Ministers say trauma reforms are too Dublin-centric

Two Government ministers have objected to proposals for a revamp of trauma centres, which include plans to treat severely injured patients at three centres in Dublin.

Minister for Environment Denis Naughten and Minister for Rural and Community Development Michael Ring want more trauma facilities located in the west than is proposed by the Department of Health.

The department has proposed a major streamlining of existing arrangements for treating people injured in incidents such as falls, car crashes and violent attacks.

Under Minister for Health Simon Harris’ proposals the State would be divided into two trauma networks, with one covering the south and the other designated as a larger “central network”.

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The exact boundaries of these areas are yet to be determined but it is envisaged that the central network could have a catchment population of about three million and the southern network would cover about 1.5 million people.

Within each network a hospital would be designated as a major trauma centre, one in Dublin and another in Cork.

But Mr Naughten has questioned why three trauma centres, including a major regional facility, should be based in Dublin.

Reconfiguration of existing arrangements should not take place before improvements to current air ambulance services are put in place, he has also urged.

Separately, Mr Ring has expressed concern at the absence of a major trauma centre in the west, northwest or midlands under the department’s proposals.

The department has argued that concentrating major trauma cases in centres containing specialist infrastructure and dealing with large volumes of cases would lead to better outcomes.

The recruitment of additional staff is forecast to cost between €53 million and €57 million, while the capital costs for the system could be some €28 million

Major trauma centres “must treat a minimum volume of critically injured patients to maintain a critical mass of specialist expertise,” it says. In the UK, the Royal College of Surgeons of England recommended that such major trauma units should admit a minimum of 250 critically injured patients annually.

Specialist services

The department has proposed to Government that within the system the larger central network would also have a trauma unit containing specialist services – but not neurology – which it suggests would be located in Galway.

The plan envisages each network having a number of trauma units – three in the southern area and seven in the central network.

It is estimated that up to 134 additional consultants could be required to operate the new system.

It could also require the appointment of up to 50 non-consultant hospital doctors as well as 226 nurses and more than 90 health and social care staff. The recruitment of additional staff is forecast to cost between €53 million and €57 million, while the capital costs for the system could be some €28 million.

Minister for Public Expenditure Paschal Donohoe has welcomed the new initiative while warning the additional funding – estimated at up to €57 million – would have to be sought under the annual budgetary estimates process.

Minister for Justice Charlie Flanagan sought assurances that a new national trauma policy would "increase the preparedness for mass casualty incidents".

Under Government rules the Department’s proposals were circulated to members of the Cabinet for their consideration in advance of the issue being considered by ministers.

In his observation, Mr Naughten argued the new trauma policy “fails to recognise the unique population dispersal of the country”.

“The Minister is unclear as to why the Dublin area is to have three designated trauma units (one major) but the proposed south region, which serves a similar population, has only one specifically designated in the plan.

“It would seem from the best international practice that the Dublin area should just have one major trauma centre rather than being supplemented with two additional ancillary centres so that all of the specialist expertise is located on one site and not spread over three sites.”

Mr Naughten’s official observation said there had been a failure to date to progress the night-time operation of helicopter emergency medical services and to expand it from a single aircraft as provided for under the Programme for Government.