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

For Planned Care
Review of acute hospital services in HSE Mid-West
An action plan for acute and community services
Major planned surgery should not be undertaken on an occasional basis or
dispersed across multiple sites. It is recognised that the best clinical outcomes are
achieved by such surgery being undertaken regularly, by teams specialising in that
aspect of surgery.
We recommend, in the interest of patients having the best clinical outcomes, that
major planned surgery is delivered as one regional service.
With the present fragmentation of surgical services across four sites, one of the other issues
is where major planned surgery is undertaken.
It is generally acknowledged that individual units carrying out low numbers of major
operations i.e. not undertaking such surgery on a regular weekly basis, are associated with
poorer quality clinical outcomes. Cancer surgery is a good indicator of this critical mass
argument. Table 3 below summarises the 2005 experience, which indicates that many cancer
operations were undertaken on an occasional basis on all sites.
Overall, there were 812 cancer procedures undertaken across the four acute hospital sites
equating to some 16 procedures a week across the Mid-West.
Table 3: Summary of Cancer Procedures in HSE Mid-West
Major Cancer Procedure Dooradoyle Ennis Nenagh St. John’s Total
Breast 41 17 25 188 271
Cervix 8 9 17
Colon 73 27 20 74 194
Oesophagus 2 5 14 7 28
Ovary 32 7 39
Prostate 51 3 13 11 78
Rectum, Recto-sigmoid & Anus 28 11 10 27 76
Uterus 44 2 63 109
Total 279 65 82 386 812
Source: Analysis of HIPE data, 2005.
Best practice is to reduce the spread of surgeons who undertake this category of surgery by
establishing sub-speciality teams to manage them, as reflected in the reorganisation of
cancer services that is now well under way in many countries 15 16 17 18 19 20 21 , including
Ireland 22 23 .
15 National Service Framework for Cancer Services. Department of Health, UK, 2001.
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