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the president writes
of Irish hospitals into six hospital groups, organised around medical
schools as central hubs promoting education and research. RCSI
welcomes the announcement of the hospital networks and anxiously
awaits the Governance arrangements to be put in place.
While this concept was easily deliverable through the Cork and
Galway medical schools and the three medical schools in Dublin,
the South East Region proved problematic. Historically, the South
East has been organised into a region built around the South Eastern
Health Board. This grouping of hospitals has now been broken up
with St Joseph's, Clonmel and Waterford Regional Hospital linked
to University College Cork and St Luke's, Kilkenny and Wexford
Regional Hospital becoming part of the Dublin East network.
Networks will allow, at least within larger regions, rationalisation
of acute trauma services and vascular services to add to the already
rationalised cancer services. They will also, it is hoped, allow the
development of protected elective surgery services in hospitals from
which trauma and acute surgery will be diverted.
There was improvement in throughput of elective surgery towards the
end of 2012, via the Elective Surgery Programme and support from
the Special Delivery Unit, but the `winter surge' undid much of the
progress. In many hospitals, elective workload remains an easy option
to sideline in order to facilitate targets for emergency room waiting
times. I am concerned about the target-driven ethos of Department
of Health and HSE policy makers. The recent Francis Report on the
mid-Staffordshire scandal identified an obsessive focus by hospital
management on achieving targets, rather than delivering quality of
care, as fundamental to the genesis of problems there. We have an
opportunity to avoid such mistakes here.
workforce morale
Our new Surgical Training Pathway seems to have generated renewed
interest in surgery as a career. Despite this, morale among NCHDs
and Consultants is at a low ebb. The Department of Health and
the HSE is driving a major change process throughout the health
service at a time of major financial constraints. Working hours of
some NCHDs are unacceptable and many incidents of significant
exhaustion and ill health have been attributed to excessive hours.
The Department and the HSE have suddenly taken a great interest in
implementation of the European Working Time Directive. There is a
sense this is related to potential financial savings rather than concern
for NCHDs. We have clarified that it is impossible to train a surgeon
within the time constraints Europe proposes.
Through the development of skills courses, mobile skills units and
didactic teaching based in RCSI, we support surgical training outside
the hospital setting. However, surgical experience, in its truest sense,
is only achieved in a hospital setting, where trainees care for surgical
patients and observe their treatment in operating theatres. Continuity
of care, fundamental to surgical training, will be adversely affected by
rigid imposition of working time directives.
camPus DeveloPment
At time of writing, the Finance Committee and the Council of
the College have signed off on the plans for the New Academic
Education Building (NAEB), which will be located on York Street,
opposite the main entrance to our St. Stephen's Green Campus.
This will be an eight-storey building, including three underground
levels. The top two floors will be the surgical and clinical skills
centre, providing state-of-the-art facilities for undergraduate and
postgraduate students. The Surgical Skills Training Centre will
include a skills simulation centre and a surgical training centre
which will be inter-independent with the clinical skills centre.
The next step is the application to Dublin City Council for
planning permission. We hope to commence building later this
year or early in 2014.
consultant surgeons
There has been significant change in the delivery of surgical
services at our hospitals in the past number of years, characterised
by steady shrinkage in resources enabling skilled surgeons to do
their jobs appropriately. It is not uncommon that a Consultant
Surgeon will have operating room access for elective work on
only one day, or even half a day per week. A recently appointed
General and Breast Surgeon has one half day operating every
These circumstances are custom-designed to produce disaffected
young surgeons. The problem is compounded by the fact that,
under the new contract's terms, these young surgeons are
prevented from operating in private hospitals. Several private
hospitals have plenty of available theatre resource and excellent
nursing staff to provide high-quality surgical care. There are idle
surgeons, unoccupied operating theatres and growing numbers
of patients waiting. Daft ideologies must be set aside and valuable
surgical resources must be used.
In discussions with the Minister for Health, we have put it to
him that, surely, he does not want to promulgate a dysfunctional
health delivery system designed by his predecessor. Leaders of
the profession must bring their opinions to bear, sooner rather
than later. Otherwise, this financially constrained administration's
concentration on number-crunching while medical personnel
are sidelined and demoralised will do irreparable damage. I
assure you, our Members & Fellows, that this College will not
be found wanting in engaging forcefully and meaningfully, on
your behalf, to ensure the preservation and renewal of our strong
surgical tradition.
Professor Patrick J. Broe MCh FRCSI
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