‘Tentative’ discussions with Beaumont on neurosurgery

The Mater Misericordiae University Hospital has had “tentative” discussions with Beaumont Hospital around future neurosurgery provision, in the context of the Mater’s bid for major trauma centre status, according to the Mater CEO.

Speaking to the Medical Independent (MI) at the Mater’s 4th annual trauma conference, Mr Gordon Dunne commented: “We have had initial discussions, very tentative at this point in time, but positive, and there has been positive engagement.”

At last year’s trauma conference, Mr Dunne told MI the Mater envisaged that elective and emergency neurosurgery could be separated, but operate under one governance framework. The Mater would deliver the emergency service as a major trauma centre.

Also at the 2018 conference, the National Director of Neurosurgery at Beaumont, Mr Mohsen Javadpour, warned that neurosurgery must not become “fragmented” as a result of trauma service configuration. Mr Javadpour said it would be “hard” to separate the elective and emergency work.

However, Mr Dunne said the Mater has identified international models, in London and northern Australia, where the structure is successfully deployed.

“What is clear is that, like most services in Ireland, neurosurgery is under-resourced the same as most other surgical areas, and our colleagues in Beaumont have been finding that as well, in our discussions and [it was raised] at the conference last year. So we need an additional resource – it is just how we configure that resource to best meet the needs of the patients.”

A Trauma System for Ireland: Report of the Trauma Steering Group, published by the Department of Health in February 2018, recommended the establishment of a major trauma centre in Dublin city and at Cork University Hospital, which would each operate within two trauma networks.

The Trauma Review Implementation Group (TRIG) is expected to issue a call for submissions shortly and a decision is anticipated later this year.

A spokesperson for Beaumont told MI: “It is correct that RCSI Hospitals Group, Ireland East Hospital Group, Mater Hospital and Beaumont Hospital identified that the model of care espoused by the national strategy ‘A Trauma System for Ireland’ requiring the development of a hub-spoke central Ireland network could be best achieved through a joint engagement of the two Hospital Groups.

“As such the optimal solution being a collaboration of existing clinical specialties from Beaumont Hospital and the Mater Hospital, these being the only two level IV hospitals possessing all clinical specialties relating to Major Trauma (with the exception of burns). This development potential has been identified to both Minister Simon Harris and the HSE.”
However, Beaumont’s spokesperson added there had been no discussion between the Groups or hospitals on the specific matter of neurosurgical elective and emergency services being geographically segregated between the two hospitals.

“Segregating a section of existing neurosurgical emergency patients in the manner (apparently) outlined by the Mater Hospital CEO is unlikely to be successful unless all existing neurosurgical services (direct/support) are duplicated on the Mater Hospital campus.”
This would be “inefficient and very costly from both a capital and revenue perspective with no likely patient outcome improvements being achieved”.