Review of acute hospital services in the Mid - Health Service Executive

Review of acute hospital services in HSE Mid-West
An action plan for acute and community services
As part of the National Framework for Service Change in NHS Scotland 112 , a review was
undertaken concerning the future configuration of neurosurgical services. Currently, services
are provided from four sites but following an appraisal of future options against specific
criteria, the preferred direction of travel was for a single centre of neurosurgical intervention,
serving a population of 5 million, as part of a service model that would provide local
outpatient, rehabilitation, and pre- and post-operative care and diagnosis. This intervention
service would be co-located on a university teaching hospital site with other neuroscience
specialties and be integrated, using a managed clinical network approach, across specialist,
secondary and primary care. The review also concluded that paediatric neurosurgery should
be concentrated on one site co-located with paediatric intensive care.
For these highly specialised, low volume specialties, a viable and sustainable workforce
dictates, to a greater or lesser extent, the catchment population they serve. Whilst additional
consultant and medical staff could be employed to provide multiple service provision, the
need for these services would be insufficient to support maintenance of skills and
competencies of these staff.
Guidelines for ratios of consultant staff per population have been produced across a number
of countries, and indeed, Ireland has also made recommendations regarding recommended
consultant staffing levels for tertiary services.
For example, for neurosurgery, the Royal College of Surgeons in England 113 (RCSE)
recommends 5-6 surgeons per 1,000,000 population and in Australia, a viable specialist
service with a minimum of 2 consultants requires a catchment between 200-250,000 114 . In
Ireland, the Royal College of Surgeons (RCSI) 115 has set a target ratio of consultant to
population of 1:258,000. Similarly, for paediatric surgery, the RCSE recommends a ratio of
1:250,000 and in Ireland, the RCSI has set a ratio of 1:500,000. In Australia, the population
catchment for a viable service is between 250,000 and 500,000, dependent on whether the
centre is serving an urban or rural population.
A comparison across countries of population catchments required to provide sustainable
specialised services is presented in Table 43.
112
Building a Health Service Fit for the Future, A National Framework for Service Change in the NHS In Scotland, NHS
Scotland, May 2005.
113 Developing a Modern Surgical Workforce, A Report from the Royal College of Surgeons of England, January 2005.
114
Sustainable Specialist Services: A Compendium of Requirements, Australian Medical Workforce Advisory Committee,
August 2004.
115 The Future of Surgical Specialties in Ireland, Royal College of Surgeons in Ireland, November 2003.
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