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

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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. 121
Table 43: A comparison of specialist services across countries Specialty Oral and Maxillofacial Surgery Royal College of Surgeons of England 1 consultant per 150,000 population Review of acute hospital services in HSE Mid-West An action plan for acute and community services Australian Medical Workforce Advisory Committee Plastic Surgery 1 consultant per 100,000 population Cardiothoracic 1 consultant per Surgery 150,000 population Vascular Surgery 4 consultants per 500,000 population Neurosurgery 5-6 consultants per Minimum of 2 1,000,000 consultants serving population 200-250,000 population Paediatric Surgery 1 consultant per Viable service 250,000 population serves a catchment of between 250- 500,000 Source: Teamwork analysis 122 Centre for Rural and Northern Health Research, Canada 116 1 consultant per 107,938 population 1 consultant per 128,793 population 1 consultant per 165,791 population Royal College of Surgeons in Ireland 1 consultant per 148,000 population 1 consultant per 103,000 population 1 consultant per 258,000 population 3 consultants per 500,000 population 1 consultant per 258,000 population 1 consultant per 500,000 population These highly specialised services may be provided from one or more regional hospital campuses or volumes may dictate the requirement to provide the service sub-regionally or even nationally. Infrastructure to enable healthcare delivery To support this model requires a new infrastructure (see Figure 7) which brings together those elements of healthcare delivery identified above. This infrastructure includes: • Clinical networks; • Assured quality; • Tele-medicine; and • Information and communication technology. 116 Geographic Distribution of Physicians in Canada, Centre for Rural and Northern Health Research, Laurentian University, Canada, 1999.
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Key messages Review of acute hospit
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educe the length of stay in hospita
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Integrating PCCC services with the
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Resource type Proportion Patients A
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The Mid-West needs 3 local ‘centr
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The regional elements of the networ
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