29th November 2011
By Bryan T. Smyth
A significant restructuring of acute hospital and community services is underway in Cork city with the clear purpose of providing sustainable services of a higher quality for the people of Cork and the surrounding area. It is important to recognise at the outset that while services are being relocated to allow for better functioning, there is no net loss of service involved and some services including continuing care beds for older persons are being expanded. Important highlights include the following:
· Transfer of cardiology services from South Infirmary Victoria University Hospital (SIVUH) to the Cardiac Renal Centre, CUH. The new centre opened earlier this year equipped with expert staff and the most modern equipment and technology in this region.
· Transfer of orthopaedic services from St. Mary’s Orthopaedic Hospital (SMOH) to SIVUH. Services transferring from a stand-alone service to a general hospital with complementary services on site, three newly built operating theatres and recruitment of three additional orthopaedic consultants to allow paediatric orthopaedic services re-commence in Cork.
· Opening of Regional Pain Centre at SIVUH, the first of its kind in Ireland.
· Moving SIVUH towards becoming a fully elective hospital which means planned patient surgeries, etc. cannot be interrupted by emergency admissions.
· Streamlining emergency services (major trauma, minor injuries, medical and surgical) so that patients are treated in appropriate facilities to suit their emergency need.
· Increasing long stay bed capacity for older people in new purpose built community nursing units.
HSE South’s Regional Director of Operations Mr. Pat Healy said “This service re-organisation clearly demonstrates what can be achieved when acute hospital and community services work collaboratively on health service delivery. It is a true testament of the efficiencies and targets that are being achieved under the Public Service Agreement. At the end of the day what we collectively want to achieve is what’s best for people in Cork and the changes currently taking place will go along way in achieving that.”
During November and December 2012 the following changes are underway:
Medical Rehabilitation – Services for Older People
Medical Rehabilitation – Services for Older People relocated from South Infirmary Victoria University Hospital (SIVUH) to the Rehabilitation Unit at St. Finbarr’s Hospital (SFH) on 18th November 2011 to consolidate rehabilitation services on one site. The Rehabilitation Unit in SFH will be expanded to have a total of 72 beds (an increase of 20 beds on site; 13 beds from SIVUH and seven additional beds). This will be managed by all consultant geriatricians across all city hospitals in an integrated manner. Outpatient appointments associated with this service will continue at SIVUH until early 2012.
The Cardiac Renal Centre (CRC) in Cork University Hospital (CUH) (which opened in April 2010 at a cost of €85m) has been identified as the specialist centre to treat cardiology patients in this region. Cardiology services relocated from SIVUH to the CRC at CUH commencing with SIVUH inpatients on 25th November 2011 and outpatients and cardiac rehabilitation on 28th November 2011. Cardiology patients currently attending the Warfarin Clinic at SIVUH will continue to do so.
Approximately 50 staff involved in the delivery of cardiac care at SIVUH such as consultant cardiologists, NCHDs (junior doctors), nursing and support staff, allied health professionals (physiotherapists, occupational therapists, social workers, etc) and administration staff transferred to the CRC along with SIVUH patients. This ensures continuity of care for patients who will be reviewed by the consultant cardiologists they are currently under the care of at SIVUH.
Patients attending the CRC will have access to the full range of cardiology services and expertise in a new building equipped with the most up-to-date technology and equipment and supported by staff with the necessary expertise. The centre spans 13,000m2, over 6 floors and represents the most significant service development in relation to cardiology, cardiothoracic surgery and renal medicine in the region to date.
Dr. Peter Kearney, consultant cardiologist said, “the centralisation of services at the Cardiac Renal Centre today allows for the integration of acute cardiology services, inpatient and outpatient services and cardiac rehabilitation, in one readily accessible unit for patients with cardiovascular disease. This new facility provides a much enhanced environment for all our patients and we are delighted to be part of this significant development for cardiac services in the region. Until now, patients requiring cardiac catheterisation for diagnosis or treatment had to transfer in from the SIVUH for this. Similarly, patients requiring implantable defibrillators were transferred from CUH to the SIVUH. These examples illustrate how patients requiring treatment will no longer have to transfer between hospitals for services.”
Orthopaedic services, Elective Plastic Surgery and new Regional Elective Pain Medicine Centre
Elective orthopaedic services will transfer from SMOH to SIVUH on 12th December 2011. Three new orthopaedic theatres have been built at SIVUH to accommodate this move. Elective orthopaedic surgery ceased at SMOH on 25th November to accommodate the service transfer. Orthopaedic trauma rehabilitation patients will transfer on 5th December 2011. Trauma/emergency orthopaedic surgery will continue to be delivered in Cork University Hospital (CUH) as is the current practice. Outpatient appointments for Orthopaedic services will continue at SMOH until April 2012.
Three new permanent orthopaedic consultants will be employed; one in January 2012 and two in July 2012, bringing the total number of permanent consultants from five to eight. Two of these appointments will have a special interest in paediatrics which will enable the recommencement of elective paediatric orthopaedic surgery in Cork in January 2012 (delivered in Our Lady’s Hospital Crumlin since 2008).
The patient benefits anticipated from the relocation can be summarised as follows:
· Locating elective orthopaedic and rehabilitative orthopaedic services in the same hospital as complementary services, such as plastic surgery and rheumatology, means that patients don’t have to travel between centres for care as all specialist services will be located on the one site.
· Increase in the number (from two to three) and size of operating theatres.
· All patients will have pre-operative assessments prior to admission which will enable patients to be admitted on the day of their surgery rather than the night before.
· Recommencement of paediatric orthopaedic surgery in Cork.
· Access for patients to out-of-hours medical and anaesthetic cover as part of a wider elective surgery service.
· Increased efficiency through extended theatre working day and increased level of day surgery.
· Reduced waiting lists for elective orthopaedics over time.
There are important synergies between orthopaedics, pain medicine and plastic surgery and these services are also transferring from SMOH with orthopaedics to the SIVUH. Elective plastic surgery is scheduled to transfer on 5th December 2011 and elective pain medicine on 12th December 2011. A new regional pain management centre has also been built at SIVUH, the first regional pain centre in Ireland. The centre will treat patients with conditions such as chronic back pain and headaches and persistent post surgical pain.
SIVUH’s Chief Executive Officer, Mr. Ger O’Callaghan said “I want to pay tribute to our staff who have been involved in the delivery of services at SIVUH. We have worked very closely with our colleagues in the HSE South in order to ensure the smooth transition of services throughout the relocation process. I have no doubt that centralising cardiac, orthopaedic, emergency and medical rehab services in particular sites is a very positive move for the people of Cork. We are now looking forward to working with our colleagues in the HSE South to ensure a similar transition of remaining services over the coming weeks and extend a warm welcome to staff who will join us from HSE South.”
In welcoming the transfer of services to the SIVUH, Mr. Mark Dolan, Orthopaedic Consultant & Clinical Chair of the Orthopaedic Service said “I am confident that the enhancements in the service, which include the construction of three new operating theatres, will greatly benefit adults and children with musculoskeletal problems in the Cork and Kerry region.”
Emergency Department SIVUH
The transfer of cardiology services from SIVUH will be followed by the phased closure of the Hospital’s Emergency Department (ED). It is anticipated that the ED will close at night from 12th December 2011. The target date to close the ED fully is April 2012. This is compatible with the role of SIVUH being designated as an elective hospital, which means that planned surgeries and other procedures will not be interrupted with emergency admissions.
The HSE South is confident that the planned streamlining of emergency department services in Cork city will deliver the best care for patients as they will receive the right care in the right place from the right person. When these planned changes are fully implemented, they will ensure that there is more capacity in these services in 2012, than is currently available.
The majority of patients attending SIVUH’s ED are seen before 8.00pm. From December 2011, the ED will open from 8.00am to 8.00pm to accommodate peak presentation times during the winter months. There are, on average, seven patients seen between 8.00pm and 8.00am per night in SIVUH’s ED. When the 12 hour ED is introduced on 12th December 2011, these seven patients will be accommodated in the 24 hour EDs at MUH and CUH.
In April 2012 when the ED in SIVUH closes, the following facilities will be available:
· Acute Medical Unit (short stay and medical assessment) at CUH will cater for 8,000 – 9,000 emergency medical patients annually.
· A new Surgical Assessment Unit due to open at CUH in the first quarter 2012 will treat 3,600 emergency surgical patients annually.
· A new Urgent Care Centre at St Mary’s Orthopaedic Hospital under the governance of Mercy University Hospital, is to open in January 2012, will have capacity to treat between 8,000 – 9,000 patients (with facilities to expand if greater numbers attend) with injuries that are unlikely to require hospital admission. The Urgent Care Centre will be medically led and will treat patients with injuries such as suspected broken bones, sprains, facial injuries, minor scalds and burns. It will be open 12 hours per day, seven days per week.
· Major trauma patients will be treated at the ED at CUH.
· The MUH’s ED will continue to operate as normal.
· Cardiology patients will attend the Cardiac Renal Centre at CUH.
These emergency service developments will see up to 22,000 patients being treated in more appropriate settings ensuring that there is capacity for the 15,000 patients seen at the SIVUH’s ED in 2010.
Dr. Gerry McCarthy, Consultant in Emergency Medicine said “re-organising the emergency services in Cork city has been a challenging and difficult process given the complexity of emergency medicine, its interaction with other hospital services and their availability. I am however fully convinced that we will see improvements for our emergency patients once the services have been reorganised with patients who have certain conditions given the option of attending the urgent care centre to receive a service in a more timely fashion.”
All HSE residential services for older people will be required to comply with HIQA accommodation standards with each facility required to have a minimum of 80% single rooms. As part of HSE South’s plan to maintain its bed capacity for older people across the city, three new purpose built Community Nursing Units (CNUs) have been developed, meeting HIQA standards, over the past two years namely;
· Heather House CNU on St Mary’s health campus (50 bed CNU comprising 25 replacement beds, which opened in April 2011 and 25 new beds, due to open in December 2011);
· Ballincollig CNU (100 new beds – commenced opening on a phased basis in September 2011). Mowlam Healthcare have been contracted to provide this service on behalf of the HSE and;
· Farranlea Road, CNU, Farranlea Road, Cork city (100 beds; 75 replacement beds and 25 new beds – due to commence opening on a phased basis in December 2011).
The net impact of this will be 20 additional long stay beds for older people, 25 places for young disabled adults and seven rehabilitation beds for older people in Cork city and its immediate vicinity. This is in addition to the 100 beds in Ballincollig CNU.
Farranlea CNU will provide the capacity to replace 75 existing long stay beds at St Finbarr’s Hospital, which do not meet HIQA accommodation standards. 168 beds (91 long stay, 72 rehabilitation and five sub-acute) will continue to be provided at SFH. The HSE South is engaging fully with residents and their families in order to identify those who wish to transfer.
According to Area Manager for the HSE in Cork, Ger Reaney, “the community services re-organisation is a vital component in our entire re-organisation process which aims to provide our older people with more choice in terms of long stay care and better facilities.”