There are severe deficiencies in the current provision of neurosurgical services in the Republic and significant investment will be required to address them, according to a report drawn up for the Health Service Executive. Eithne Donnellan, Health Correspondent, reports.
The unpublished report which has been seen by The Irish Times states that these deficiencies are in staffing, beds and theatre access as well as lack of specialised equipment.
There are two neurosurgery units in the State - at Dublin's Beaumont Hospital and Cork University Hospital - and both need to have their capacity and staffing enhanced as soon as possible, it says.
But the review carried out by Comhairle na nOspidéal comes down against setting up a third neurosurgical unit at Galway's University College Hospital. It says such a unit, given the population it would serve, would not be viable.
Referring to long waiting times for patients in need of admission to neurosurgical units which would include those with head injuries and brain tumours, the report says: "There are lengthy hold-ups at all entry points to the neurosurgical services."
It adds: "Emergency/urgent referrals often wait unacceptably long to be admitted to a neurosurgical unit for surgery. This usually means that patients are cared for in the general intensive care unit of a general hospital without neurosurgical services until a bed becomes available. This has potential morbidity and mortality consequences for such patients and, as such, is considered unacceptable."
There are also lengthy waiting lists for non-emergency admissions for surgery, for day case neurosurgical services and for outpatient appointments. In September 2005 the waiting list for inpatient neurosurgery at Beaumont stood at 426 and more than half of these had been waiting for more than a year for surgery.
On the long waiting times for outpatient appointments, it says: "This means that there is potential for significant deterioration before assessment and can result in increased numbers of patients presenting at A&E in order to bypass the outpatient system."
Regional hospitals, the report states, find it "extremely difficult" to have a patient transferred to a bed in a neurosurgical unit due to lack of availability. The situation seemed to be particularly marked in areas referring to Beaumont. And it says the use of air transport to transfer patients is "seriously inhibited" by the lack of a helipad at either Beaumont or Cork University Hospitals.
The report says "a significant proportion" of acute neurosurgical beds are at any given time occupied inappropriately by patients awaiting return to referring hospitals, rehabilitation or long-term care facilities".
It recommends the Dublin unit be staffed by 10 consultants - it currently has six. It says the Cork unit should be staffed by six consultant neurosurgeons - it currently has three. And both units, it says, should have ringfenced beds and theatres. Both hospitals should also be equipped with a helipad and better diagnostic and telemedicine services are needed at referring hospitals, it says.
The HSE says it will implement the recommendations and that paediatric neurosurgical services should be provided at the new national children's hospital when it is built at the Mater, with consultants at Beaumont serving the two units.
A spokesman for Beaumont Hospital last night welcomed the report, describing it as "thorough and enlightened" and entirely consistent with a submission recently made by it to the HSE for funding to improve its services.