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haired by Mr M. Kevin O'Malley, Mater Misericordiae
University Hospital, Dublin, the session featured
presentations from speakers with informed insights
on the realities of centralisation and regionalisation
processes in the health care sector, each from a
different specialty and geographical region:
Vascular surgery Mr Paul Blair, Royal Victoria Hospital, Belfast;
Urology Mr Hugh D. Flood, University Hospital, Limerick;
Plastic surgery Mr Eoin O'Broin, Cork University Hospital; and,
General surgery Professor Peter Gillen, Our Lady of Lourdes
Hospital, Drogheda.
CHANGE DRIVERS IN NORTHERN IRELAND
Mr Paul Blair, Royal Victorial Hospital, Belfast, opened his overview
of the changes in vascular surgery in Northern Ireland by identifying
key drivers of change in the specialty. Increased questioning of the
effectiveness of existing approaches in the UK was spearheaded both
by the Vascunet Report (2008), which suggested that mortality after
open aortic aneurysm repair was too high, and by regional reviews that
indicated an imbalance in the distribution of vascular surgery work
among hospitals. In the case of London, for example, Mr Blair noted:
"About 75% of surgery took place in six hospitals. This was not deemed
appropriate for achieving optimal outcomes for patients."
In response, in 2009, after consultation with its membership, the
Vascular Society of Great Britain and Ireland (VSGBI) Council
endorsed a framework for quality improvement in elective abdominal
aortic aneurysm (AAA) repair surgery with the aim of halving
the elective mortality rate for AAA surgery in the UK (to 3.5%)
by 2013. Implementation of the Abdominal Aortic Aneurysm
Quality Improvement Programme in Northern Ireland culminated
in 2013 with the Northern Ireland Vascular Surgery Registry
(NIVASC) producing an overview of the options for change. The key
recommendations that emerged from the Northern Ireland Vascular
Review (NIVR) included:
the establishment of a single arterial centre in Belfast with 10-12
Surgeons (eight IRs) and 42 beds;
decentralisation of VVs, AV fistula, minor surgery; and,
local investigation and imaging.
The establishment of a reconfigured vascular surgery service was
followed by the merger of Belfast City Hospital and the Royal Victoria
Hospital. According to Mr Blair, the merger process, while challenging,
was successful thanks to the level of professional respect and courtesy
shown by all involved and the unifying effect of the NIVR. He
highlighted key issues that need to be managed in a merger process:
"It's important to get everybody involved in the process early. Lack of
initial engagement causes problems later. Similarly, it's important to
establish and integrate multidisciplinary teams as soon as possible.
It's about patients, not politics and you will have to be prepared to
make brave decisions. And, of course, the whole process must be
appropriately resourced."
RECONFIGURATION: A MID WEST PERSPECTIVE
Mr Hugh D. Flood, Consultant Urologist with the Department of
Urology, University Hospital, Limerick shared his experience of
the implications of regionalisation for the reorgansation of urology
services in the mid-west.
The Teamwork Report 2008, Mr Flood explained, envisaged that no
acute service would be withdrawn from the current general hospitals
until the regional centre of excellence was resourced and ready to
deliver that service with reference to international quality standards.
Mr Flood added that the report had stated as a precondition for
reorganisation that adequate infrastructure must be in place such as
clinically-relevant information technology and access to diagnostic test
results.
The reconfiguration of surgical services in the Mid West took place
in 2009 and Mr Flood compared the urology services of the pre and
post-configuration eras. Pre-reconfiguration, i.e. before October 2009,
"IT'S ABOUT PATIENTS,
NOT POLITICS"
A SUMMARY OF THE HIGHLIGHTS FROM THE PLENARY SESSION,
AT THE RCSI CHARTER DAY MEETING, FRIDAY, FEBRUARY 7, 2014,
ENTITLED "CENTRALISATION VS REGIONALISATION WITHIN A
NETWORKED ENVIRONMENT"
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