Health: a system stuck in a holding pattern

26 hospitals can receive trauma patients but not one fulfils the criteria for designation as a major trauma centre

 

When, one is entitled to ask, will real reform of the health service begin? Waiting lists for appointments and operations are at record levels, as are the number of patients on trolleys in emergency departments. These problems can only get worse as the population ages.

There is a plan for the future, in the form of the Sláintecare report published last year. Its proposals enjoy cross-party support for the most part, but there is no agreement on how to fund its ambitious objectives. So we remain stuck in a holding pattern whereby the Government inches forward with implementation of the report.

Sláintecare was long on proposals for additional spending, despite the fact that Ireland’s health spending is already well above the international average. It was much shorter on the detail of reforming the system to reduce waste and overspending while improving outcomes. Yet there is much that can be done to achieve these objectives now. The streamlining of trauma services is a case in point. Currently, 26 hospitals can receive trauma patients, though not one of them fulfils the criteria, in terms of services and patient throughput, for designation as a major trauma centre. About one-quarter of patients have to be taken from their original hospital to a better equipped facility. Almost half of patients with a brain injury never get to be treated in a neurological unit. Severely injured patients are not getting the right care, where they need it.

It is more than a decade now since cancer services were rationalised. The National Cancer Control Programme was established, and services were centralised in eight sites in place of the 30 centres that previously treated patients. The result was a dramatic improvement in patient outcomes. The same process needs to be undertaken in a number of areas of the health service, including trauma. This is not happening, though, for a number of reasons, but mainly due to political opposition to the loss of locally-based services, even when these are sub-optimal. Witness the delay in reconfiguring the Midland Regional Hospital in Portlaoise, despite the serious concerns of senior clinicians about standards there.

It comes as no surprise therefore to learn that the Department of Health’s plans for streamlining trauma services is meeting resistance, and that this resistance is to a large extent based on regional considerations rather than concerns over improving quality and outcomes. Ministers Denis Naughten and Michael Ring – both based west of the Shannon – appear to want more services located in Connaught. There may be some merit in Naughten’s objection to the siting of three trauma centres in Dublin – why not in one location? – but it behoves Minister for Health Simon Harris not to delay in implementing trauma care reform in a way that will ultimately save lives.

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