Speech by Simon Harris TD, Minister for Health at formal launch of A Trauma System for Ireland

Check against delivery

RCPI, Kildare Street, 21 February @ 11.30am

The government approved the publication of the Report of the Trauma Steering Group just over two weeks ago at its meeting on Tuesday the sixth of February. The report was immediately published on the website of my department and, tellingly, there was a broad and very welcome acceptance of its recommendations.

That acceptance is both a recognition of the need for improvement in how we deliver trauma care, and a testament to the robust and evidence-based work of the Trauma Steering Group, which was established in 2015 by An Taoiseach, Leo Varadkar, when he was Minister for Health.

The then Minister asked Professor Eilis McGovern to chair the Group. He charged it with examining the international evidence base for the efficient and effective organisation of trauma services for Ireland. The aim was to reduce preventable death and disability and improve outcomes.

Today I am delighted to be here to formally launch the Steering Group’s report, A Trauma System for Ireland, with Professor McGovern, with the Steering Group members and with many of those who have the greatest stake in this report – patients, clinicians and healthcare professionals, as well as health service managers and health policy makers.

Today gives me an opportunity to thank, personally, all those who were involved in developing the strategy set out in this report. Through the Steering Group and on the five Working Groups which looked in detail at each element of the care pathway, many of you have shared your expertise, your knowledge and your experience. Patients, clinicians, nurses and allied health professionals have all worked together to ensure the focus is on outcomes and on patient-centred care.

Today is also an opportunity for me to emphasise my own commitment to the implementation of this report, in the interests of patients. We know that the number of major trauma patients in Ireland is relatively low – the estimate is that 1,600 people are likely to suffer major trauma each year, when measured in terms of the Injury Severity Score.

But while the numbers are relatively small, there is no doubting the impact on patients and their families. As A Trauma System for Ireland points out very clearly, these injuries can be life changing. It is vital that we do all we can to reduce death and disability from trauma. And the international evidence which has informed this report points unequivocally to the importance of introducing a trauma system.

Vision of the report

Reducing death and disability, and improving patient outcomes drive the vision in this report to reduce the incidence and the burden of trauma, and to significantly improve the survival rate of major trauma patients. And to do this by ensuring that every patient receives the best possible standard of care in the most appropriate facility.

The report’s objectives, therefore, and my objectives as Minister are to:

• decrease the incidence and severity of trauma
• ensure equitable access to the right care for all patients sustaining trauma
• prevent unnecessary deaths
• reduce disabilities and to significantly improve the chances of attaining the fullest possible recovery

That is what the 45 recommendations in this Report aim to achieve.

Evidence based policy

As Minister for Health I am committed to evidence-based policy making and data is an essential component of that. In 2016 I approved the endorsement of the Major Trauma Audit as the first national clinical audit to be published as an NCEC National Clinical Audit.

Data published by the Major Trauma Audit for 2014 and 2015 informed the development of A Trauma System for Ireland. Three weeks ago the publication of the Major Trauma Audit 2016 provided us with further excellent data which will enable us to measure health outcomes and processes.

So we know that at the moment, severely injured patients may present to any acute hospital regardless of how much expertise and experience exists there. We know that in 2016 only eight per cent of trauma patients were assessed by a trauma team on arrival at hospital. We know that 28% of trauma patients were transferred at least once to another hospital to receive care. We know that more than half of patients with traumatic brain injury were not admitted to a neurosurgical unit.

The Major Trauma Audit report of the 31st of January highlighted these deficiencies in our current trauma services. It underlined the need for improvement and it will provide us with a baseline against which we can judge the effectiveness of changes in how we deliver trauma care.

The Major Trauma Audit report also served to underpin the broad acceptance we have seen for the recommendations of today’s report of the Trauma Steering Group. It is very clear that there is really no alternative – we must improve the way we deliver trauma care, through the introduction of a trauma system.

We know that other countries have already established organised systems of trauma care delivery and the international evidence is clear – such trauma systems are associated with better patient outcomes, more lives being saved and fewer people being left with a disability following severe injury.

The recommendations in A Trauma System for Ireland are underpinned by consideration of extensive international research, and the experience in other countries, including England and Australia.

This report reflects the evidence, and very importantly it translates it to the Irish context to ensure it responds to our population needs, demographics and geography and that it takes account of where we are starting from in our current services.

What will the Trauma System look like?

A Trauma System for Ireland addresses the entire trauma care pathway – from prevention to rehabilitation. It recognises that each stage has a key role in preventing death and disability and, where injury occurs, in improving the patient’s chances of the fullest possible recovery.

The recommendation for two inclusive hub and spoke Trauma Networks takes specific account of the geographical spread of the population in Ireland.

Each Trauma Network will have a Major Trauma Centre which will see a minimum 240 to 250 cases. The relationship between volume and outcomes is now much better understood in Ireland than it has been in the past. We now know that specialist complex care should be consolidated in fewer centres while less complex care can be delivered as close to home as possible. Each Major Trauma Centre will have the required volume to maintain critical mass and ensure the necessary concentration of specialist expertise for the most complex and serious injuries.

The report also recommends a Trauma Unit with Specialist Services at Galway. Galway should be able to provide definitive care for a wide range of injuries occurring in the surrounding region. This will require resources and expertise on a par with the Major Trauma Centres other than for neurosurgical and neurocritical services.

The media coverage of the report’s publication two weeks ago, while very positive, concentrated disproportionately on Dublin, Cork and Galway. The report, emphatically, does not do that – it recognises the need for trauma receiving hospitals around the country.

Trauma Units at Letterkenny, Sligo and Mayo, at Kerry and Limerick, at Waterford, Tullamore and Drogheda will see significant numbers of trauma patients. These hospitals have been identified as potential Trauma Units, since they have both 24/7 Emergency Departments and trauma and orthopaedics surgery.

The report also points to the potential of co-operation with Northern Ireland to enhance trauma service delivery and coverage. My department and the Department of Health in Northern Ireland intend to engage on this, as we have already done on other health areas of the health service, and I am very pleased to see representatives from the Department of Health and the health service in Northern Ireland here today.

The most significant change to the configuration of trauma services will be within Dublin where the recommendation is that the number of trauma receiving hospitals should fall from six to three – one Major Trauma Centre and two Trauma Units. This will ensure critical mass in the Major Trauma Centre, while maintaining adequate service availability for a population the size of Dublin.

The consolidation of care that up to now has been fragmented is a major change for Dublin hospitals. I think it is clear to all of us here that that change has to happen.

Implementation and leadership

Implementing change is not easy. Where we have had success in our health service in the past, the common ingredients have been strong political leadership, evidence based policy direction, defined accountability and authority and clear, dedicated implementation structures. That’s what we have with the National Cancer Strategies and the ongoing work of the National Cancer Control Programme. I think it is fair to say that no-one today disputes the need to ensure our cancer services are organised so as to ensure critical mass of specialist services, for best outcomes. The latest figures published by the Lancet recently confirm that Ireland is moving up the global rankings in regard to cancer survival – in other words, cancer is a clear example of the outcome benefits to be gained from evidence-based organisation of services.

We now need to do the same for trauma.

The government has demonstrated its commitment to best outcomes for trauma patients, by approving the vision and objectives of A Trauma System for Ireland at its meeting of the 6th of February.

The inclusion of trauma care as a key area for capital investment in Project Ireland 2040 is a further marker of our commitment. The funding identified for trauma, within an overall 10.9 billion euro for health capital needs, is expected to address the need for dedicated trauma receiving areas, trauma wards and trauma operating theatres, in line with the designation criteria for Major Trauma Centres and Trauma Units set out in the report.

Other areas of funding within Project Ireland 2040 are also key to the successful implementation of the Trauma System. It includes the redevelopment of the National Rehabilitation Hospital. It also includes the provision of 2,600 additional acute hospital beds in line with the recommendations of the Health Service Capacity Review. This is part of the overall investment that is required in our acute hospital services to enable the delivery of high quality safe care, including trauma care.

As well as political leadership, I believe clinical leadership is also crucial for change. The appointment of a National Clinical Lead for Trauma Services, and the establishment of a National Office for Trauma Services within the HSE will provide an essential foundation for implementation of A Trauma System for Ireland. But broadly based clinical leadership across the system will be needed to support it.

Many of you, as clinical leads, have already played a crucial part in the development of the report either on the Steering Group or the five Working Groups. I ask you to bring your leadership to bear now, in implementation.

I want to acknowledge also the Royal College of Surgeons and the Royal College of Physicians, and the leadership and support you have shown. Your superb communication on behalf of this report has been influential and effective. You have helped to demonstrate the high level of clinical backing for its recommendations. That matters, in bringing about change.

In conclusion

It remains for me to thank once again, first of all, Professor McGovern. Your commitment and dedication to delivering this major report is clear to all of us and I thank you most sincerely.

I want to thank each member of the Steering Group and the five Working Groups. The combined expertise and experience of the more than 50 members of these Groups has delivered a clinically robust roadmap for trauma services. I encourage you to be champions for the Irish trauma system into the future.

The patient perspective has been central to the development of this report. I want to express particular gratitude to Ger Scully, Alan Mulligan, Damien McGovern, Galen English, Stephen Shortall and Colm Whooley, who participated in the consultation process or as members of the Working Groups.

I also want to thank Professor Chris Moran, National Clinical Director for Trauma in NHS England. Professor Moran acted as an external adviser to the Steering Group and I am delighted to note that he is able to be with us today.

The combined dedication and leadership of so many has laid the groundwork for the transformation of our trauma services over the coming years. In this report, we now have an evidence-based patient-centred roadmap towards better outcomes.

Thank you.

ENDS