A HSE review of neurosurgery actually makes the case for a unit in the west, argues the Western Neurosurgery Campaign. Lorna Sigginsreports.
When Minister for Health Mary Harney reads the Comhairle na nOspidéal report on neurosurgical services, she may be pleasantly surprised to find it makes a compelling case for establishing a new and third unit in Galway.
That's the view of the Western Neurosurgery Campaign (WNC) which says the report repeatedly contradicts one of its own key recommendations. The report, completed in September 2005 but released by the HSE just last month, identifies severe deficiencies in the current neurosurgical provision based in Dublin's Beaumont Hospital and Cork University Hospital and calls for significant investment.
In advising against setting up a new unit to serve the west coast, it says the population base wouldn't make it "viable" and might in any case "negatively affect" Cork by reducing its catchment population.
If that sounds like consultants jealously guarding their patch at the expense of the health and safety of people living in the west, there's more than a hint of same in the 59-page review. An analysis of the document by the WNC finds so many flaws in the argument that the Minister is, in its opinion, likely to be more convinced than ever of the need for neurosurgery in the west but also of the need to commit far more resources to neurosurgery generally. The Minister has as yet to respond to the report, but in January 2005, Harney indicated that she supported establishing such a unit in Galway - where cardiac and radiotherapy are already now in place - if there is to be "regional autonomy".
Certain accident cases requiring specialist neurosurgical treatment could not be transferred to Dublin for distance reasons, and the case for a service has been made in a "very impressive" presentation by the WNC, according to Harney.
The group, led by chairwoman Pam Fleming and including medical practitioners and Irish-American philanthropist Pat O'Dwyer (see panel), now hopes Harney will start asking the first questions from page 12 of the report. Here, section 3.3 of the 59-page document measures neurosurgical workload by the number of discharges with an operation, procedures undertaken through the National Treatment Purchase Fund and an estimate of private practice cases. This omits to take account of the number of patients requiring neurosurgery who were never referred or not accepted in either Beaumont or Dublin, and the fact that not all neurosurgical admissions require an operation, the campaign group says.
The review draws on the recommended minimum criteria for a viable neurosurgery unit identified by the Society for British Neurological Surgeons, which says such a unit should be staffed by a minimum of six whole-time equivalent consultant neurosurgeons serving a minimum catchment of one million people. However, units serving smaller populations can be considered where the surface journey time of two hours to a neurosurgery unit is exceeded, the society says, and where there is "concern that equity of access is significantly compromised".
As part of its research the Comhairle review group visited services in Britain and Australia including a unit in Aberdeen which has a population catchment of half a million. The review notes that management and consultant representatives there believed this Scottish unit to be "viable and necessary". They also visited another unit in Cairns, Australia, which has an even smaller population catchment of 250,000, spread over a large geographical area.
A complementary visit to the Royal Flying Doctors service base in Cairns noted that three fatal helicopter ambulance crashes in recent years had resulted in a reluctance to use helicopters except in exceptional circumstances - a point which the WNC notes in relation to Comhairle's recommendation that helipads be developed at Beaumont and Cork.
The report notes that 66 per cent of neurosurgical workload in Beaumont is emergency surgery, and in September 2005 the waiting list for inpatient neurosurgery stood at 426 cases - some 272 of which had been waiting for more than a year. The waiting list in Cork University Hospital was 24.
On page 36, the report notes that while many of the problems with the existing level of service provision are related to "capacity issues", the committee also found a "lack of collegiate networking, between the two neurosurgical units and with referring hospitals in their catchment areas".
The review does note that the WNC's own submission argues that Galway has a catchment population of up to 750,000 which is widely dispersed, and increasing. "On the other hand," it says, "during the consultation process the consultant neurosurgeons in Ireland stated their unanimous opposition to the establishment of a third neurosurgical unit."
Fine Gael east Galway senator Ulick Burke said: "If Galway is being caught up in a turf war between consultants in Dublin and Cork, at the expense of people's lives, I would hope that the Minister for Health would address that." He has raised the issue in the Seanad.
Dr Kevin Clarkson, consultant at University College Hospital, Galway, says the report is "entirely weighted" and questions the absence of an independent neurosurgeon on the committee.
Dr Oliver McAnena, HSE West's regional director of cancer services, says the findings must be understood in the context of chronic underfunding but argues that to deny the west coast a service is a "form of medical apartheid".
"The recent Estimates provide €4 million for such services for 2007, and yet Prof Ciaran Bolger, consultant neurosurgeon at Beaumont, is on the record as stating that €50-€100 million is required," McAnena says.
"If I was a consultant in Dublin or Cork trying to run a service with such under-funding, I would quite understand why a third unit in Galway might be seen to be drawing further from that limited resource."
Population catchments were used, and over-ruled, when campaigns were being waged for cardiac and radiation therapy services for the west, McAnena says: "Galway is now recognised as a supra-regional centre for cancer patients, and the cancer forum says it meets a population catchment of one million."