Duplication of services is a little-discussed aspect of the problems faced by the Irish health service. For a small country, we have a large number of general and maternity hospitals, often with overlapping services. Smaller facilities with lower throughput of patients and no direct link to teaching hospitals often struggle to attract qualified staff.
As a new report on the future of emergency surgery in Ireland points out, 25 hospitals across the State provide this service round-the-clock. This has implications for many of these hospitals, with services reliant on the use of locum staff and, in some cases, the employment of consultants on the general register in specialist roles.
This is not optimal for patients but it is also unsatisfactory for staff, requiring them to work many on-call shifts through the night. Previous generations of surgeons might have accepted this level of disruption in their lives, but this is less the case nowadays. As a result, it is becoming a challenge to attract suitably qualified staff into surgery, and to retain them after employment.
The Royal College of Surgeons in Ireland report, entitled Surgery for Ireland, proposes a new networked approach to the provision of emergency surgery.
It suggests many of the existing centres should cease working 24/7, a proposal that is likely to prove contentious. To compensate, the report suggests bolstering day-time services through the wider provision of acute surgical assessment units for straightforward work, along with emergency surgery units and larger centres, linked to elective hospitals.
These new structures would deliver a higher quality service to patients and a better working environment for staff, it suggests. They could be delivered within the proposed new regional health areas (RHAs) due to be set up later this year.
Given the extent of the staffing crisis in the health service, doing nothing is not an option. This report should be seen as one part of a jigsaw designed to make hospitals more attractive to work in for staff, as well as safer for patients.