Tuesday, 2 July 2019

Questions (54)

Barry Cowen


54. Deputy Barry Cowen asked the Minister for Health the status of the implementation of the trauma strategy; if the Midland Regional Hospital, Tullamore will provide the trauma unit for the midlands; and if he will make a statement on the matter. [27771/19]

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Oral answers (6 contributions) (Question to Health)

As the Minister is aware, the report of the trauma steering group published in February 2018 highlighted that 16 acute hospitals, including the Midland Regional Hospital in Tullamore, which could potentially meet the designation criteria for trauma units. There is an overwhelming case for a trauma unit to be located at Tullamore hospital, given that it is the only one of the 16 hospitals to be located in the midlands. It was stated by Fianna Fáil on the publication of the report that the onus was on the HSE and the Minister to implement its findings quickly and sanction the resources for units to fulfil their role. Some 17 months on, we would like to know what progress has been made. Not much, it appears. Why is that so and when can we expect decisions to be taken in that regard?

The report of the trauma steering group was approved by Government in 2018 and a HSE interim implementation group is currently progressing its four immediate actions, the first of which was the recruitment of a national clinical lead. Mr. Keith Sinnott has been appointed to that position. The second action relates to orthopaedic trauma and major trauma bypass protocols, the third relates to the selection of a major trauma centre for Dublin and the fourth relates to detailed implementation planning. I am pleased to state that significant progress is being made on the four immediate actions.

On 21 June, the formal process for the designation of the major trauma centre for the central network commenced, with each of the Dublin hospital groups invited to make a submission which will be reviewed and scored by an independent assessment panel comprising local and international experts. On 1 July, the national clinical lead for trauma services assumed his position. In order that decisions are made that ensure the best configuration of trauma services from a population health perspective for the Dublin region and the wider central trauma network, of which Tullamore is part, the submissions will also be considered for designation as Dublin trauma units. It is expected that a final recommendation to my Department will be made in autumn. There are 16 acute hospitals which could meet the criteria for trauma units, including the Midland Regional Hospital, Tullamore.

It is expected that further detailed implementation planning, including the designation of trauma units nationally, will be required to fully implement the trauma strategy, and this will be led by the newly appointed national clinical lead and the office for trauma services. On foot of the Deputy's question, I will ask that the new clinical lead, Mr. Sinnott, meet management of Tullamore hospital as it is one of the 16 potential centres.

I thank the Minister for his reply, particularly his final point that, further to that process having commenced, he will ask the clinical lead to meet representatives of the relevant hospitals, particularly Tullamore. The steering group in its report and recommendations pointed out that many of the 16 hospitals currently provide acute trauma care and that there are some resource deficiencies which need to be further enhanced in order to ensure the level of provision required to meet their current roles in addition to fulfilling the designation criteria. Can the Minister confirm that there is provision within the capital programme to ensure that whatever improvements are necessary to meet current delivery are made, let alone what might ensue on foot of the designation in the autumn?

The Deputy is correct that this will involve revenue and capital costings. The overall estimated maximum staffing requirement suggests that an indicative estimate of revenue costs of €53.6 million on the cost of developing orthogeriatric fracture liaison services is included. This can be considered as a gross cost which carries a need for careful examination because there are existing staffing levels and opportunities to optimise efficiencies. The national service plan 2018 provides for seed funding, mainly for the establishment of a national office for trauma services and the national clinical lead for trauma services. That office will prepare its estimate bid in regard to our existing trauma services. There will also be capital requirements and I am considering them in the context of a capital plan I am finalising with the HSE. I am happy to share with the House an indicative estimate of a capital cost of approximately €28 million over a seven-year period.

I wish to reaffirm that there is provision within the HSE and hospital services estimate to provide for improvements over a seven-year period notwithstanding another commitment which will ensue once the nomination in respect of the allocations has been made by the clinical lead for trauma services. I am conscious of the fact that the major trauma centre may be placed in Dublin along with a satellite to serve the wider region. I hope that due consideration will be given to all relevant hospitals in the process of selecting the site of the satellite unit and that a Dublin hospital is not selected by way of compensating it for not being selected as the location for the major centre.

The Deputy will agree that it is important that this decision will be made by clinicians and an independent assessment panel and independent of me and the House. Deputies regularly raise with me the cases of constituents who are in hospital as a result of a very bad trauma and need to be transferred to another hospital which can better deal with their complex needs.

This is about ensuring that we can get the patient to the most appropriate hospital. For a limited number of trauma procedures, this is not about altering the significant footfall that goes into hospitals; it is about the small number of patients who have undergone severe trauma. It is about getting them quickly to the appropriate hospital. That is the right thing to do. This will not be a Dublin-centric model though. While there will be a major trauma centre in Dublin - that will not come as a surprise to anyone - there will also be trauma units at other locations throughout the country. These will be able to deal with all but the most complex cases. I am happy to keep the Deputy updated as the plan advances.

Written Answers are published on the Oireachtas website.