Neurosurgeons at Beaumont Hospital, Dublin, have said a State-run emergency air ambulance service would be preferable to establishing a neurosurgery unit on the western seaboard.
"An air service as proposed by the Helicopter Emergency Medical Service (HEMS) campaign would be cheaper, and it would make far more sense in terms of maintaining standards of care," Prof Jack Phillips, senior consultant neurosurgeon at Beaumont, told The Irish Times.
However, Prof Phillips acknowledged there could be an argument for a unit in the west to cater for emergencies and spinal injuries.
A third neurosurgery unit, based in Galway, would not be viable, and would not meet the standards demanded by the Specialist Advisory Committee in Neurosurgery for Britain and Ireland, according to Mr Daniel Rawluk, director of the National Department of Neurosurgery at Beaumont, and programme director for training in Ireland.
Comhairle na nOspidéal is reviewing the neurosurgical services at a time when a strong case is being made in the west for such a specialised unit at University College Hospital, Galway (UCHG), to complement existing services in Dublin and Cork.
The Western Neurosurgery Campaign, chaired by Ms Pam Fleming - whose son, Sammy (26), sustained brain injuries in a road accident in Co Galway - argues that road accident victims and other critically ill patients west of the Shannon cannot be treated due to the lack of a neurosurgery service.
Supporting the Western Neurosurgery Campaign is a leading Irish-American neurosurgeon, Prof Patrick Kelly, professor of neurosurgery at New York University. He has offered key medical equipment worth $4 million to UCHG if a unit can be included in the hospital's current construction programme.
The offer, made over three years ago, has been "hanging by a thread" for the past few months due to the Department of Health's reluctance to accept it, according to Prof Kelly's envoy, Ms Pat O'Dwyer, who asserted: "80 per cent of neurosurgical admissions are emergencies, which have to be seen immediately. So many lives could be saved, so many brain injuries with consequent and very costly lifelong care avoided at savings to the Exchequer if this unit was established."
Irish-American support for the initiative is becoming harder to sustain in the wake of the many charitable demands that followed the 9/11 disaster, she noted.
The proposal has been backed by the Western Health Board, which made the case for a neurosurgery unit back in 1989, when the last review of neurosurgical services was conducted by Comhairle na nOspidéal. This review recommended that all neurosurgical activity in Dublin be centralised at Beaumont, and said the unit at Cork Regional Hospital should be upgraded to minimum viable size.
As part of the new review neurosurgeons at Beaumont and Cork were invited to give their views. Mr Rawluk, department of neurosurgery in Beaumont, said: "We don't see the viability of a unit in Galway, given the population levels."
Mr Rawluk said he was aware that the Western Neurosurgery Campaign had cited Scotland as an example to justify the case for the western seaboard. Dundee has three neurosurgeons catering for a population of 600,000, while a unit in Tromso, Norway, caters for a population of 470,000.
"Scotland is now talking about closing down its smaller units as they were not viable under the staffing demands placed by the European Worktime Directive and maintenance of expertise," Mr Rawluk said.
The western campaign was basing its argument on standards that were 10 to 15 years old, he added. Trauma work was only one part of neurosurgery, and this could be served by setting up a HEMS service to fly accident victims to Beaumont - although the hospital still has no helipad, he acknowledged. The Specialist Advisory Committee in Neurosurgery would accredit a new unit in Ireland only if at least six neurosurgeons were appointed, he said.
Prof Phillips said neurosurgeons at Beaumont were not against the establishment of a unit in the west, if the appropriate standard of care was provided.
Ms Fleming also challenged Mr Rawluk's claim that small units were being reviewed in Scotland. Certain adaptations, such as "networking" of existing hospitals, were taking place to tie in with the European Worktime Directive, which will affect all small hospitals in all fields of medicine when implemented.