Services for people with cystic fibrosis in Ireland conclusions of a working group established by the Health Service Executive

摘要

In response to the Pollock Report which was published in 2005, the HealthudService Executive established a Working Group with multi-disciplinaryudmembership to undertake a wide-ranging review of the current infrastructure forudCF in Ireland. The recommendations of the review endorse many aspects of theudPollock Report in identifying deficits in staffing levels and appropriateudaccommodation across the country which has not kept pace with the increase inudthe CF population.udOptimum care for people with CF as defined by the European Consensusuddocument 16 is based upon multi-disciplinary care supervised by a specialistudcentre. It is clear that these requirements cannot be met in all of the hospitalsudcurrently providing CF care and that a new structure is required whichudcoordinates:ud· an appropriate level of care for patients at the most convenient locationud· access to all of the specialist elements required for optimum outcomesud· appropriate transition between child and adult servicesud· information required to plan for a rapidly changing population which hasudongoing service requirementsud· access to care in an appropriate environment, e.g. facilities which enableudinfection control measuresudThe HSE Working Group concludes that the needs of the CF population wouldudbe best met by the following configuration of specialist cystic fibrosis centresudoffering either full care or supervision of structured shared care with satellite CFudcentres:ud· Dublin North: Beaumont (adult) linked with Children’s University Hospital,udTemple Street (children)ud· Dublin South: St Vincent’s (adult) linked with a more closely integratedud5udOLCH, Crumlin / AMNCH, Tallaght service (children)ud(pending the establishment of the new national children’s hospital)ud· Cork: Cork University Hospital (children and adult)ud· Limerick: Regional Hospital, Limerick (children and adult)ud· Galway: Galway Regional Hospitals (children and adult)udThe Working Group also recommends that Waterford Regional Hospital and OurudLady of Lourdes Hospital, Drogheda should provide shared paediatric care with auddesignated specialist centre (Our Lady’s Children’s Hospital, Crumlin and theudChildren’s University Hospital, Temple Street respectively).udWith the regard to adult patients, the group recommends that a ConsultantudRespiratory Physician with a special interest in Cystic Fibrosis be appointed toudWaterford Regional Hospital with a view to the hospital developing as a CFudspecialist centre over time. Other units currently providing services may continueudto do so on a shared care basis linked with a specialist unit.udThe Working Group recommends that a tertiary clinical service linked with audnational lung transplant programme should be formally designated for both adultudand paediatric services. St. Vincent’s University Hospital is suggested as theudnational referral centre for adult patients and Our Lady’s Children’s Hospital,udCrumlin (pending the establishment of the new national children’s hospital) as theudnational referral centre for paediatric patients due to the current availability ofudhepatobiliary, paediatric surgery and other specialist services required by audproportion of CF patients.udOther key recommendations of the report are as follows:ud· The enhancement of staffing and accommodation to internationaludguideline levels - proposed staffing requirements appropriate to theudcurrent number of patients are outlined in appendix 2.ud· All services should be designed to minimise the risks of cross-infection byudthe adoption of a service control of infection policy.ud6ud· The establishment of a national CF reference laboratory should beudformally designated as a priority.