The Royal College of Surgeons in Ireland (RCSI) has proposed a new networked approach for emergency surgery.

The Surgery for Ireland report, which will be launched at the College’s annual Charter Day meeting, sets out a series of recommendations including that new emergency surgery networks should include injury units, emergency surgery units and emergency surgical centres, with each network supported by access to an elective hospital.

The RCSI report proposes that acute surgical assessment units should be available in every hospital receiving surgical emergencies to streamline surgical assessment and treatment and to allow a reduction in the number of hospitals providing out-of-hours emergency general surgery.

 “Access to high quality emergency surgical care is lifesaving and must be available to everyone,” said RCSI Vice-President Professor Deborah McNamara.

“Emergency surgery is safest when performed during normal working hours by fully- trained staff and where sufficient volumes of surgery are performed to maintain the expertise of the multidisciplinary emergency surgery team. A networked system of emergency surgical care enables most emergency surgical care to be delivered as near as possible to the patient’s home while ensuring equitable access to complex care when required,” added Professor McNamara.

The new RCSI report also recommends that geographically-based surgery networks are developed with agreed pathways to allow “safe and efficient escalation of care” in situations where a patient’s needs exceed the services available locally and to support repatriation when patients needs can be met closer to home.

The HSE has launched a new set of clinical practice guidelines in obstetrics and gynaecology.

The areas covered by the 12 guidelines include post-menopausal bleeding, stillbirth, vaginal birth after caesarean section, and post-partum haemorrhage.

“Clinical guidelines are an important resource for doctors, midwives and allied health professionals who are committed to delivering safe and respectful quality care,” said Dr Cliona Murphy, Clinical Director at the National Women and Infants Health Programme.  

“The National Women and Infants Health Programme is committed to improvements in women’s and infants health, and with the support of the Women’s Health Task Force, has developed initiatives in ambulatory gynaecology, endometriosis and menopause – all of which will be strengthened by national guidance.”

Prof Keelin O’Donoghue, Clinical Lead for the National Clinical Practice Guidelines, said the “Clinical practice guidelines assist healthcare practitioners, service users, policymakers and other stakeholders to make informed decisions about health practice, public health and health policy.”

“Clinicians also need up-to-date and reliable resources to keep up their knowledge, and guidelines are important to address this need,” added Prof O’Donoghue.

The first suite of guidelines will be followed with over 30 updated clinical practice guidelines during 2023 and 2024.

The updated guidelines can be found at www.hse.ie/eng/about/who/acute-hospitals-division/woman-infants/clinical-guidelines/national-clinical-guidelines.html

The Medical Council has today launched a public consultation on new draft maintenance of professional competence rules and accompanying guidelines.

Maintenance of professional competence is the formal way by which doctors record their continuing professional development throughout their medical career.

The current maintenance of professional competence framework model has been in operation since 2011. Over the last number of years, several processes pointed to the need to strengthen the framework to increase its “relevance and usefulness for doctors”, according to the Council.

The Medical Council has developed new draft rules which provide information on doctors’ and scheme operators’ obligations under a new “strengthened” framework. Alongside this, a set of draft guidelines were developed to further expand on the obligations contained in the draft rules and to act as an accompanying document.

The public consultation will enable the Medical Council to obtain a broad range of feedback from individuals and organisations which will inform the finalised versions of the documents.

Dr Suzanne Crowe, President of the Council said: “The Medical Council, as the regulatory body for doctors, has a statutory role in protecting the public by promoting the highest professional standards amongst doctors practising in Ireland. The path to lifelong learning starts for a doctor in medical school, and continues until they retire, all part of the continuum of medical education.”

“Engaging in lifelong learning helps improve the safety and quality of care provided for patients and the public. Ensuring doctors maintain their professional competence is an essential element in allowing the Medical Council to safeguard the public, by verifying the quality of the doctor’s competence through the new draft rules and guidelines.”

Ms Jantze Cotter, Director of Professional Competence, Research and Ethics in the Medical Council, said: “The new draft maintenance of professional competence requirements are not entirely different to what is already in place. However changes made to the maintenance of professional competence rules and associated guidelines will now bring these in line with best practice.”

“This consultation will be an important process to collect feedback provided by stakeholders, grounding the framework in experience and practice. Stakeholder input and collaboration is an important aspect in developing new draft maintenance of professional competence rules and guidelines, taking into consideration the impacts on the wider health ecosystem.”

The documents are available at  https://www.medicalcouncil.ie/public-information/public-consultations/ . This consultation closes on Thursday 16 February.

The Medical Council today announced the procedures for the election of the six directly elected members of the Council.

The body has a statutory role in protecting the public by promoting the highest professional standards amongst doctors practising in Ireland, and is made up of 25 members, with a majority of 13 non-medical members and 12 medical members. Members are appointed through a mixture of elections, nominations by several bodies and through the public appointments system.

In order to be eligible for nomination for election to the Medical Council, a medical professional must be on the register of medical practitioners and must be practising medicine in the State (but excluding any visiting EEA practitioner) on 15 February 2023, the day before nominations close. They must be nominated for election by 10 registered medical practitioners practising medicine in the State.

An independent Returning Officer has been appointed and in accordance with the provisions of section 17(1) and (8) of the Medical Practitioners Act 2007, will conduct the election process.

The six members appointed following the election process must fall under the following categories:

• One medical practitioner registered or able to be registered in the Specialist Division in relation to Obstetrics and Gynaecology
• One medical practitioner registered or able to be registered in the Specialist Division in relation to Anaesthesia
• One medical practitioner registered or able to be registered in the Specialist Division in relation to Public Health Medicine
• One medical practitioner registered or able to be registered in the Specialist Division in relation to Pathology or Radiology
• One registered medical practitioner, practising medicine in a hospital but not a consultant
• One registered medical practitioner who does not fall into the categories above

Candidates nominated should demonstrate relevant experience or skills in at least one of the following areas: corporate governance, risk management, strategy development, change management, regulation, and health sector knowledge. They should also show effective judgement, have effective communication skills, and be improvement focused.

The Medical Council is encouraging all interested and eligible doctors to consider running for election.

Mr Leo Kearns, Chief Executive of the Medical Council, said “The Medical Council is keen to promote equality, diversity and inclusion at board level, as ideally, a board should reflect the stakeholders its decisions impact. We would encourage all eligible doctors to consider putting themselves forward, and in particular those who have moved to Ireland and now work in the Irish healthcare system. The impact of the Council and its committees reflects the input from its members, and a diverse Council can only positively impact those we support.”

The closing date for receipt of nomination papers is Thursday 16 February 2023 at 1pm. The independent Returning Officer will attend at the offices of the Medical Council to receive nomination papers, which can be submitted via post or in person on 16 February 2023 between the hours of 10am – 1pm.

If there is more than one nominated candidate an electronic poll shall be taken. Voting opens from 12pm on 1 March 2023 and closes at 12pm on 21 March 2023.

The 25-member Council consists of 13 non-medical members and 12 medical members. Of these, six members are elected by registered medical practitioners, five are appointed by the Minister for Health, one is nominated by the Minister for Further and Higher Education, Research, Innovation and Science and the remaining 13 are nominated by a number of nominating bodies.

Since the last elections in 2018, the Council has introduced a ‘rolling term’, whereby some Council members sign up for either a three-year term or a term of up to five years. This ensures efficient functioning of Council by minimising loss of experience, skill and corporate knowledge associated with a change of all Council members every five years.

The newly appointed Council members will begin their term on 1 June 2023, and all those appointed following the election process will serve a term of up to five years.

Nomination papers and other information is available on the Medical Council website www.medicalcouncil.ie/elections

The College of Psychiatrists of Ireland has stated the new Mental Health Commission (MHC) interim report on child and adolescent mental health services (CAMHS) has failed to take adequate account “of poor governance structures and support systems”.

While welcoming and supporting the publication of the interim report, the College said it has also not sufficiently addressed “the significant doctor recruitment and retention crisis in our mental health services at present”.

The MHC interim report arising from an independent review of the provision of CAMHS in the State, found that children and young people accessing mental health services with open cases have been “lost” to follow-up care.

The interim report found that in one Community Healthcare Organisation (CHO) alone, there were 140 “lost” cases within the CAMHS team. These children and young adults “lost” within the system did not have an appointment, in some cases for up to two years.

According to the College’s statement in response to the report: “Despite the College calling for inspection of community mental health services, including CAMHS, this has not occurred as it has for approved centres.  Regrettably, had the necessary inspections and reviews taken place years before now, the distressing and upsetting situation for all those waiting for and in CAMHS, including serious shortfalls identified by the Maskey Report into South Kerry CAMHS, would have been uncovered and highlighted for action before now.”

 “The service provided by CAMHS is equivalent to hospital level, consultant-led and multi-disciplinary team care in the community for children and adolescents with moderate to severe mental illnesses. Consultant CAMHS psychiatrists are central to this. The same support structures, and patient/ family -friendly appropriate clinic buildings, are needed for consultants and multidisciplinary teams practicing in both these service locations. This would ensure that best evidenced practice, driven by appropriate expertise, is the foundation of the patient-centred care provided.”

The IHCA said the report has shown health service management’s failure to adequately and safely staff the mental health service or provide the capacity needed to ensure that patients receive essential care.

Commenting on the interim report, IHCA Vice-President and Consultant Liaison Psychiatrist, Prof Anne Doherty said: “The consequences of failing to have the necessary level of staffing and required frontline supports across our health service have once again been cruelly exposed, this time by the Mental Health Commission who deemed the risk to patients within the child and adolescent mental health service so serious that a decision was made to publish an interim report while vital investigations are still ongoing.”

“The failings identified in the interim report unfortunately come as little surprise to consultants working in frontline Mental Health Services on a daily basis and who have been desperately highlighting the need for more specialists and greater capacity across the board for years.”

The HSE has also issued a response to the interim report.

Commenting, Mr Damien McCallion, HSE Chief Operations Officer, said: “This Mental Health Commission report comes at a time when we have a major CAMHS improvement process underway, and we will be putting a senior clinical/operational team in place to drive and support that process. This interim report, as well as the current prescribing review and other ongoing HSE audits in CAMHS, combined with the service improvement work underway, will all contribute to this process.”

“The report makes systemic findings and conclusions, as well as highlighting concerns about the specific care provided to some children. The HSE engaged with the Inspector of Mental Health Services in the course of her work and where specific concerns were identified, we immediately put in place targeted actions plans to address them. In the case of all children where concerns have been raised by the MHC in their report, these have been managed directly by the service caring for them.”

At this stage in the review of the provision of CAMHS, five out of nine Community Healthcare Organisations have been completed. These are CHO 3 (Clare, Limerick, North Tipperary/East Limerick) CHO 4 (Kerry, North Cork, North Lee, South Lee, West Cork) CHO 5 (South Tipperary, Carlow Kilkenny, Waterford, Wexford) CHO 6 (Wicklow, Dun Laoghaire, Dublin Southeast) and CHO 7 (Kildare/West Wicklow, Dublin West, Dublin South City, Dublin Southwest.)

The Inspector of Mental Health Services’ review is continuing with the remaining four CHO CAMHS, and this will involve further meetings with young people, parents, and stakeholders. These areas CHO 1 (Donegal, Sligo/Leitrim/West Cavan, Cavan/Monaghan) CHO 2 (Galway, Roscommon, Mayo) CHO 8 (Laois/Offaly, Longford/West Meath, Louth/Meath), and CHO 9 (Dublin North, Dublin North Central, Dublin Northwest).

The Inspector’s final Report is due for publication later this year.

Medical News for the 24th January 2023. The Medical Independent. Read the current issues affecting healthcare and the medical industry in Ireland.

The Medical Council will spend approximately €2.6 million on renovations at its rented headquarters, Kingram House, a spokesperson has informed the Medical Independent.

Under the existing long-term lease on Kingram House in Dublin, the Council is “required” to maintain the building. “The approximate total cost for the project is €2.6 million. The majority of the costs relate to mechanical, electrical, furniture, and fit out requirements to ensure the building is compliant with building, fire and health and safety legislation requirements, and to maximise building use with [an] increase in staffing numbers. Existing furniture is also being reused,” said the Council spokesperson.

All options were considered in advance of the renovation works, stated the spokesperson. An expert group was convened and “this course of action was recommended as the best financial solution. Considerations took place over several years before this decision was reached.”

The refurbishments had to be carried out to ensure the building was compliant with health and safety legislation.

“As the lease holder we are responsible for ensuring the building remains fully functional, compliant with building and fire regulations, and meets the legislative requirements, which Medical Council staff will benefit from,” the spokesperson said.

“By completing the renovation at this point, we can capitalise on our investment through the greater use of the building, as increased numbers of staff can be accommodated, while more versatile use of space will allow for other events including fitness to practise hearings and Council meetings to be held on-site.”

Kingram House was vacated when the refurbishment process began in 2021. Office space in Dublin has been rented in the interim. Since mid-2022, all staff have returned to the office one day a week under a blended working policy.

It is expected staff will return to Kingram House in April. Under “normal circumstances” no other office space is required, added the spokesperson.

According to the Council’s 2021 annual report, operating lease payments recognised as an expense were €827,500 (2020: €827,500). In September 2018, the Council entered into a contract for additional office space due to limited space at Kingram House. The cost for 2021 included in the rent and rates expense was €111,776. In November 2021, the Council entered into an additional 12-month lease for additional office space due to refurbishment works at Kingram House. The cost for 2021 was €70,186.

In 2008, the Council entered into arrangements whereby it was tied into a 20-year lease at Kingram House from 2013 at a cost far above recent market rates. The tenancy terms were subject to litigation and the judgement was in favour of Kingram House’s owner Tanat Ltd. The Council appealed this decision and a confidential settlement was reached in 2015.

The IMO has proposed tax relief for trainees required to ‘double rent’ or pay concurrent mortgage and rent payments due to their rotations, the Medical Independent (MI) understands.

The union also supports greater regionalisation of training to minimise the need for trainees to uproot from their accommodation. However, regionalisation has not yet been systematically implemented by the training bodies. Rotations are driven by specialty-specific requirements and the service provision needs of the health system. 

The recent NCHD agreement between the IMO, Department of Health, and the HSE acknowledged “a particular issue for NCHDs who rotate and have to rent a second residence”. The parties recognised “measures are required to address this specific issue” and would be agreed as a priority.

NCHD committee member Dr Brian Doyle told MI that in many other employment sectors, employers cover the costs borne by employees who are required to move locations as part of their role.

“But NCHDs fully bear that cost themselves at the moment and it is grossly unfair. I think regionalising training will remove some of that [expense]. The HSE have recognised this is a particular issue in the latest industrial relations agreement… but no solutions have been found to help alleviate it at the moment.”

Dr Doyle said if the HSE was not going to cover the additional accommodation costs borne by their employee NCHDs, measures such as tax relief needed to be considered by the State. The tax relief measure has been put forward by the union.

A spokesperson for the Department of Finance stated: “Any proposals for tax-related measures are considered in the context of the annual Budget and Finance Bill cycle.”

The HSE is seeking to hire a consultancy service to aid the implementation of its new capital strategy.

The HSE Capital and Estates Strategy 2022-2050 sets the direction for the future management, development, and investment of the healthcare estate in Ireland.

In a recently published tender document, the HSE said implementation planning in relation to the strategy has commenced.

The HSE is seeking to appoint a consultancy service in relation to financial modelling and investment planning, asset management, and digital systems development.

The consultancy service would also be expected to provide business intelligence, innovative design advice, and procurement and construction expertise.

“The SME [small and medium-sized enterprise] consultant will co-develop and deliver a clear pathway to achieve these goals within national constraints and policy, and deliver solutions for the future management, development, and investment of the healthcare estate in Ireland,” according to the tender.

“The strategy’s implementation will be iterative, and the implementation approach will be continuously updated as workstreams are established, subject matter expertise on boarded, and detailed programme plans developed.”

One of the main objectives of the strategy is to “develop an estate that is net carbon zero no later than 2050”.

Other key workstreams relate to strategic investment, the development of “data-driven” asset management, and progressing digital technologies to support capital investment; “innovative approaches” to design, procurement, and construction; and workforce planning.

In order to develop “a prioritised approach” on capital investment, as well as developing an appropriate maintenance budget for the HSE’s built portfolio, the Executive requires the condition of the estate to be accurately assessed to ensure a healthcare environment that is safe and fit-for-purpose.

“The HSE faces considerable challenges to ensure properties are fit-for-purpose, comply with statutory legislation, are of the required size, type, and location and are maintained in good order to ensure that capital and revenue budgets are spent wisely to achieve value for money,” according to the tender.

The HSE recently completed a survey of the acute service estate. A similar survey of the remaining community, primary, and administration accommodation buildings will be required.

In 2023, the consultancy service will deliver defined outputs in “the commissioning of the specific workstreams” in the implementation plan.

The implementation of the strategy will be a multi-year programme that requires “significant investment in time and resources”, according to the HSE.

The strategy and implementation plan will be reviewed annually and updated on a five-yearly basis to ensure continued alignment with HSE requirements.

The deadline for the tender is Friday 3 February.

Nobody who follows the Irish health service can say that the record levels of overcrowding in emergency departments (EDs) earlier this month came as a big surprise.

The total of 931 patients waiting for beds on 3 January was the highest since the Irish Nurses and Midwives Organisation’s Trolley Watch figures began.

Only in December, HIQA had warned the health service was under “unprecedented strain” with increasing number of patients presenting to EDs. The number of presentations was “significantly” higher than in previous years, the Authority pointed out.

HIQA made the announcement to coincide with the publication of an overview report of its monitoring programme against the national standards in seven EDs in 2022.

Throughout 2022, HIQA commenced a new monitoring programme of inspections in healthcare services against The National Standards for Safer Better Healthcare. As part of the initial phase, HIQA’s core assessment in EDs focused on key standards.

HIQA’s Director of Healthcare Mr Sean Egan said findings from this new programme of inspections continued to highlight that “overcrowding in emergency departments compromises the dignity and respect of patients and poses a risk to health and safety of patients”.

He continued: “…. The Irish healthcare system remains challenged by bed capacity and workforce shortages and access and capacity issues in primary care. Emergency department overcrowding and insufficient access to acute and primary services will continue to occur unless a system-wide approach is taken to address major structural concerns and respond to, rather than continuing to tolerate or normalise, this problem.”

The problem has been normalised for some time. In 2006, the then Minister for Health Mary Harney described the levels of overcrowding, which were occurring in Irish hospitals, as a national crisis.

This description has been used by politicians, doctors, and commentators whenever the situation gets particularly bad. And the situation is rarely particularly good.

In essence, this is a crisis that has been unresolved for over fifteen years. There have been positive developments over this period, such as the establishment of the national emergency medicine programme. Over the last year there has been an increase in capacity, and a political commitment to recruit an additional 50 emergency medicine consultants.

But more ambition is required, especially given the continued additional strain that Covid-19 infections are placing on the health service.

The interim CEO of the HSE, Mr Stephen Mulvany, recently told the joint Oireachtas committee on health that the levels of infectious respiratory diseases were “at exceptional levels, with sustained peaks when compared to the past five seasons”.

The HSE’s emergency response to the current crisis is welcome. However, without the type of “systems-wide” reform referenced by HIQA, we can expect pretty much the same story next January, and the one after that.

The ICGP has welcomed the publication of new ESRI research on the extension of free GP care to all in 2026. However, it warned it was “unrealistic” to expect universal free GP care by this date due to lack of GP capacity and infrastructure.

According to the College, many GP practices are already at full capacity and are unable to take on new patients. Many are also unable to find GPs to replace the retiring workforce.

Chair of the ICGP board Dr John Farrell said: “While the ICGP supports the extension of free GP care in principle, in practice this is unachievable without a huge expansion in GP numbers.”

 “We welcome the research by the ESRI which estimates that there would be an additional 1.9 to 2.3 million GP visits in 2026 if free GP care is extended to all, as this gives clarity to the demands that universal free GP care would place on general practice.”

The extension of free GP care to the under sixes in 2015 led to a 30 per cent increase in GP visits. Extending free GP care puts a large strain on daytime practices, and even more pressure on out-of-hours services.

Medical Director of the ICGP, Dr Diarmuid Quinlan, said: “We have had an exceptionally busy winter period so far, and there is no surge capacity in the system.  The ICGP is now training 70 per cent more GPs per year than it did six years ago, but we have an ageing workforce, with 25 per cent of our GPs over 60 years of age.”

He added: “We currently have over 4,000 GPs, of whom 570 are likely to retire by 2026. We need to increase the number of GPs to around 6,000 by 2028 to meet existing demand and cater for a growing population and GP retirements. Expanding free GP care will inevitably exacerbate patient waiting times to see GPs.”

The CEO of the ICGP, Mr Fintan Foy, said: “The ICGP has presented 10 workable solutions to the GP workforce crisis in our ‘Shaping the Future’ discussion document, and we urge the Minister for Health to establish a High-Level Working Group on the Future of General Practice, with all the relevant stakeholders. We cannot deal with the existing GP workforce crisis without innovative solutions, which go beyond a review of the existing contract.”

At present, there are 932 GPs in the four-year training programme, including an intake of 258 in July 2022. The College plans to increase training places to 286 in 2023 and will reach 350 by 2026.

To increase the numbers in training beyond that number requires not just more access to hospital posts, but also increased numbers studying medicine at an undergraduate level, who might then decide to do general practice specialist training.