CONSULTANT NEONATOLOGIST

19.5 hours Children’s Health Ireland (CHI) at Temple Street 19.5 hours Rotunda Hospital

Job Specification

Location of Post

This is an appointment to the Children’s Hospital Group on a Type B basis under the Consultants’ Contract 2008 (as per standard text issued by the HSE) by the Health Service Executive. The initial commitment for this post will be to Children’s Health Ireland at Temple Street for 19.5 hours per week and to the Rotunda Hospital 19.5 hours per week. This is a new post. This post may be subject to restructuring in the future to facilitate the reorganisation of acute services in line with new clinical models of acute and community services. It is noted that the post must be congruent with the requirements of, and facilitate implementation of national health policy, the HSE’s National Clinical Programmes including commitment to deliver the relevant performance outcomes.

Details of Current Service

The Government has approved the development of a new children’s hospital to be co-located on a campus shared with St. James’s Hospital with paediatric outpatient urgent care centres at Connolly and Tallaght Hospitals. Children’s Health Ireland was legally established on 1st January 2019 to integrate the three children’s hospitals in Dublin: Our Lady’s Children’s Hospital, Crumlin, Temple Street Children’s University Hospital, and Tallaght University Hospital (TUH). The legislation to legally establish Children’s Health Ireland as the entity for paediatric services in the greater Dublin area also gives authority to the new entity to act as the centre of a paediatric clinical network in Ireland. It therefore has a remit to develop and operationalise this networked approach

Children’s Health Ireland at Temple Street is a quaternary referral centre for neonatology. It accepts nationwide referrals of infants with complex congenital malformations, neurosurgical and neurological issues and surgical problems. There is a Neonatal high dependency (HDU) unit and the consultant Neonatologists also manage all non-HDU infants less than 6 weeks of age admitted to the hospital and a full outpatient service. A twenty-four hour on call service is provided. The neonatal service is provided by 1.75 whole time equivalent consultants. Due to sessional commitments and dual site nature of the posts it is not possible to deliver an on- call service that involves ward attendance out of hours and as such is limited to a phone advice service. The service is underserved due to the lack of a clinical lead, as all post holders have majority sessions elsewhere. As such it has not been possible to further the service through the development and updating of clinical guidelines, establishing regular multidisciplinary team meetings, instituting a departmental teaching programme and insuring robust clinical governance.

The Rotunda Hospital was established in 1745 in the heart of Dublin and it is a modern, busy and progressive Maternity Hospital, which delivers close to 9,000 infants annually. The Rotunda Hospital provides tertiary maternity care for around 9000 deliveries per year. The

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Neonatal Intensive Care Unit (NICU) of the Department of Paediatrics provides specialist intensive, high dependency and special care for approximately 1300 infants per annum.

Within the Department of Paediatrics, there is a weekly Journal Club and a weekly neonatal Seminar. The Journal Club reviews recent articles in the neonatal literature. Core topics in Neonatology are presented and reviewed at the neonatal seminars, and unit guidelines are reviewed and developed at these sessions also. All unit guidelines are available on the hospital intranet.

Purpose of this Post

Since the Department of Neonatology has been established in Children’s Health Ireland at Temple Street the volume of paediatric surgery performed in Temple Street has increased, in particular the number of complex paediatric neurosurgical cases managed in the hospital. A tertiary service is provided for several other paediatric subspecialties, in particular metabolic disease, neurology, nephrology and ophthalmology. Joint care by a consultant neonatologist is required when babies are admitted to Temple Street for such subspecialty management. In addition, a neonatology outpatient service is provided for neonatal patients referred from primary care and other specialists. To improve continuity of care and safety of new-borns being cared for in Temple Street the Rotunda on call rota is provided to that hospital and also provides a named consultant 9am to 5pm Monday to Friday. The shared Consultant posts with Temple Street only equate to 1.04 WTE for Temple Street, but if a separate rota was to be in operation this would be close to a 1:1 on call. The current on call arrangements do not permit the facility for out of hours ward review by a consultant neonatologist, rather this is limited to phone advice only.

Paediatrics has seen a decline in certain common childhood illnesses, but the burden of Neonatal Medicine continues to increase as new technologies and management strategies push back the boundaries of viability in the preterm population and allow increased survival and improved quality of life of infants with severe congenital anomalies and complex needs. The combination of decreased NCHD hours and the increased complexity of conditions being managed have led to greater hands-on consultant care. There is a rise in public expectation that children will be seen by a consultant or trained doctor. Inquiries into adverse outcomes have emphasised the importance of consultant presence in clinical areas, and in clinical decision-making. A child seen by a consultant is less likely to be admitted to hospital, to be subjected to an inappropriate investigation or to have a prolonged duration of inpatient stay.

In 1979, the Comhairle na nOispideal Report “Discussion document on the development of hospital services” noted that there should be one neonatologist (i.e. 11 consultant sessions) per 2000 deliveries (page 12 of the Report of the Committee on Neonatal Care Services in Dublin, April 1998). Subsequent reports have acknowledged the increasing complexity and intensity of neonatal intensive care, and have noted the need for increased consultant numbers. The Royal College of Paediatrics and Child Health, in “A Charter for Paediatricians” November 2004, notes that on call rotas should be no more frequent than 1 in 5, ideally with eight consultants working in a typical rota. The minimum for inclusive call for colleagues is 1 in 5.” There are 6 substantive consultant posts in Neonatology in the Rotunda Hospital. However because of sessional commitments to both teaching (Royal College of Surgeons of Ireland, 2 sessions) and the two children’s hospitals there are only 4.6 whole time equivalent (WTE)

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consultants servicing the Neonatal Intensive Care unit of the Rotunda Hospital, the postnatal wards, the outpatient department and the emergency room. The Rotunda has led the way as an institution in setting up as the first regional perinatal centre. Since 2011 all babies < 27 weeks are accepted from Cavan and Drogheda. The Neonatal Unit is also a national referral centre for therapeutic hypothermia and has a 9-5 to 24/7 national neonatal transport role every third week. The Rotunda is the regional centre for neonatal support to Cavan and Drogheda (RCSI Hospital Group). This Neonatal network was established in 2008 and was originally set up and funded to cater for all babies < 27 weeks in the region. An appropriate developmental follow up service is a recognised standard of care in neonatal medicine. We are not in a position to provide such a service with the current staffing levels to all infants meeting criteria for developmental follow up and the proposed post holder would oversee the set-up of such a service which will provide both useful clinical information to parents and caregivers on transition from our service as well as crucial outcome data to assess our interventions and further support vital research projects.

Reporting Relationship

The Consultant’s reporting relationship and accountability for the discharge of his/her contract is:

i) to the Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) through his/her Clinical Director (where such is in place). The Hospital Group Chief Executive Officer or Chief Officer, Community Health Organisation may require the Consultant to report to him/her from time to time.

Eligibility Criteria

Professional Qualifications

Registration as a specialist in the Specialist Division of the Register of Medical Practitioners maintained by the Medical Council in Ireland in the speciality of Paediatrics and two years certified postgraduate training in Neonatology

Post Specific Requirements

Experience of managing surgical neonatal patients in a NICU setting.

Two years postgraduate training in Neonatology

Desirable:

Formal fellowship training in Neonatology

A post graduate research degree (M.D. or equivalent)

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Entry to competition / recruitment process

For the purposes of eligibility for entry to any competition or recruitment process associated with this post, a candidate must fulfil the eligibility requirements laid down in the consultant appointment documents for the post.

The successful interviewee must be registered as a Specialist in the relevant Specialist Division of the Register of Medical Practitioners maintained by the Medical Council of Ireland before taking up appointment. The candidate will be allowed a maximum of 180 days from date of interview to secure this registration and produce evidence of special interest training where relevant.

Should the successful candidate not be registered as a Specialist at that time, the post may be offered to the next suitable candidate (or, in the case of HSE posts, the Public Appointments Service may chose not to recommend that candidate to the employer). Should no suitable candidate exist, a further recruitment process may be initiated.

The employer may decide to make a proleptic appointment as provided for at Section 2 d) of the Consultants Contract 2008.

Health

A candidate for and any person holding the office must be fully competent and capable of undertaking the duties attached to the office and be in a state of health such as would indicate a reasonable prospect of ability to render regular and efficient service.

Character

Each candidate for and any person holding the office must be of good character

Age

Age restrictions shall only apply to a candidate where he/she is not classified as a new entrant (within the meaning of the Public Service Superannuation (Miscellaneous Provisions) Act, 2004). A candidate who is not classified as a new entrant must be under 65 years of age on the first day of the month in which the latest date for receiving completed application forms for the office occurs.

Skills, competencies and/or knowledge

a) Demonstrate the ability to provide a level of clinical care required by this post according to the standards set by statutory bodies such as the Medical Council, Royal College of Physicians and the Consultants Appointments Unit.

b) Demonstrate a high level of verbal and non-verbal communication skills in order to effectively communicate with Patients/Parents, colleagues, hospital management, other hospital staff and stakeholders from other institutions.

c) Demonstrate leadership and team management skills including the ability to manage his/her staff and service and work with multi-disciplinary team members.

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d) Demonstrate evidence of effective planning and organising skills including awareness of resource management

e) Demonstrate a knowledge and understanding of the current governance structures and anticipated changes with the establishment of a National Paediatric Hospital.

f) Demonstrate evidence of computer skills.

Standard Duties and Responsibilities

a) To participate in development of and undertake all duties and functions pertinent to the Consultant’s area of competence, as set out within the Clinical Directorate Service Plan and in line with policies as specified by the Employer.

b) To ensure that duties and functions are undertaken in a manner that minimises delays for patients and possible disruption of services.

c) To work within the framework of the hospital / agency’s service plan and/or levels of service (volume, types etc.) as determined by the Employer. Service planning for individual clinical services will be progressed through the Clinical Directorate structure or other arrangements as apply.

d) To co-operate with the expeditious implementation of the Disciplinary Procedure.

e) To formally review the execution of the Clinical Directorate Service Plan with the Clinical Director / Employer periodically. The Clinical Directorate Service Plan shall be reviewed periodically at the request of the Consultant or Clinical Director / Employer. The Consultant may initially seek internal review of the determinations of the Clinical Director regarding the Service Plan.

f) To participate in the development and operation of the Clinical Directorate structure and in such management or representative structures as are in place or being developed. The Consultant shall receive training and support to enable him/her to participate fully in such structures.

g) To provide, as appropriate, consultation in the Consultant’s area of designated expertise in respect of patients of other Consultants at their request.

h) To ensure in consultation with the Clinical Director that appropriate medical cover is available at all times having due regard to the implementation of the European Working Time Directive as it relates to doctors in training.

i) To supervise and be responsible for diagnosis, treatment and care provided by non- Consultant Hospital Doctors (NCHDs) treating patients under the Consultant’s care.

j) To participate as a right and obligation in selection processes for non-Consultant Hospital Doctors and other staff as appropriate. The Employer will provide training as

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required. The Employer shall ensure that a Consultant representative of the relevant specialty / sub-specialty is involved in the selection process.

k) To participate in clinical audit and proactive risk management and facilitate production of all data/information required for same in accordance with regulatory, statutory and corporate policies and procedures.

l) To participate in and facilitate production of all data/information required to validate delivery of duties and functions and inform planning and management of service delivery.

Specific Duties and Responsibilities:

To carry out the duties of a Consultant Neonatologist at Children’s Health Ireland at Temple Street, pending transfer to the National Paediatric Hospital and at the Rotunda Hospital

a. The successful candidate will be responsible to the Board of Children’s Health Ireland via the Site CEO and Clinical Director for 19.5 hours per week and the Clinical Director, Master and Board of the Rotunda Hospital for 19.5 hours per week.

b. He/she will have both in-patient and outpatient responsibilities at both Children’s Health Ireland at Temple Street and the Rotunda Hospital. In-patient duties will consist of supervising and managing infants admitted to the Neonatal Department, both the neonatal intensive care unit and the special care baby unit and examination and assessment of new-born infants on the post natal wards as requested. The outpatient duties include evaluation and follow-up of infants who have been admitted to the special care baby unit and any other infants born at the hospital who have specific problems.

c. On Call To participate in the neonatology on-call rota covering Children’s Health Ireland at Temple Street and The Rotunda Hospital, and to cover colleagues during holiday, sick leave or other approved absence. There are 6 Consultant Neonatologists at The Rotunda Hospital. Consultant on-call service is provided on 1 in 4 arrangements. Each Consultant is on-call for one week and during that week the neonatologist is expected to conduct a daily morning ward round in the neonatal unit. He/she will also advise regarding any baby problems that occur on the postnatal ward. He/she will also consult with the Obstetricians on antenatal patients who may present difficult management problems, which relate to the fetus/infant.

d. Teaching The successful candidate is expected to participate fully in the department’s academic and teaching roles in both hospitals. This includes teaching of junior hospital doctors and medical students.

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e. Administration The post involves a significant administrative role. The successful candidate will be expected to participate in drawing up policies for patient care and will be involved on rotating basis with the other Consultant Neonatologist in the running of the neonatal department.

The above Job Description is not intended to be a comprehensive list of all duties involved and consequently, the post holder may be required to perform other duties as appropriate to the post which may be assigned to him/her from time to time and to contribute to the development of the post while in office.

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