The NCPS contributed to the Surgery for Ireland: Report of the Short-Life Working Group on the Provision of Emergency Surgery. The document was launched at Charter Day in February 2023, and proposed a new networked approach for emergency surgical care which would deliver a higher quality service to patients, preserve access across the country to senior surgical decision-makers, and create a working environment that is optimal for training, recruitment and retention of staff.

The report considered the current framework for delivery of emergency surgical care in Ireland, wherein it is provided at most hospitals. This can result in significant variation between hospitals in roster intensity, admission volume and operative complexity with all hospitals having a significant reliance on locum staff. There are challenges in emergency access to specialist surgery and a lack of clarity among surgical trainees about their career trajectory and responsibilities.

The report’s key recommendations included:

• New emergency surgery networks should include injury units, emergency surgery units and emergency surgical centres, with each network supported by access to an elective hospital.
• Emergency surgery centres should have availability of interventional radiology services and endoscopy on a 24/7 basis.
• Each hospital accepting emergency surgery patients should have an Acute Surgical Assessment Unit.
• Emergency and elective surgery should be carried out by the same consultant surgeon workforce in volumes sufficient to maintain the competence of the entire surgical team.
• Emergency duties and scheduled activity should be separate to allow consultant provided care, service continuity and to enable high quality surgical training.
• Consultant surgeons should work across more than one site in the network to enable full participation in both emergency and scheduled care activities.
• With appropriate policies and safeguards, senior surgical decision-maker rosters at emergency surgery units could include not only consultant surgeons but also senior surgical trainees, non-training grade doctors, advanced nurse practitioners and other health and social care professionals.
• Opportunities to increase advanced nurse practitioner and physician associate participation in the emergency surgery workforce should be explored.

NCPS Co-Lead Professor Deborah McNamara said at the launch, “Access to high quality emergency surgical care is lifesaving and must be available to everyone. Greater life expectancy among Irish people means that emergency surgery patients are more complex and have greater co-morbidity so the demands on our health service to deliver this care will continue to increase. At the same time, advances in surgery, interventional radiology and endoscopy mean that more treatment options than ever before are now available to surgeons and their patients. The majority of emergency operations can be delivered safely in most hospitals but the current system, with onerous on-call rotas and low volumes of high risk cases in many hospitals, makes it difficult for the more complex emergency patients to receive the care they need.”

“Emergency surgery is safest when performed during normal working hours by fully-trained staff and where sufficient volumes of surgery are performed to maintain the expertise of the multidisciplinary emergency surgery team. A networked system of emergency surgical care enables most emergency surgical care to be delivered as near as possible to the patient’s home while ensuring equitable access to complex care when required.”

From left to right, Professor Laura Viani (President of RCSI), Dr Colm Henry (Chief Clinical Officer HSE), and Professor Deborah McNamara (Vice-President of RCSI and NCPS Co-Lead) at the Charter Day launch in February 2023.