Major trauma centre plans unworkable, neurosurgeon warns

Two major trauma centres, one in Cork University Hospital and one at the Mater Misericordiae University Hospital in Dublin, have been announced. File picture

A decision to set up a major trauma centre without full neurosurgery access is “nonsense” and puts patients’ lives at risk, a top neurosurgeon has warned.

On Tuesday, two major trauma centres, one in Cork University Hospital (CUH) and one at the Mater Misericordiae University Hospital in Dublin, were announced. 

The aim is to consolidate trauma care in specialised units.

However, while CUH already has a neurosurgical centre, the Mater does not.

Ciaran Bolger, professor of clinical neuroscience at Beaumont Hospital in Dublin, said creating a “new mini-neurosurgical centre” as proposed, is not workable. 

“The only solution is either to put the major trauma centre in Beaumont because that is where the neurosurgery is, or relocate neurosurgery to the Mater campus,” he said.

“People are trying to pass it off as Irish hospital politics. To be honest we don’t care where it is, but neurosurgery needs to be with it, like they have in Cork.” 

More than half the people who die from trauma die of brain injury, he said. 

Patients with head injuries make up more than half of those needing immediate life-saving surgery.

Major trauma cases usually make up about 20% of their workload so consultants will lose other emergency skills, he said. 

Prof Bolger said: “The idea that you pick a surgeon out and he will run everything is just nonsense, it shows a complete lack of understanding of modern medicine. At a really basic level, they don’t understand how it works.” 

It can take up to two years to train a neuro-specialist nurse, and other staff are required to give top-level care.

“It is about the care you get in a fully-functioning service,” he said. “This has not worked anywhere else in the world.” 

An open letter from all consultant neurosurgeons at the National Neurosurgical Centre in Beaumont Hospital also warns of risks to patient safety.

Echoing Prof Bolger’s call for co-location, the letter states: “Any in-between solution will result in avoidable loss of patients’ lives.” 

Prof Bolger was sharply critical of the lack of neurosurgical input to the decision, saying consultants in Cork and Beaumont were side-lined.

The group has been making representations through the HSE, the Department of Health, and the political system for about 18 months. But he only heard the final decision through the health minister’s social media account.

Prof Bolger said a presentation he made to the Independent Assessment Panel had little impact.

However, a HSE spokeswoman said neurosurgeons were welcomed to the process.

The spokesperson said the HSE expects to collaborate with the centre in Beaumont, and she said half the panel are experts in “retrieval and acute management of all trauma including head injuries.” 

She said inclusive trauma systems can “reduce the chances of dying following major trauma by 20%.”