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Proposal for eight-bed national intestinal failure unit in St James’s Hospital

According to available data, more than 256 patients with intestinal failure were discharged on intravenous nutrition between 2010 and 2016 from at least 21 hospitals in Ireland, none of which have the training, resources or specialist experience required to meet minimum guidelines or commissioning standards produced within the NHS system in the UK.

The proposal has been put forward by the Irish Society for Clinical Nutrition and Metabolism (IrSPEN) to bring the standard of care in Ireland in line with other countries in Europe.

Consultant Gastroenterologist in St James’s Hospital, Dublin, Dr David Kevans told the Medical Independent (MI) that while Northern Ireland has a well-developed unit, there is none in the south, despite its higher population.

“If you are an intestinal failure patient in the North, you have a very strong, structured service; if you are in the Republic of Ireland, you have all the acute hospitals doing great work and [staff] work hard, but they don’t have the appropriate infrastructure to manage these patients, even with the best will in the world.”

He added that while there is a strong paediatric intestinal failure unit based in Our Lady’s Children’s Hospital, Crumlin, the concern is what happens to these patients when they transfer to adult services.

The proposal for a national unit in St James’s would be to start incrementally, where 50 per cent of patients would be seen over a three-year period, and then for services to be expanded, potentially to other parts of the country afterwards.

“We really need a dedicated capital outlay to develop a unit or units; whether there would be one unit or two, for example, would be an open discussion,” said Dr Kevans.

He added: “If it happened elsewhere, we would just be very happy that it happened.”

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