NATIONAL PROGRAMME IN SURGERY
Professor Frank Keane
Mr Ken Mealy
delivery during initial admission."
Audit, Mr Mealy emphasises, is not a `bean counting exercise' but
a pragmatic path to measure and improve the quality of care that a
patient receives. Patient safety will benefit hugely from the current
development of a comprehensive range of sophisticated clinical
audit mechanisms such as Irish Audit of Surgical Mortality, the
Trauma Audit and Research Network (TARN) and the Irish National
Orthopaedic Register, he adds. "The development of a strong audit
framework and better measurement of clinical outcomes is essential
to the provision of accessible and effective patient care. We have
made a good start. We must not waste the hard-won opportunities
presented by our progress to date."
WHITHER THE NPS?
Professor Keane echoes Mr Mealy's comments and warns against
complacency. "Much has been achieved to date but there are many
challenges still facing us. An array of concerns threaten the progress
that has been made so far. Firstly, there is a shortage of surgeons and
significantly increased demands on the cohort of surgeons that we do
have, who are being asked to do more work and give greater amounts
of time to teaching and administration.
"Simultaneously, there is less support available within hospitals,
because of recruitment constraints and the inflexibity of the
requirements of the European Working Time Directive. All of
these factors are exacerbated by evidence of an increasing shortage
of nurses, in critical areas such as operating theatres, and allied,
supporting health professionals, such as physiotherapists."
The cumulative effect of these trends means that the NPS must be
supported and encouraged by all stakeholders, if current gains in
performance and patient treatment are to be sustained, he said.
Professor Keane is mindful too, that the surgery programme is one
constituent part of a wider strategic initiative. "The NPS is one of a
portfolio of programmes developed by the HSE's Clinical Strategy
and Programme Directorate and, while these programmes have
evolved individually, it is vital, if they are to be effective, that their
future development is integrated in a systematic and coherent
"Most importantly, these programmes some of which are
specialty-focused, some of which are condition-focused need to
be worked and developed with a degree of mutual awareness of their
Professor Keane added: "In particular, programme development
of areas not currently in train, such as general practice, must
be addressed, with support from existing programmes where
appropriate, including the surgery programme, but not at the cost of
neglecting existing programmes. Otherwise, we're adopting a `one
step forward, two steps back' approach."
He concluded: "The NPS is now at a critical juncture. The progress
that has been made to date is significant and encouraging but cannot
be taken for granted. The full potential of the programme will only
be realised through the sustained determination and commitment of
all who have responsibility for delivering the best, most efficient and
most appropriate surgical care to patients."