Minister for Health Simon Harris is facing objections within Cabinet over plans to rationalise the provision of trauma care services in hospitals across the country as part of a €57 million reform programme.
A new plan drawn up by an expert group and proposed to Government by the Department of Health would see the country divided into two trauma networks for dealing with patients who, for example, have experienced car accidents, head injuries or broken limbs.
There would be a major trauma centre established in Dublin and one in Cork, as well as a number of other units which would deal with less serious cases. The move would ultimately see three of the six Dublin adult hospitals currently providing trauma services losing these facilities as part of a centralisation process.
In Galway, there would be a trauma unit “with specialised services” but it would not have neurosurgical facilities.
Mr Harris's proposals are facing opposition from Minister for Communications Denis Naughten and Minister for Rural and Community Development Michael Ring.
Population dispersal
Mr Naughten has argued internally within Government that the new plan “fails to recognise the unique population dispersal around the country” and that there would be too many trauma units in Dublin under the proposals.
He has also contended that any reconfiguration of trauma services should not go ahead until proposed improvements in existing air ambulance services are introduced and additional ground ambulance resources provided.
Mr Ring has expressed concern there would not be a major trauma centre in the west, northwest or the midlands.
Minister for Justice Charlie Flanagan has sought assurances the Health Service Executive would use the new trauma policy to increase preparedness for dealing with mass casualty incidents.
Minister for Finance and Public Expenditure Paschal Donohoe welcomed the initiative but argued further work was required to set out current annual spending on trauma services and the number of patients affected.
He warned that the proposed additional €57 million revenue funding and €28 million capital costs involved in the new plan would be considered as part of the normal Government spending estimates process “in the context of other requests, strategies and the likely resources available”.
Less likely to die
Mr Harris has said up to 134 additional consultants could be required to operate the proposed new trauma system. He has told the Cabinet that at present hospitals are dealing with about 1,600 major trauma patients annually.
He said studies had consistently shown that severely injured patients were 15-25 per cent less likely to die if admitted to a major trauma centre than if admitted to other hospitals.
“The major trauma centre must treat a minimum volume of critically injured patients to maintain a critical mass of specialist expertise, which means that Dublin should have only two trauma units in addition to the major trauma centre to ensure necessary volumes,” Mr Harris has told the Cabinet.
He said all eight hospitals outside of Dublin which currently had 24/7 emergency departments and trauma and orthopaedic surgery had the potential to be designated as trauma units under the new plan.
He said the new plan did not address the broader mix of emergency department activity “or recommend any changes to emergency departments in any other hospital outside of Dublin”. He said trauma care represented a subset of emergency department activity which overall dealt with more than 1.1 million people each year.
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