The Children's University Hospital, Temple Street has said that proposals by the Health Service Executive (HSE) to centralise surgery for young babies at Our Lady's Hospital in Crumlin are unnecessary and impractical, writes Martin Wall.
In a confidential submission to the HSE, Temple Street also warned that any loss of neonatal general surgery would affect other services at the hospital, hit staff recruitment across all grades and would threaten the survival of its paediatric intensive care unit.
The Irish Times reported last month that the HSE had proposed significant new reforms for paediatric services in Dublin to be carried out in advance of the development of the planned new national children's hospital. Under the proposals, neonatal surgery would be centralised at Crumlin.
The HSE also suggested that paediatric neurosurgical services could be developed at the Temple Street Hospital.
In its submission, Temple Street said proposals for the centralisation of specialist paediatric and neonatal surgery at Crumlin were first advanced more than a decade ago. However, it said that in the intervening years there had been a 200 per cent increase in the number of neonatal surgical cases dealt with annually at Temple Street.
It argued that "this number is now so significant that it is unlikely that with its present limitations that Our Lady's Hospital in Crumlin could cope with this increased workload".
The Temple Street report said the number of serious neonatal surgical cases at the hospital had increased from 23 in 2000 to 53 last year. It maintained that the number of general neonatal surgery cases had risen from 24 in 2000 to 77 in 2004.
The hospital said a small number of non-general surgical neonatal cases were also being carried out.
"If general neonatal surgery were to be lost to the hospital, it would be difficult to maintain adequate skills to care for this small number of neonatals from other sub-specialities. Some of these other neonatal surgical services are only provided on the Children's University Hospital site, eg opthalmology," according to the report.
It said it seemed unnecessary to fix what was clearly working well in the hospital while there were other areas in the delivery of children's healthcare services that had been highlighted as being sub-optimal and perhaps putting children at risk, such as paediatric neurosurgery.
The report said the current figures for Temple Street compared well with similar sites in the UK.
It said the successful management of neonatal surgical patients depended not only on consultant general surgeons but also on other medical personnel such as consultants in anaesthetics and intensive care medicine, consultant neonatologists, cardiologists, paediatricians, respirologists, neurologists, nephrologists, endocrinologists and specialists in radiology and pathology.
"The specialist paediatric anaesthetists and intensivists play a key role. They have acquired the appropriate skills to function at an international level with all the most up-to-date strategies.
"Loss of the neonatal service would result in the loss of this skill base. We are also concerned that any transfer of neonatal general surgery to another site would make it very hard to attract appropriately trained candidates to future consultant posts within the hospital in the immediate future," it stated.
The report said that intensive care facilities at Crumlin were operating at 100 per cent occupancy and that the hospital also had closed beds and difficulties recruiting and retaining nursing staff. Temple Street said it would not be logical to overburden the intensive care facility at Crumlin with further demands by transferring its neonatal cases there.
The report proposed that neo-natal intensive care services for children requiring general surgery should be run as a single system co-ordinated between both Temple Street and Crumlin.