background image
S
ince my fi rst involvement in RCSI in 1991, there
has been a long campaign for the introduction of
countrywide audit among surgical practitioners.
Th ere is no doubt that RCSI's work in conjunction
with the HSE, over the last number of years, in
relation to Clinical Programmes has contributed to
the establishment of the National Offi ce of Clinical Audit (NOCA).
NOCA
In particular, direct support from Dr Philip Crowley, Director of
HSE Quality and Patient Safety combined with the determination of
Ken Mealy, a long-time advocate of clinical audit and patient safety,
has allowed RCSI to lead the way in establishing governance and
framework structures through the NOCA. Th e NOCA is governed
by a multi-stakeholder Board, chaired by myself, which is currently
overseeing the design, delivery and governance of several audit
streams, including the Irish Audit of Surgical Mortality; the Irish
National Orthopaedic Register, the National ICU Audit linked to
ICNARC UK and, most recently, a Major Trauma Audit which will
connect to TARN UK.
In relation to the Audit of Surgical Mortality, there has been a delay
in commencement because of the issue of confi dentiality of the
data. Essentially, we will need a new Health Information Act passed
by the Government to guarantee that information provided to a
database will be privileged and not subject to discovery, freedom of
information or data protection legislation, or any other possibility of
release, under legal threat. With these safeguards in place, all of the
surgeons in the country will be in a position, I hope, to commit to
this audit so that we will have a true and accurate fi gure on surgical
mortality in this country.
We are all aware of the Scottish Audit of Surgical Mortality which
has been in existence now for 20 years. Th ey have a similar system
in Australia and New Zealand. Mortality audits work in those
countries because the data is privileged. Nothing short of that will
be acceptable in this country.
Th e Australia and New Zealand Audit of Surgical Mortality
(ANZASM) has published case studies with a summary and
useful clinical lessons. Arising out of these cases, there are overall
recommendations, which include communication between all staff ,
the need for senior clinical leadership, the special signifi cance of
the acute abdomen in the elderly and the importance of accurate
recording of all data. ANZASM is now including private hospital
data in New South Wales and expanding into Queensland.
Many of you will be aware of the recent controversy over
publication of individual surgeon outcomes in the UK. Th is, as we
all know, will inevitably lead our policy makers and Government
to move towards this method of demonstrating surgeon
accountability and transparency in Ireland. RCSI, as a College,
must be centrally involved in discussions on an appropriate
accountability model and not have an unworkable system foisted
on the profession. Th e NOCA is the ideal governance mechanism
through which surgeons' outcome data can be managed and
published. I fi nd it ironic that we have been encouraged to
work as multidisciplinary teams over the past decade and yet,
now, apparently, outcomes are to be assessed on an individual
rather than a unit basis. We must manage this issue actively and
carefully it is all too easy for an individual surgeon's reputation
and, indeed, a national reputation for surgical excellence, to be
damaged.
ADVOCACY
RCSI is the voice of surgery in Ireland on issues of education, training
A TIME FOR VISION
AND LEADERSHIP
IN THE RECENT FREYER STATE OF THE ART LECTURE, PROFESSOR
PATRICK J. BROE, PRESIDENT, RCSI, WELCOMED THE SURGICAL
CARE BENEFITS THAT A NATIONWIDE AUDIT CAN BRING AND
CALLED FOR MORE VOICES TO CHAMPION THE PROFESSION
THE FREYER STATE OF THE ART LECTURE
Professor Patrick J. Broe, President, RCSI delivered the Freyer State of the Art Lecture entitled
`Irish Surgery: The Need for Vision and Leadership' at the Sir Peter Freyer Surgical Symposium in
NUI Galway last September. During a wide-ranging address, Professor Broe looked at key issues
confronting the healthcare sector. In this selected extract from the full presentation, he discusses
the importance of advancing the audit of surgical practice, calls for more voices to speak out
on behalf of surgeons, and urges surgeons themselves to apply their leadership skills to the
development of a broader, more ambitious vision for patient care. The full lecture is available
to download at www.rcsi.ie/fi les/newsevents/docs/20130918044034_Freyer%20Lecture.pdf
22
Sir Peter Johnson Freyer
K.C.B., M.D., M.Ch., M.A. (Hons. Caus.), L.L.D. (Hons. Caus.)
Surgical_Scope_ISSUE2.indd 22
30/01/2014 15:39