CENTRALISATION VS REGIONALISATION
there was a regional surgery site at University Hospital Limerick (UHL)
and two day-surgery sites in Ennis and Nenagh Hospitals. Significant
day surgery (three sessions per week), most paediatric surgery, and all
emergency and major procedures took place in UHL.
Post-reconfiguration, all emergency and complex urology cases were
dealt with in UHL. All `intermediate' cases were directed to St John's
Hospital. The UHL day sessions went to Ennis and Nenagh. All
extracorporeal shock wave lithotripsy treatments also went to Ennis
The establishment of the wider structure of the UL Hospitals Group
as part of the new network strategy took place last June. Assessing
the impact of the reconfiguration in the context of a regionalisation
strategy, Mr Flood identified both negative and positive impacts.
He commented: "Smaller surgical specialties can get trampled on.
Covering four hospitals every day and a 24/7 UHL call with just three
urologists is problematic. We also face severe challenges in delivering
prompt record transfers. The National Integrated Medical Imaging
System is available in only three or four hospitals. Emergency theatre
access is problematic and, overall, resourcing has not reached the levels
needed to deliver effective implementation.
"Having said that, there were some significant successes with the
reconfigured paediatric surgery arrangement widely acknowledged
to be an important advance. Equally, there have been dramatic
improvements in AvLOS and in DOSA rates."
CENTRALISATION INCREASES CUH OPERATING
Mr Eoin O'Broin, Cork University Hospital provided an overview of
his experience of reconfiguration of plastic surgery specialty services
in Cork and Kerry. He had welcomed reconfiguration of acute hospital
services in Cork and Kerry as a potential solution to the serious
challenges that the plastic surgery specialty faced in CUH. He said:
"Essentially, we had a mismatch of resources and surgical manpower.
All complex cancer and trauma work was funneled into CUH, which
also had an extremely busy emergency department."
With the reconfiguration, personnel moved from peripheral units
to CUH, resulting in an increase in operating capacity there. "The
minimum level necessary is two days operating a week, we're now at
two and a half days a week."
With centralisation, less complex procedures such as skin cancer
work, for example, moved to other hospitals in the network, although
CUH continued to have a complex workload and continued to handle
cancer, trauma and a subspecialty complex. While centralisation in the
new network environment has increased operating capacity at CUH,
unresolved issues remain to be addressed, Mr O'Broin notes: "Our
resources are being stretched to breaking point as we don't have enough
trainees to cover all sites adequately."
Ultimately, Mr O'Broin's view was that centralisation was inevitable but
"while it has huge pros, it also has a number of cons."