waterford Fine Gael Deputy John Deasy believes centralisation of critical services is vital, political opinion in each of the other areas affected is very much against any the move.

This was evident during the most recent meeting of the joint Oireachtas health committee, when Mr Aylward declared that WRH was under enough pressure already.

“We all realise that the four-hospital system we have in the South East will not continue because of financial constraints and improvements in services”, he conceded. However, “the nuclear option of moving all acute services to Waterford is not on as we serve 500,000 people in the region. There is no way one hospital could handle all the acute services for these people, so that proposal cannot go ahead.”

 The clinical director at WRH, Dr Rob Landers, says specialised surgery, paediatrics and consultant-led accident and emergency services for the region should be concentrated there rather than spread across smaller hospitals.


Dr Landers, who is on the HSE steering group examining the matter (as are his counterparts in Kilkenny, Clonmel and Wexford) believes “the region needs one centre providing complex and acute services and other smaller centres to support it. If we don’t base these services in Waterford we will lose key services and people will have to travel to Cork and Dublin for services that should be available locally”, he warns.


Outside of Waterford, concerned groups have come together to campaign for the retention of acute services in their areas. “I am glad this is happening and I hope the HSE will listen to these concerns”, Bobby Aylward says.

While accepting “there are specialist programmes such as cancer treatment, orthopaedics and ear, nose and throat procedures which must be centralised in a regional hospital”, the Fianna Fail Deputy is adamant that “other acute services for a population of 500,000 people cannot all be brought into such a centre.

“With all respect to Waterford Regional Hospital, it would not be able for it as it is already bursting at the seams with the services operating there. A specialist cancer unit is also going in.”

He added: “I hold the hand of friendship out to Clonmel as we should proceed with a strategic alliance to serve the population. Waterford is at the bottom edge of the South East and to bring people over 60 to 100 miles to get to the hospital in Waterford in not viable. It would not be prudent for an emergency patient.

“We should proceed with a two-hospital strategic approach, with Kilkenny and Clonmel coming together, and perhaps Wexford and Waterford. Kilkenny is the geographical centre, and we serve Clonmel, Laois-Offaly and Carlow. That is the way it should go.”

Clonmel Senator Phil Prendergast pointed out that though the new road between Kilkenny and Waterford will cut travel between the cities to just 25 minutes, it currently takes one hour to get from Clonmel to either Waterford or Kilkenny. “The road is extremely bad and there are no plans in the current climate to improve that.”

In response, the head of the HSE, Prof Brendan Drumm, said the issue of reconfiguration was a challenge but “there must be a reality check” on the cost of keeping acute services within smaller hospitals.

Doctor overtime

He cited the example of overnight surgery, where between Clonmel and Kilkenny there is one operation every three days after 10pm, “yet for surgery alone, we pay €100,000 per month in junior doctor overtime across those two units… it is not sustainable to spend that amount of money.”

Prof Drumm added: “The geography of the south East was not as blessed as the geography of the mid-west in terms of the location of Limerick and Waterford… We are working locally with clinicians, directors of nursing and everybody to try to arrive at an agreed strategy. It is not for me to say what that strategy should be but certainly there will have to be change.”