Wednesday, 29 November 2006
Following the publication several weeks ago of a Comhairle na nOspidéal report on neurosurgical services, it became clear there was to be the continuation of only two units in the country. Galway was not to have a unit. The report claimed the provision of a third unit would impinge on the viability of the other two. However, the report makes the best case possible in support of the provision of a unit in University College Hospital, Galway.
This time last year the Minister for Health and Children, Deputy Harney, visited University College Hospital, Galway. She indicated that neurosurgical services should be established in Galway as part of the Government's health strategy. She claimed such a service was required if there was to be regional autonomy. Certain accident cases requiring specialist neurosurgical treatment could not be transferred to Dublin for distance reasons. The case for the service in the west was made to her in an impressive presentation before Christmas last year. It is ironic that the position has changed.
Neurosurgeons at Beaumont Hospital have said that a State-run emergency air ambulance service would be preferable to establishing a neurosurgical unit on the western seaboard. They acknowledged there could be an argument for a unit for emergencies and spinal injuries.
Six reasons were given in the report why a neurosurgery unit should not be located in Galway. These are in fact the best reasons there should be. The Comhairle na nOspidéal report team comprised four medical people and two lay people. The report stated there was an "insufficient catchment population to maintain the skills of staff in a Galway unit". It stated 750,000 was the population figure needed for a viable unit. Despite this, the report's appendix B stated such a unit in Galway would cover the old western health board area of Galway, Roscommon and Mayo together with north-west Donegal, Leitrim, Sligo, Clare, parts of Limerick, north Tipperary, Offaly and Westmeath. This catchment area, as the appendix stated, comprises 1.025 million people.
The report's authors visited Australia, New Zealand, Scotland and England to examine units there. Many of the units they visited catered for populations of fewer than 1 million people. The report stated that no small units had been opened in these countries, yet on 15 June 2006, a unit was opened in Waikato in New Zealand with a population catchment of fewer than 800,000 people.
They visited Aberdeen in Scotland with a population catchment of 500,000, the nearest to Galway. The report stated:
Aberdeen Royal Infirmary is the largest hospital in the Grampian region. It has in excess of 1,000 beds and provides a complete range of medical and clinical specialties, with the exception of heart and liver transplantation. The neurosurgical unit, with a population catchment of 500,000, is staffed by 3 consultant neurosurgeons, 4 consultant neurologists, 1 full-time consultant neuroradiology, 1 consultant neuropathologist and 2 consultant neuroanaesthetists.
The report continued:
Management and consultant representatives in Aberdeen stated their belief that the neurosurgery unit in Aberdeen is viable and necessary, particularly to ensure rapid access to services. It was stated that there is a need to increase the consultant staffing to 4 consultant neurosurgeons.
The Fine Gael Party leader, Deputy Kenny, in the Dáil today highlighted the crisis in neurosurgery. No one in the west is asking that they receive a service at the expense of Dublin or Cork. No new appointment has been made in Beaumont Hospital. The technical equipment in the hospital is breaking down. Two eminent consultants, including Ciaran Bolger, have stated that people's lives are in danger. The first conclusion of the report is fallacious and those professionals who put their names to it should not be allowed to go unquestioned.
The second conclusion stated there was insufficient catchment population to maintain the skills of staff in two regional units. One consultant in Cork has stated if the catchment area in Cork were encroached upon by the provision of an additional unit in Galway, there would be problems for the Cork unit. Unashamedly, he was stating the preservation of his patch and the turf war between Dublin and Cork is more important than the health and safety of people in the west.
The report also concluded that the establishment of a third unit would be likely to inhibit the development of a tertiary neuroscience centre. The Minister for Health and Children would not have made the statement she did on her visit to Galway last Christmas if that was the case.
The most damning conclusion of all concerned the changing trends in demands for neurosurgical services. The report claimed that with new medicines and medical procedures, fewer people are in need of neurosurgical services. However, statistics show there has been a 3% increase per annum in the demand for such services. Will the Minister of State ask the Minister for Health and Children, Deputy Harney, once and for all to support this request as she did 12 months ago. This report is an opinion. It is not policy.
Nobody in Galway is trying to hinder the development of those services in Cork or Dublin. A neurosurgeon in the United States has made an offer, with no strings attached, and €1 million additional funding is available from the widow of a former professor, Pat Dwyer. The equivalent of €5 million is available, with no strings attached, to provide this service. Why is Galway the second tier of all the services in the west? I do not think the Minister for Health and Children would allow that label to be used in this instance.
I thank Senator Ulick Burke for raising this issue this evening. I am replying on behalf of my colleague, the Minister for Health and Children, Deputy Harney.
I welcome this opportunity to inform the Seanad of the position with regard to the development of neurosurgical services. The Health Service Executive, HSE, recently published a review of neurosurgical services in Ireland which was prepared by the former Comhairle na nOspidéal. It focuses, in particular, on the provision of adequate capacity and consideration of equity of access to neurosurgical services.
Neurosurgery is provided at the national centre in Beaumont Hospital and in Cork University Hospital. In summary the report recommends that the future development of safe, high quality neurosurgical services in Ireland would be best served by a two-pronged approach involving increased capacity in Dublin and Cork, and improved access to neurosurgical units, including transport and telemedicine facilities for referring hospitals.
The report identifies a clear need for significant investment in neurosurgical services. It states that the development of services must be contingent on organisational reform. This includes the need to put in place clear clinical leadership to guarantee service quality; to ensure appropriate linkages between neurosurgical units and crucially to develop clinical pathways with referring hospitals which do not have on-site neurosurgical services.
The HSE is committed to progressing the recommendations of the report to ensure the development of neurosurgical services in Ireland is in line with international best practice. A national neurosciences needs assessment is under way. Neuroscience includes neurology, neurophysiology and neurosurgery. This assessment is guided by previous Comhairle reports on neurology and neurophysiology and the recent report on neurosurgery. It aims to identify the requirements for neuroscience services as a whole across the country.
I understand an interim progress report is due to be submitted to the National Hospitals Office shortly and the final report will be submitted in February next year. The HSE is pursuing the development of additional neurology services in Waterford, Limerick and Sligo. This will facilitate the management of patients who live outside Dublin who may need neurosurgical opinions or interventions.
The Government provided an additional €3 million in 2006 to develop neuroscience services and the recently published Estimates for the Health Service Executive provide a further €4 million to continue these developments into 2007.
Comhairle na nOspidéal considered the case for a neurosurgical unit in Galway at length. Representatives of the Western Neurosurgery Campaign met the Comhairle committee to put their case for neurosurgical services to be located in the west. Comhairle's conclusion was that a unit in Galway would not be viable. It also considered that the needs of the entire population would be ill-served by the division of neurosurgical expertise and resources between three neurosurgical units.
The reasons for this decision include insufficient catchment population in the west; changing trends in demand for neurosurgical services; international experience on the viability of small neurosurgical units; significant scope for improving services by increasing capacity in existing units as well as providing improved transport and telemedicine facilities. Comhairle's conclusion is that the needs of neurosurgical patients would be better served by increased capacity in the existing units and the development of systems that promote rapid assessment, diagnosis of injury and transfer, than by the development of a third unit.
The report acknowledges that this decision will be a disappointment to many who have campaigned for the establishment of a neurosurgical unit in the west. The HSE is convinced, however, that the implementation of the recommendations of the report represent the best way forward in building a high quality neurosurgical service that will meet the needs of the entire population.
With regard to transport, the helipad and telemedicine, it will take €11.5 million in capital costs to provide helicopter transport and €4.1 million running costs per annum, making a total of more than €15 million. That sum would resource a three consultant unit in Galway.
The HSE is part of a situation in which the west does not count. The composition of that committee was biased in the first instance and that is why the situation is as described in the report the Minister of State has cited on behalf of the HSE. I urge the Minister of State to bring this to the attention of the Minister for Health and Children, who visited the location and saw the need there.
I mentioned in my response that several people would be disappointed with this decision and obviously the Senator is one of them. It is unfair to say the committee's report is biased. The committee was given a job to do and I have explained the reasons for its decision. I will do as the Senator suggests and report back to my colleague, the Minister for Health and Children, Deputy Harney.