Top Consultants speak out on risk to County Hospital

Roscommon County Hospital 12 October, 2007 Dear Sir,  Many will be aware that we, the Consultants in Roscommon County Hospital, have been asked to attend meetings with senior staff from Portiuncla Hospital and HSE management and two of these meetings have taken place within the last couple of months.    The meetings were ostensibly to look at surgical services in the two hospitals and examine how they can best function. However, it has become apparent to us that we are increasingly being pushed in the direction of closing Inpatient surgical beds at Roscommon and our service being changed to Day Surgery only with loss of 24/7 Consultant Surgeon and Consutlant Anaethetist cover at the hospital.    The meetings have also had an input from a member of the ‘Teamwork’ group, which has played a major role in ‘rationalising’ services in the north-east and which have lead to plans to downgrade certain hospitals there.   We believe that loss of this 24/7 cover by these Consultants would have major implications for the functioning of the hospital, particularly in their role with trauma cases, for example, after serious road traffic accidents and in certain other surgical emergencies.    Trauma patients will be required to travel an extra 50 minutes to Portiuncla and even further from north Roscommon (for example one hour and 20 minutes from Castlerea). This is a clear reduction in the quality of the present trauma service available to the people of Roscommon, in fact in the last week alone, two lives would certainly have been lost without the presence of a Consultant Surgeon and Anaesthetist at the hospital. Furthermore, the hospital is able to provide high quality elective or non-emergency general surgery.    There is a general lack of availability of surgical beds for this purpose around the country. Under the proposals, this routine surgery would would have to be ‘shoe-horned’ into Portiuncla. This would require a substantial investment in new buildings and staff at Portiuncula, although at present we have no guarantees that extra theatre space or accompanying staff would be provided.    We currently provide elective surgery and our waiting lists are amonst the shortest in the country. A change to the proposed system would almost inevitably lead to a lengthening of waiting times.   The HSE and Teamwork consultant are proposing that our Consultant Surgeon and Anaesthetist would be replaced by a junior doctor Anaesthetist to cover medical emergenices. We feel that this is unacceptable for two major reasons.    The first is trauma cases, which Roscommon A & E Department would no longer be able to accept because there would be nobody able to deal with them. Instead these seriously injured, often road traffic victims, would face a further 50 minute journey by ambulance to Portiuncla, up to 50 minutes more could be added to this time if the person is coming from north Roscommon. Therefore the ‘golden hour’, during which most lives are saved following serious accidents, would be spent in an ambulance instead of a fully equipped A & E Department such as we have in Roscommon.    A recent study from the University of Sheffield has shown that in general, the death rate goes up by 1% every six miles extra travelled to get to an A & E Department. Therefore the death rate would increase by 5% if the journey is 30 miles and 10% if it is 60 miles. People will die if this is allowed to happen. A similar reduction of services planned for Ennis General Hospital and the Ennis Hospital Group have estimated that 20 lives per year will be lost if the A & E is downgraded.    Ennis is closer to Limerick than Roscommon is to either Ballinasloe or Galway. The only safe alternative to the current situation would be a Helicopter Trauma Retrieval Team able to travel to the scene of an accident and stabilise the injured before transferring them to a Trauma Centre. Neither the Trauma Centre nor the Helicopter Trauma Retrieval Team exist at present, nor are there any plans to provide such a service.   The second reason that we are opposed to these proposals is because of the implications they would have for the medical department. This department at Roscommon County Hospital has been transformed over the past five years with a new Medical Assessment Unit, a third Medical Consultant, a CT scanner and an ECHO and Falls service. Medical A & E admissions are increasing by 12% per year as a result of these improvements. A Respiratory and General Physician are to be appointed in 2008.   We currently have a safe and effective service, which is made so by the presence of a Consultant Anaesthetist on call 24/7. This Anaesthetist enables rapid, intensive care to be given to acutely ill patients with breathing difficulties, collapse, cardiac arrest etc. In such crisis situations, patients need experienced experts on site, which we now have. A trainee Anaesthetist from Ballinasloe would not be an adequate or a safe substitute. This threatened loss of Consultant Anaesthetic cover is particularly alarming and would seriously reduce the safety of the medical service.   Medical admissions often have a surgical component and vice versa. This is particularly so in elderly patients, of which Roscommon has the highest percentage nationally. If the HSE proposals go through it will be necessary to transfer a sick patient 50 minutes in an ambulance to Ballinasloe for a senior surgical opinion, instead of getting an opinion on site in 15 minutes.   We have been asked to give our input to these talks and to try and develop new ‘working arrangements’. It is our opinion that twenty four hour Consultant surgical and anaesthetic cover should be maintained at Roscommon. The rotas would be awkward and not very efficient but the quality, and very largely the range, of current patient care would be maintained. We feel however, that the HSE is moving to a more radical solution wherein there would be a surgical and anaesthetic Consultant presence at Roscommon only from  nine to five, Monday to Friday.    We believe that what the HSE seems to be proposing would be far less safe. In the interest of safety and good practice, the proposed changes to surgical and anaesthetic services must not be allowed to proceed unless alternative proposals are made which are at least as safe as the current service, any downgrading must be vigorously opposed.   We are willing to continue with discussions with the HSE but now feel that the public should be aware of the content of these discussions. Yours faithfully Dr. Charles Byrne  Pat McHugh Gerry O’ Meara  Liam McMullen