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The positives he cited are:
increased elective capacity;
increased efficiency in small cases; and,
the advantages of elective facility accessibility.
Negatives he identified were as follows:
lack of integration, lack of IT capacity in relation to transfer of
patient information and lack of clerical support;
insufficient trainees to cover sites; and,
medical cover may be problematic.
A COLD EYE ON CENTRALISATION
Professor Peter Gillen, Our Lady of Lourdes Hospital, Drogheda
concluded the series of presentations with the afternoon's
most acerbic assessment of centralisation over the period from
the development of the cancer strategy to today's networked
environment.
On the issue of achieving constructive change within the new
networked environments, he remained sceptical. Praising the
work of the National Programme in Surgery and its Joint Leads,
Professor Frank Keane and Mr Ken Mealy, in developing the
Model of Care for Acute Surgery, he pointed out that its successful
implementation in a networked environment must take account of
six key factors:
populations within each catchment area;
workload and capacity of existing units;
specialty and subspecialty availability;
accessibility, transport links and travel times;
historical referral patterns based on academic links and previous
health board structures where appropriate; and,
potential cross-border services.
He felt these factors are not being adequately considered and, as an
example, he pointed to the capacity issues resulting from a lack of
theatre nurses in Level 2 hospitals: "In fact, the pool of nurses has been
declining in numbers year on year for a long time. The combination
of early retirement packages and a lack of new, young qualified nurses
means there's no sign that this trend is set to change."
He argued that the designation of hospitals as Level 4, Level 3, Level 2S
and Level 2 has the effect of encouraging surgeons to seek employment
primarily in Level 4 hospitals. In a phone survey he personally carried
out in 2007, he asked SpRs if they would apply for a job in a non-cancer
centre and 87% said `no'. Professor Gillen carried out the survey again
this year and found the proportion answering `no' was now 100%. The
message, in his view, is clear: "The train for Level 4 has left the station
and not even Denzel Washington can stop it."
He concluded the session's formal presentations with an ironic
endorsement: "Keep calm and carry on networking..."
SURGICAL STRIKES
A sample of some of the diverse opinions reflecting a complex and sometimes contradictory set of experiences
expressed in the post-presentation interactive session, moderated by Mr M. Kevin O'Malley.
"The cancer hospital strategy hasn't worked. Networks could present an opportunity to revisit the strategy and
correct its deficiencies."
"If the networks are given autonomy, they could work; if there is a very centralised control, they will be just another
random bunch of groups without the power to achieve anything."
"Where is the vision for elective surgery within the centralisation vs regionalisation debate?"
"In hospitals in the West, surgery is being side-lined."
"Protecting surgical beds in the Mid West transformed the way we did surgery. It has made the environment so much
more positive to work in."
Mr Paul Blair.
Professor Peter Gillen.
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