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Irish Institute of Orthopaedic Surgeons Page 31/36 Development of orthopaedic services: a discussion document Item Type Report Authors Comhairle na n'Ospideal Publisher Comhairle na n'Ospideal Download date 30/09/2021 07:48:48 Link to Item http://hdl.handle.net/10147/248533 Find this and similar works at - http://www.lenus.ie/hse Comhairle na n-Ospideal Development of Orthopaedic discussion docu CONTENTS Section 1: Introduction Page 3/ 4 Section 2: Factual Information Page 4/5 Section 3: Generai Observations on the Existing Situation Page 6/7 Section 4: General Considerations Relating to the Future Organisation of Orthopaedic Services Page 7 / 10 Section 5: Bed Requirements in Orthopaedics Page 10/11 Section 6: Recommendations on the Development of Orthopaedic Services in each Health Board Area Page 11 (i) Eastern Health Board Area Page 11/13 (ii) North- Eastern Health Board Area Page 13/14 (iii) Midland Health Board Area Page 14 (iv) South-Eastern Health Board Area Page14/ 15 (v) Southern Health Board Area Page 15 / 16 (vi) Mid-Western Health Board Area Page 16 (vii) Western Health Board Area Page 17 (viii) North-Western Health Board Area Page 17 Section 7: Consultant Manpower Requirements in Orthopaedic Surgery Page 18 / 19 Section 8: Postgraduate Training Programmes at Senior Registrar Level Page 20 CONTENTS continued Section 9: Miscellaneous Page 21 9.1 Peripheral Outpatient Clinics Page 21 9.2 Geriatric Services Page 21 9.3 Orthopaedic Nursing Page 21 9.4 Convalescent Orthopaedic Accommodation Page 21 9.5 Rehabilitation Services Page 22 Appendix A Elective Orthopaedics -In-patient Statistics 1975 Page 23/24 Appendix B Orthopaedic Out-patient Statistics 1975 Page 25/27 Appendix C Hospitals Providing Significant Accident & Emergency Services Page 2 Appendix D Extract from "Discussion Document on Hospital Bed Population Ratios - A Basis for Acute Hospital Planning" , (Department of Health, January, 1976). Page 29/30 Appendix E Submission by the Irish Institute of Orthopaedic Surgeons Page 31/36 2 Section 1 - Introduction 1.1 Arising from its consideration of a Comhairle is greatly indebted to number of applications, submitted Mr. MacAuley for his whole­ by various hospital authorities, hearted participation in the work for the appointment of additional of the sub-committee and for the consultant orthopaedic surgeons invaluable assistance which he and because of the feeling on the rendered to the exercise. part of the members that there was a need to examine the 1.3 The first meeting of the sub­ organisation of orthopaedic ser­ committee was held on 31 st vices in the country generally, the March, 1976. In pursuance of its Comhairle decided, early in 1976, task, the sub-committee, in to establish a sub-committee on addition to holding meetings of orthopaedic services under its own members, also visited the Section 41 (7) of the Health Act, following hospitals and held dis­ 1970. The task of the sub-com­ cussions on general problems in mittee was one of fact-finding to the field of orthopaedics with the ensure that the Comhairle would administrators and consultants have available to it all the associated with these hospitals :- necessary information to enable Merlin Park Regional Hospital, policy to be deterlJ1ined in the Galway, field of orthopaedics. In addition, Sligo General Hospital, the sub-committee was requested Ardkeen Hospital, Waterford, to consult with the various Kilcreene Orthopaedic Hospital interests concerned for the pur­ Kilkenny, pose of identifying the main Croom Orthopaedic Hospital, problems to be faced and possible Limerick, solutions to these. Finally, the St. Mary's Orthopaedic sub-committee was asked to Hospital,Gurranabraher,Cork, make recommendations to the Orthopaedic Unit, Navan Comhairle on the issues which Hospital, they identified. Cappagh Orthopaedic Hospital, Dublin (including Temple The following members of the Street and the Mater Comhairle were appointed to Hospitals) serve on the sub-committee:- Dr. Steevens' Hospital, Mr. J. S. R. Lavelle (Chairman) Discussions were also arranged Professor Eoin O'Malley with (i) the consultants from St. Mr. G. A. McLean Lee Laurence's Hospital, Jervis Street Mr. P. G. McQuillan Hospital and Our Lady's Hospital Mr. G. P. Martin (Chief Officer) for Sick Children, Crumlin, (ii) officials and consultant general In addition, Mr. Patrick MacAuley, surgeons from the Midland Health Consultant Orthopaedic Surgeon, Board, (iii) representatives of the who is not a member of the Senior Registrars in Orthopaedics, Comhairle, was invited, with the (iv) representatives of St. approval of the M inister for Vincent's Hospital, Dublin, and Health, to participate in the work (v) representatives of the Irish of the sub-committee and he I nstitute of Orthopaedic accepted the invitation. The Surgeons. 3 1.4 The sub-committee, which com­ vices incorporates the findings pleted its task in February, 1977, and the recommendations of the was greatly assisted by the advice sub-committee. It has been and information supplied by the adopted by the main body of the various groups with whom Comhairle and has been discussions were held. The forwarded to the Minister for Com hairle wishes to record its Health and to the health boards sincere appreciation to the many in pursuance of the advisory individuals who participated. function of the Comhairle on the organisation and operation of 1.5 This discussion document on the hospital services (Section 41 (1) development of orthopaedic ser- (b) (iii) of the Health Act, 1970). Section 2 Factual Information 2.1 Basic figures on in-patient The Children's Hospital, services are set out in Appendix Temple Street, Dublin A and on out-patient services in Appendix B. North-Eastern Health Board The existing situation is sum­ Area: marised in the following para­ Orthopaedic Unit, Navan graphs. Hospital, Co. Meath (82 beds·) 2.2 Orthopaedic Units - In-patient services for elective or "cold" South-Eastern Health Board orthopaedics are provided at the Area: fifteen hospitals listed below. Kilcreene Orthopaedic Hospital, (An asterisk denotes beds used Kilkenny (90 beds*) exclusively or mainly for elective Ardkeen Hospital, Waterford surgery) . (38 beds) Eastern Health Board Area: Cappagh Orthopaedic Hospital, Southern Health Board Are . Dublin (200 beds*) St. Mary's Orthopae Jervis Street Hospital, Dublin Hospital, Gurranabrah I , (20 beds approximately) Cork (187 beds*) St. Laurence's Hospital, Dublin (8 beds approximately) Mid-Western Health Board James Connolly Memorial Area: Hospital, Blanchardstown, Croom Orthopaedic Hospital, Dublin (20 beds*) Limerick (120 beds*) Adelaide Hospital, Dublin (28 beds) Western Health Board Area: Merlin Park Regional Hospital, Dr. Steevens' Hospital, Dublin (32 beds) Galway (176 beds*) Meath Hospital, Dublin B~tween them, these hospitals Our Lady's Hospital for Sick provide a total of about 1,061 Children, Crumlin, Dublin beds (0.36 per 1,000 population) (60 beds) of which 875 (those with asterisk) 4 are exclusively or mainly used for 2.4 Out-patient Clinics: According elective surgery, the remaining to the information available to the 186 beds being available for both sub-committee, out-patient elective and traumatic ortho­ clinics are conducted by ortho­ paedics. It will be noted that only paedic surgeons at 41 centres four of the fifteen units have more (mainly general hospitals) than 100 beds. Five of the ortho­ throughout the country, involving paedic units are physically approximately 250 clinics per separated from a general hospital month (see detailed breakdown (Cappagh, Kilcreene, Gurrana­ at Appendix B). Some of these braher, Croom and Merlin Park) centres are situated a consider­ and these include the largest of able distance away from the the units comprising, between orthopaedic unit at which the them, 73% of the beds available consultants are based, notably in for elective work. In several the case of the Merlin Park unit instances, the lack of a second and the Navan unit. Figures of operating theatre was cited as a first attendances and total attend­ major deficiency as was also the ances which are available only absence of adequate clean-air in respect of the West North­ systems in theatres for the control West South and part of the East of infection. and Mid-West indicate a ratio of 1 : 3. During the course of 2.3 Accident Hospitals: There is a several discussions with local total of 40 hospitals in the consultants, comments were country which receive a signifi­ made about the lack of bas ic cant number of accident and facilities (e.g. radiology) at some emergency cases. These are listed centres where clinics are held and at Appendix C. There are no also about the large number of figures available to indicate the relatively minor complaints which number of beds used for trauma are referred to specialist cl inics cases. Of these 40 hospitals, only particularly from the school 13 have a significant presence medical service. (i.e. attendance on a regular and frequent basis by orthopaedic 2.5 Convalescent Accommoda­ surg30ns), 10 have no ortho­ tion: Separate convalescent paedic surgeon associated with accommodation, to which long­ them and the remaining 17 have stay patients can be transferred, limited access to the services of is available in only a small number an orthopaedic surgeon, mainly of areas - the Incorporated on the basis of out-patient clinics Orthopaedic Hospital, Clontarf, held on either a weekly, fort­ (131 beds - mainly adult). nightly or monthly basis during Leopardstown Hospital, Dublin, the course of which consultant and St. Joseph's Hospital, Coo le, advice is usually made available Co. Westmeath . for in-patients as well. Of course, it must be noted that, in many of the hospitals with either limited or no access to an orthopaedic surgeon, there are general surgeons who are experienced and competent in the treatment of musculo-skeletal injuries. 5 Section 3 -General Observations on the Existing Situation 3.1 The general view within the 3.2 At present, there are no ortho­ medical profession is that an paedic units within the country elective orthopaedic unit should which meet the ideal requirements ideally be an integral part of a described in the preceding para- general hospital and be located graph.
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