The Department of Health knew 25 years ago that the Downe Hospital would never be viable as a major hospital - yet several years later a £69 million new hospital was built.
There are now renewed questions over the future of the hospital because of moves to centralise many hospital services, something which many doctors believe leads to a better standard of care, even though patients have to travel further.
Files from the early 1990s declassified at the Public Record Office show that many of the arguments now being made which could lead to the current hospital being downgraded were familiar to officials at that point. A Department of Health review of Down District Council’s opposition to downgrading the hospital set out a bleak prognosis.
It said that the arguments for transferring services from the Downe were that it was “antiquated”, dating from 1834 and “the cramped nature of the accommodation and restricted site make it unsuitable for modern acute medicine”.
However, even if the hospital could be upgraded and the buildings replaced – as happened in 2009 – the document said that “no acute service in Down district, whether modern or old, could possibly attract an adequate caseload to allow cost effective and clinically viable services to be provided in the long-term”.
It said that the view of a joint review team which examined the issue was clear that “the factors preclude any purely local solution to the problem of acute services for Down District Council and dictate the transfer of inpatient services to Belfast or Dundonald”. That, it said, was “straightforwardly consistent with departmental policy on the concentration of acute services”.
The document said that opposition to proposals to move services to larger hospitals had generally been on the basis that “local people and their representatives do not believe that acute hospital services can be adequately provided for the population of Down District Council area from Belfast or Dundonald”.
There was also a historical commitment to the building of a new hospital in Downpatrick and the population “vigorously opposes” moves to take services elsewhere.
The document acknowledged that anyone seriously ill needed to quickly get to an appropriately staffed hospital. However, it said: “Nevertheless, in considering the organisation of acute services, it is necessary to balance the need for the services to be accessible against the gains in standards of care which can be achieved by the policy of concentrating hospital services.
“In the department’s view, the policy of concentrating hospital services on fewer sites is the only way of securing for the people of Northern Ireland standards of care comparable to those available in the rest of the United Kingdom.”
It said that a travel time of less than 40 minutes to hospital was regarded as “not unreasonable” but that more than that length of time was “excessive”. Some 60% of the residents of the Down District Council area were within the 40-minute travel zone but it conceded that about 21,000 people from the coastal strip between Strangford and Newcastle were more than 40 minutes away from another hospital so an ambulance station in Downpatrick would be “essential”.