A new “comprehensive” national framework designed to strengthen patient safety, accountability and quality improvement across surgical services in Ireland has been published.

A Framework for Surgical Clinical Governance was launched by the RCSI following work by the College’s Expert Group on Best Practice in Clinical Governance Surgical Leadership.

Aligned with international best practice, the framework is intended for use across public, voluntary and independent healthcare settings. It outlines four key domains – morbidity and mortality meetings, multidisciplinary team engagement, patient safety and clinical audit, and the governance of innovation, research and new technologies – which are “central to the safe and effective governance of surgical care”.  

The framework provides a “governance maturity model” that surgical services can use to assess the extent to which their governance arrangements are embedded, reliable and integrated within the wider hospital system, and in planning progressive improvement over time. 

Prof Deborah McNamara, President of the RCSI, said: “Surgeons are privileged to care for people at some of the most vulnerable moments in their lives. With that privilege comes the profound responsibility to learn from our experiences, as enabled by safe, transparent and learning-oriented surgical governance.”

“High-quality surgical care depends on strong clinical governance, clear accountability and a culture of continuous learning,” continued Prof McNamara. 

“The public have the right to high quality and safe surgical care. This framework is RCSI’s constructive contribution to the national effort to improve patient safety and support our surgical workforce, providing practical guidance for surgeons, clinical leaders and healthcare organisations to support patient safety and improve outcomes. In particular, the use of the governance maturity model will support our hospitals in reflecting on the areas of improvement they need to prioritise.” 

Mr David Moore, Chair of the Expert Group on Best Practice in Clinical Governance in Surgery and RCSI Council Member, said: “Surgical teams across Ireland are committed to delivering safe, effective care, often under significant pressure. This framework is designed to support that work by providing a clear, consistent structure for governance that is clinically led, evidence-informed and focused on learning and improvement. Our aim is to help surgical services strengthen governance in a way that is practical and sustainable.” 

The framework is now available on the RCSI website here. 

Surgical hubs and elective hospitals, “will go a long way to address the challenges in elective surgery”, the RCSI President Prof Deborah McNamara told this newspaper.

However, Prof McNamara cautioned that even with this extra infrastructure, there remained “a huge need” for the health service to focus on patients who need a longer stay in hospital.

She said these are patients who require “all of the resources of a bigger hospital in order to get the surgical care that they need”.

“And we have major concern about that, I’ll be honest. So, the elective surgical hubs, and elective hospitals will go a long way to address the challenges in elective surgery. But for some of the most complex, elective operations, they won’t address the totality of what we need.

“That needs to be taken into consideration alongside interventions to protect surgical beds and theatre capacity in our [existing] bigger hospitals that have emergency departments.”

Prof McNamara was speaking to the Medical Independent (MI) at the recent annual Millin Meeting held in the RCSI. (Coverage of the Millin meeting will be carried in the 9 December issue of MI).

Separately the HSE told MI the elective hospitals in Cork and Galway are being progressed first.  The design team are actively working on the design for these hospitals, including carrying out necessary surveys and site investigations to inform the design as it develops toward planning permission applications. 

“A key issue emerging for the Cork site is the road access, and the HSE continues to actively engage with Cork City Council to find a solution,” the spokesperson told MI.

In relation to the two Dublin sites, the demand modelling and validation are underway, along with the assessment of current and planned infrastructure for ambulatory care in the catchment area to underpin the scope and scale required.

A total of nine HSE surgical hubs are also at various stages of development nationally, two of which are operational.

Posting bowel cancer screening kits directly to people who are eligible for BowelScreen can boost participation rates, according to a new RCSI study.

The research, supported by the HSE National Screening Service’s BowelScreen, showed a 6 per cent increase in screening uptake among people who were sent a postal kit, a strong improvement given the simplicity of the intervention. 

The study, which was funded by the Irish Cancer Society, offers a strategy to enhance prevention and early detection efforts for one of Ireland’s most common cancers.

With Bowel Cancer Awareness Month starting today, the publication of this study is timely, highlighting the need to increase screening participation across the country. In Ireland, bowel cancer is the second and third most common cancer among men and women respectively, with around 2,500 new cases each year. Screening can help prevent bowel cancer and detect it before the cancer progresses to later stages when treatment is not as effective. Despite the proven benefits of screening, BowelScreen’s screening uptake is approximately 10 per cent below comparable bowel screening programmes in Europe.

The BowelScreen approach requires first-time invitees to request a home screening kit on receipt of their invitation to take part – an important step to confirm consent to participate in screening and personal details, and reduce potentially costly kit wastage, but a step that may deter participation.

The study, led by Dr Nicholas Clarke at RCSI’s School of Population Health, tested two interventions to encourage more people to take part. 

Rather than waiting for people to request a kit, the study sent kits automatically to those who had not responded to the initial invitation letter. This intervention alone resulted in a 6 per cent increase in participation rates.

Additionally, the study introduced a more personal reminder letter co-written by a patient and public involvement (PPI) panel. This revised version of the letter addressed common concerns about the screening process identified from previous research conducted by Dr Clarke and incorporated personal insights from the panel aiming to reduce hesitation and improve response rates.

Findings indicated that this intervention had the most impact on women from lower socio-economic areas when sent alongside the screening test kit. 

The study highlights the need to remove barriers to bowel cancer screening, particularly among men and those in socioeconomically disadvantaged areas, where participation remains lowest. Participation in screening can reduce the risk of a cancer diagnosis and even prevent it by detecting polyps that could progress into cancer if left unchecked. 

“This research highlights simple yet effective changes that can significantly increase participation in bowel cancer screening,” said Dr Clarke, Research Fellow and senior author on the paper. “By making the process easier and addressing concerns upfront, we can save more lives. However, based on 2020/21 data, which was the latest available when the research was carried out, overall screening uptake still remains lower than the EU’s recommended uptake levels of at least 65 per cent. Indeed, evidence has shown that few screening programmes in Europe have achieved uptake rates above 50 per cent. Continued implementation of screening and further refinements to understand what works best and for whom are essential to ensure more people benefit from cancer prevention and early detection.”

“The continued implementation of these small changes can increase bowel screening uptake and ultimately lead to better bowel cancer prognoses and mortality outcomes overall. It is hoped that further research will help improve understanding of the lack of participation among certain groups, so that all communities can access the lifesaving benefits of BowelScreen across Ireland.”

BowelScreen Programme Manager, Ms Hilary Coffey Farrell, said: “We are marking Bowel Cancer Awareness Month in April by encouraging all people aged 59 to 70 to reduce their risk of bowel cancer developing by choosing bowel screening. 

“Uptake rates in BowelScreen are a priority for us and we are focused on working to remove any possible barriers to bowel cancer screening, particularly among men, and those in socioeconomically disadvantaged areas, where participation remains lowest. 

“Our partnership work on this research project will add to the evidence that supports our decision-making around measures to increase equitable uptake, whilst continuing to ensure we meet our population health aims; balance the benefits and harms for our participants, be cost-effective, and enable more people to choose screening.”

The HSE’s BowelScreen programme offers screening every two years for people between the ages of 59 and 70. Visit hse.ie/bowelscreen to register for your screening today.

The research is supported by Irish Cancer Society and the National Screening Service through the Research Grant SCR20CLA and supported in part by grants from the Health Research Board and Research Ireland.

A new model of care for the sustainable delivery of paediatric general surgery has been launched by the National Clinical Programme in Surgery (NCPS) and the National Clinical Programme for Paediatrics and Neonatology.

The model was developed as part of a collaboration between the HSE, RCSI, RCPI and a national network of hospitals providing surgical care for children supported by Children’s Health Ireland.

Paediatric General Surgery: A model of care for Ireland 2024 outlines a comprehensive framework to enhance surgical services for children close to where they live, ensuring access to a high standard of surgical care with clear oversight and governance.

The model addresses the growing challenges faced by the paediatric surgical community, including the increasing specialisation of surgical practices and the recruitment of general surgeons who can deliver paediatric care. Without intervention, these challenges could impact access to local or regional general paediatric surgical care for children in the future.

The model of care sets out recommendations on how service improvements in the provision of general paediatric surgery could be achieved with the designation of both regional paediatric surgical facilities and local paediatric surgical facilities, outlining operative procedures appropriate for each site.

The framework aligns with the Sláintecare principles of treating patients closer to home, whenever possible. Complex surgeries will continue to be delivered through Children’s Health Ireland (CHI) in Dublin.

Speaking at the launch, Mr Ken Mealy, Chair of the working group for the General Paediatric Surgery Model of Care and Co-lead of the National Clinical Programme in Surgery, said: “Today’s launch represents a significant step forward in ensuring that every child in Ireland has access to safe, high-quality surgical care, no matter where they live. This model of care has an emphasis on safety, workforce planning, training, and quality assurance of service provision, to ensure that all children who require acute or elective general paediatric surgery are managed in an appropriate environment by staff with the requisite skills.”

Prof Deborah McNamara, President of RCSI, said: “This model of care will support the delivery of excellence in paediatric general surgery in Ireland and drive improvements in policy and practice for the benefit of patients and their families. I look forward to seeing the implementation of the recommendations of the framework which represents the commitment of the paediatric surgical and medical community to providing a sustainable, equitable system of care for children in the future.”

Dr Ciara Martin, National Clinical Advisor and Group Lead for Children and Young People, HSE, said: “Having a networked approach to surgical care that is underpinned by national standards and supported training and education for the teams of nurses and doctors delivering care in all of our national hospitals is important. It is important for those delivering care to children and young people and even more so it means that patients and their families can be confident of the care they receive wherever and whenever they need it”

The key principles of the model of care are:

• A national network of hospitals provides safe surgical care for children supported by CHI
• Children and families benefit from being able to access appropriate elective and acute surgery close to home and regional general paediatric surgeons decide where surgeries will be delivered, ie:

-Children who require transfer to CHI in Dublin are transferred in a timely and safe manner with senior surgeons regionally and in CHI coordinating the transfer

– Acute surgery for children provided locally occurs in an appropriate environment.

• RCSI incorporates appropriate paediatric surgical experience within the general surgery training programme supporting general paediatric surgery workforce planning for the regional and local general surgery paediatric units.
• An audit and peer review process are developed to assure the quality and safety of care.

Paediatric General Surgery: A model of care for Ireland 2024 can be downloaded from publications section of the NCPS’s online resources – https://www.rcsi.com/surgery/practice/national-clinical-programmes/surgery