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

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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. 29
Review of acute hospital services in HSE Mid-West An action plan for acute and community services It is our understanding that since 2005, with the consolidation of cancer/oncology services at the Dooradoyle site, cancer surgery is increasingly centralised e.g. all breast surgery in the Mid-West is now centred on two sites, namely Dooradoyle and St. John’s. This is a welcome trend in line with other cancer strategies. Finally, the generally low volumes of planned inpatient surgery carried out across the sites in 2005 raises questions about clinical viability and quality of outcomes. This is particularly relevant to Ennis (292 procedures in the year) and Nenagh (266 procedures in the year). Recommendation We recommend that the HSE formally requires the centralisation of all major planned surgery in the appropriate sub-specialty regional service. 16 New Zealand Cancer Control Strategy. Ministry of Health and Cancer Control Trust, August 2003. 17 Cancer in Scotland. Action for change. HDL(2001)54 Executive Letter. 18 Canadian Strategy for Cancer Control: Treatment Working Group, Final Report, January 2002. 19 Optimising Cancer Care in Australia, A consultative report prepared by the Clinical Oncological Society of Australia, The Cancer Council Australia and the National Cancer Control Initiative, February 2003. 20 Skinner KA et al. Breast Cancer: Do specialists make a difference? Annals of Surgical Oncology 10:606-615, 2003. 21 European Strategy for Breast Cancer. European Parliament calls for breast screening and breast surgery centres, 2003. (http://www.epgbc.org/pdf/pressroom/press_2.pdf). 22 A strategy for Cancer Control in Ireland, National Cancer Forum, 2006. 23 Establishment of Managed Cancer Control Networks and Designation of Eight Cancer Centres, National Cancer Control Strategy, 2007. 30
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Current service delivery Regional s
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Consultant Medical Workforce Review
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Centralising specialist acute servi
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Critical care network Review of acu
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