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  1. 1. THE UNIVERSITY OF DUBLIN Trinity College PROFESSOR OF NEPHROLOGY / CONSULTANT NEPHROLOGIST & GENERAL PHYSICIAN at The Adelaide & Meath Hospital, Dublin Incorporating the National Children’s Hospital (AMNCH) FURTHER PARTICULARS 1
  2. 2. Table of Contents Page 1. Background 3 2. University of Dublin / Trinity College 3 3. The Faculty of Health Sciences 4 4. The Adelaide & Meath Hospital, Dublin Incorporating 5 the National Children’s Hospital 5. Trinity College, Dublin - Department of Medicine 10 at The Adelaide & Meath Hospital, Dublin Incorporating the National Children’s Hospital 6. Position of Professor / Academic Consultant 14 7. Contact Information 17 8. Applications 17 Appendix 1 HSE Approval Letter 18 Appendix 2 Teaching Facilities in the Trinity Centre for Health Sciences and the Hospital’s Education Centre 21 Appendix 3 Hospital Statement 23 Appendix 4 Renal Dialysis Expansion in Dublin, Mid Leinster HSE 25 Area with Particular Reference to AMNCH Appendix 5 Strategic Plan – Trinity College Dublin 31 Appendix 6 School of Medicine Staff List 32 Appendix 7 Draft Consultants Contract 33 2
  3. 3. 1. Background Trinity College, Dublin and the Adelaide & Meath Hospital, Dublin Incorporating the National Children‟s Hospital (AMNCH) seek to appoint a Professor of Nephrology / Consultant Nephrologist & General Physician with a distinguished reputation in research and teaching to provide leadership in both the University and the Hospital. The appointment of Professor of Nephrology/ Consultant Nephrologist & General Physician based in the AMNCH should be seen in the context of an unprecedented rate of development in the national economy, the University, and, within it, the Faculty of Health Sciences and the Medical School. The College has invested heavily in teaching and research facilities and Medicine at Trinity College, Dublin is the most sought after university course in the country. In recent years, the University has embarked on a building programme which has transformed its city centre campus. In addition, €38.09m has been invested in the Trinity Centres at St. James‟s and the Adelaide & Meath Hospital, Dublin Incorporating the National Children‟s Hospital. Planning for a Phase II building at AMNCH has commenced. 2. The University of Dublin/Trinity College Dublin Trinity College is the single constituent college of the University of Dublin, founded in 1592 by Royal Charter of Queen Elizabeth I. The College has grown rapidly in recent years in response to the high demand in Ireland for third level education and to government policies designed to meet this demand. Today there are some 15,000 students and 2,000 full-time staff of which about 600 are tenured academics. There is, in addition, a large number of part-time staff, particularly in the Faculty of Health Sciences. In recent years the University has embarked on a €200m building programme and has a current external research income of some €70m per year. The College has implemented fundamental structural reform. In excess of 60 departments have been combined into 24 schools and are grouped into three faculties. These reforms have been complemented by the introduction of a new academic resource allocation model (ARAM) based on teaching/education and research activities. In Health Sciences the original seven schools have been restructured into three: School of Medicine School of Dental Sciences School of Nursing and Midwifery The School of Pharmacy and Pharmaceutical Sciences has also been incorporated into the Faculty of Health Sciences. In the School of Medicine nineteen departments/academic units have been restructured into six academic divisions. One of the Divisions is devoted to education and the other five are interdisciplinary and research driven. It is envisaged that departments will be replaced by disciplines and that disciplines may be involved in more than one division. 3
  4. 4. Funding for university research has received significant government support in recent years. The new National Development Plan (2000 – 2006) included approximately €2.53bn for research, development and innovation and the College has been very successful in competing for these funds particularly from Science Foundation Ireland. Trinity has also been highly successful in securing funds under the Programme of Research in Third Level Institutes (PRTLI) funded through the Higher Education Authority, winning €101.57m to date, including €15.4m for an Institute of Molecular Medicine to conduct a programme of research with University College Dublin as the Dublin Molecular Medicine Centre. In the most recent round of HEA funding, Trinity was awarded €25.39m for the Trinity Institute of Neurosciences. In 2006, the College updated its five-year Strategic Plan launched in July 2003 which further outlined commitments to build on current strengths, to further develop an internationally competitive research and scholarship programme and an education programme characterised by quality and innovation. 3. Faculty of Heath Sciences and the School of Medicine The Faculty of Health Sciences at Trinity College Dublin has four constituent Schools. The School of Medicine. The School of Dental Sciences. The School of Nursing & Midwifery. The School of Pharmacy & Pharmacological Sciences. Within the School, the Professor of Nephrology post is associated with the Clinical Medicine academic unit in The Adelaide & Meath Hospital, Dublin incorporating The National Children‟s Hospital. The Faculty of Health Sciences provides education and training for medical doctors, dentists, nurses, midwives, physiotherapists, occupational therapists, radiotherapists and pharmacists. The Faculty has a strong graduate programme with over 170 students registered for research degrees (Ph.D. /M.D.) and over 250 participating in the wide range of taught M.Sc./Diploma programmes. The Faculty promotes an environment which fosters a team approach to the delivery of healthcare in the hospital and the community. This multi-professional ethos seeks to encourage mutual respect and understanding between health professionals and the sharing of knowledge and skills, which facilitates efficient teamwork and healthy professional relationships. This shared experience also promotes co-operation in education and research within the professions and allows more efficient use of expertise and educational facilities. The Faculty is actively working with its teaching hospitals on joint initiatives in postgraduate education and research. These initiatives complement and underpin the Faculty‟s own developments in the area of postgraduate studies. A wide range of over 25 taught courses leading to Postgraduate Diplomas and M.Sc. degrees have been developed in recent years and a number of further courses are in the process of development. Some of these courses are targeted at a specific profession, such as the M.Sc. in Physiotherapy; others are directed towards research such as the M.Sc. in Molecular Medicine and the 4
  5. 5. M.Sc. in Molecular Pathology, whilst others are of an interdisciplinary nature, such as the M.Sc. in Health Services Management. Some courses are part- time, providing opportunities for individuals to continue in their professional work and others are full-time. There are 291 students registered on taught postgraduate courses (M.Sc./Diploma) in the School of Medicine for 2007/08 and 199 students registered for postgraduate research degrees. Educational facilities for the professional schools in the Faculty are situated both on the city centre campus and in the Trinity Centres associated with affiliated hospitals. In 1994 the College opened major new academic facilities at St. James‟s Hospital located approximately 2 miles from the main campus, and it has a complementary facility at the new Hospital at Tallaght, approximately 7 miles from the main campus. In all, the College undertook a €39m capital programme in Health Sciences in the ten-year period to 2004. A new Biosciences Building will be opened in 2011. The building is situated on Pearse Street as part of the main campus of Trinity College Dublin. It will house the School of Medicine including Anatomy, Physiology, lecture theatres, seminar/teaching areas and an administration block. This will be a significant contribution to the School of Medicine in the University. At present, the majority of didactic clinical lectures and teaching in the clinical laboratory sciences is based at the Trinity Centre for Health Sciences at St. James‟s Hospital where there are lecture theatres, seminar rooms and the John Stearne Medical Library The Trinity Centre in the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital, Tallaght contains office accommodation, a lecture theatre, seminar rooms, a 40 workstation computer-teaching laboratory and research space. Discussions have commenced aimed at devising specific computer-based modules in pathology that can be delivered at the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital using this technology. Clinical teaching takes place on both hospital sites. Students are also accepted in the Faculty to work towards the degrees of M.D., M.Ch., M.A.O., M.Sc. and Ph.D. by research. Such students work under the supervision of a designated member of the Faculty. There are ongoing discussions in respect of shared governance/partnership between the College and its teaching hospitals. The School will celebrate its Tercentenary in 2011. A Tercentenary Committee has been established and it will focus on fund-raising, emphasising the central role of the medical school in the scientific and cultural life of the city. The primary focus will be on resourcing the capital development of building programmes on the College Green campus, St James‟s Hospital campus and the campus at the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital, Tallaght. Emphasising the key role of the Meath and Adelaide Hospitals in the history of medicine and of medical education, it is proposed to work towards establishing a facility incorporating clinical skills coupled with integrative medicine and surgery and preventative medicine on the Tallaght campus. Translational medicine will be primarily based at the St James‟s campus, and central administration and non-clinical teaching at the College Green campus. All three strands will be integrated in a historical sense 5
  6. 6. with particular emphasis on: (i) marrying traditional and new technologies; and (ii) complementary developments on the three sites. The current Strategic plan for the School of Medicine is available via the following link ategic_Plan.pdf 4. The Adelaide & Meath Hospital, Dublin Incorporating the National Children’s Hospital, Tallaght, Dublin 24. 4.1 Introduction The Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital (the Hospital) has been developed as a result of the merging of three distinguished city-centre teaching hospitals: the Meath Hospital (founded 1753), the National Children‟s Hospital (founded 1821) and the Adelaide Hospital (founded 1839). Some of the internationally known medical names associated with the history of the Hospital include Robert Graves (1796-1853), William Stokes (1804-1877) and Denis Burkitt (1911-1996). The famous Adelaide School of Nursing was founded in 1859 in the Nightingale tradition. The three former hospitals continue their tradition through their legally constituted successors (Foundations): The Adelaide Hospital Society, The Meath Hospital Foundation and The National Children's Hospital which support the Hospital through Board representation and fund-raising activities. The three hospitals moved from their existing locations in 1998 to a newly built state-of-the-art Hospital on a 38 acre campus in Tallaght, South County Dublin. The new hospital represents the largest single hospital project ever commissioned by the State and was incorporated under Charter on 1 August 1996, bringing together over 600 years of renowned medical training, research and nursing excellence. The Hospital provides a comprehensive range of diagnostic and treatment services, many with national or regional status commensurate with a university teaching hospital. The Hospital delivers medical and surgical services to children, adolescents, adults and the elderly. There are designated accident and emergency, out-patient, in-patient, theatre and diagnostic services for children. In addition to these services the Hospital embraces the acute in- patient psychiatric services hitherto provided by St. Loman‟s Hospital. The Hospital operates under the unique legal framework of the Charter which was enacted by Dáil Eireann on 1st August 1996. The voluntary and independent character of the Hospital, which stems from the Charter, will ensure an imaginative, innovative atmosphere for fulfilling the objectives of the Charter in respect of university teaching, medical research and flexibility in responding to new developments. The Hospital in partnership with other Irish major academic teaching hospitals, has embarked on an accreditation programme and has achieved Pre-Accreditation Advanced. The Hospital also has a comprehensive range of Information Technology / Information Systems. All areas within the hospital are computerised and networked. Facilities available on the system include Patient Information 6
  7. 7. Management System (PIMS), Accident and Emergency System (Footman Walker), Order Communications, Laboratory Information System (LIS), Electronic Mail, Intranet, and the Hospital‟s own web site . The Board of Management of the Hospital, of which the Dean of the Faculty of Health Sciences, Trinity College, is a member, has an explicit commitment to academic excellence and a Teaching Agreement between Trinity College and the Hospital, agreed on 26th October 1995, recognises the Hospital as one of the College‟s two main clinical teaching centres. There is a strong academic commitment between the Hospital and the Trinity Centre for Health Sciences which opened in 2000. The Adelaide Hospital Society, The Meath Hospital Foundation and The National Children's Hospital and St James‟s Hospital are partners in their development of education and research facilities for the School of Medicine and Faculty of Health Sciences. This building is interlinked with the Hospital's Education Centre and together they accommodate the Medical School, the Postgraduate Medical Centre, the Hospital's School of Nursing and Midwifery, the library and research facilities. 4.2 Corporate Strategy The Hospital has completed the exercises of transferring the services from the four hospitals and of integrating them into a functioning whole at Tallaght. It has now embarked on a planning exercise to delineate a corporate strategy which will guide the development of services for the next three to five years. It is very much hoped that the Professor appointed would be able to share in this planning process. The objective is to improve the way patients are dealt with and treated, bearing in mind quality, timeliness and cost. 4.3 Catchment Area The Hospital serves a rapidly growing catchment population (currently 550,000+) and also continues its national tertiary referral and regional services. The catchment area includes North Kildare area, which is the fastest growing “young family” area in Europe. Approximately 40% of the population are less than 15 years old. The Hospital also has a unique clinical and executive relationship with Naas General Hospital which has undergone a major re- building programme (€63.49m) to provide Accident and Emergency, Surgical and Medical Services with a number of joint Consultant appointments in medicine and other specialities. There are shared lecturers posts in medicine and surgery between Tallaght and Naas. The holders of these posts co- ordinate teaching for undergraduate students and are involved in research in the surgical and medical professorial departments. There is also a unique clinical and executive relationship with Peamount Hospital with a number of joint appointments. 4.4 Surgical Facilities There are twelve major operating theatres, including state of the art instrumentation, laparoscopic facilities and extensive clinical support services. There are also two minor operating theatres in the day area for ambulant procedures performed under local anaesthetic. The Endoscopy Unit consists of three endoscopy suites and a 13 bed day-ward area. A comprehensive diagnostic and therapeutic service is provided including therapeutic ERCP, 7
  8. 8. endoscopic ultrasound, haemostatic techniques, enteral stenting and laser therapies. The Hospital has been at the forefront in developing rapid access day surgery. 4.5 Nephrology Facilities The Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital (AMNCH) is the principal Nephrology service in the Dublin and South Leinster HSE area (Population 1.2 million). The hospital has a 12 station dialysis unit with two isolation rooms. It operates a satellite dialysis facility in Beacon Renal Unit, Sandyford in conjunction with St. Vincent‟s Renal service (30 Stations). AMNCH provides chronic Haemodialysis dialysis services for its own population, Naas and St. James‟s Hospitals. It also provides a supra- regional peritoneal dialysis service and has the largest peritoneal dialysis programme in Ireland. The unit is the second largest non- transplant centre in Ireland and as of the end of June 2008 was treating 190 Dialysis patients and 223 renal transplants. It supervised in excess of 15,000 dialysis sessions in 2007. The hospital is actively pursuing the establishment of a Regional Renal Medicine Clinical Network with St. Vincent‟s University Hospital and the Midlands Regional Hospital in Tullamore. 4.6 Initiatives in Planning Currently there are four groups planning interdisciplinary initiatives in clinical service, education and research. These include an Institute of Preventative Health, “Cancer Prevention Institute” involving six major disciplines, a Neurosciences Axis involving 12 disciplines and a Cardiovascular Institute which also involves a large number of disciplines. All involved consider that these strategies will provide significant opportunity to make a notable contribution to the international field of research and science. 4.7 Emergency Medicine The Hospital plays an integral part in the provision of Emergency Medicine services together with the other major Dublin hospitals. There is a separate designated Emergency Medicine Department for children. 4.8 Diagnostic Services Radiology All conventional X-Ray services are available including Magnetic Resonance Imaging (MRI), CT Scanning, Ultrasound, Nuclear Medicine, Angio- Interventional and Mammography. The Hospital has incorporated a fully filmless PACS and Radiology Information System (RIS) integrated with the Hospital's Information System. Development plans for the department include an increase in Consultant manpower and expansion of links with Naas General Hospital. Pathology There are comprehensive pathology laboratory services encompassing all 8
  9. 9. laboratory medicine disciplines: Clinical Chemistry, Haematology, Histopathology / Cytopathology and Medical Microbiology. The laboratory is equipped to a high standard and offers all routine diagnostic modalities including flow cytometry, computerised image analysis and molecular techniques (in-situ hybridisation, FISH, PCR). The laboratory is fully computerised and on-line result reporting is available in ward and out-patient areas over the hospital network. Clinicopathological meetings take place on a regular basis including a weekly gastroenterological conference and a weekly multidisciplinary meeting with pathologists, radiologists, surgeons and gastroenterologists. Integration of laboratory services with Naas General Hospital is proposed, including referral of samples from Naas to the Hospital for specialised tests together with a number of joint Consultant appointments. There are active research programmes in many disciplines and collaborative research with clinical services is facilitated. Areas of research include cystic fibrosis and Helicobacter pylori (microbiology), apolipopotein and homocysteine metabolism and medical informatics (clinical chemistry), myelodysplasia and haematological malignancy (haematology), Inflammatory Bowel Disease, colorectal carcinogenesis, breast cancer prognostic indices, urologic malignancies (histopathology). 4.9 Clinical Support Services The full range of clinical support services is available on site in the Hospital. These include physiotherapy, psychology, occupational therapy, speech and language therapy, clinical nutrition and dietetics, social work, pastoral care, medical physics and clinical engineering and pharmacy. 4.10 Education Facilities The Hospital has a long and distinguished history in medical education and research and with the support of funding from the three base hospital foundations, built and equipped the Trinity Centre for Health Sciences which is intimately linked with the Hospital's Education Centre. The two together provide a significant academic and educational presence on the hospital site. Strong research and teaching in laboratory-based medicine is seen as essential for the development of the Hospital. The Laboratories in Phase One of the Health Sciences Building provide research space which requires expansion. Phase Two development provides for a dedicated Research Centre which is presently at advanced planning stages. A state-of-the-art integrated audio-visual system has been commissioned which supports education and training to all students of various disciplines in the Hospital. This system provides links between the main Operating Theatres and Endoscopy and Angiography to the Education Centre and the Trinity Centre for Health Sciences building as well as Tutorial rooms dispersed throughout the Hospital. The Robert Graves Centre is located in the Education Complex and represents a joint initiative between the Postgraduate Medical and Dental Board, the Hospital and Trinity College, Dublin. In conjunction with its sister centre, the 9
  10. 10. William Stokes Postgraduate Centre in St James‟s Hospital, it provides postgraduate facilities and resources for doctors in South and South-West Dublin. The Hospital currently provides local, regional or national services in the following areas: Emergency Medicine Services Medical Oncology Anaesthesia, Intensive Care, and Nephrology Pain Clinic Neurology Cardiology Neurophysiology Dermatology Orthopaedic Surgery - Elective Diabetic and Metabolic Disorders Orthopaedic Surgery - Trauma Diagnostic Services - Laboratory Otolaryngology Medicine, Radiology Palliative Medicine Endocrinology Paediatric Medicine Gastroenterology Paediatric Surgery General Medicine Psychiatry General Surgery Rehabilitation Medicine Geriatric Medicine: Assessment Respiratory Medicine Rehabilitation and Day Hospital, Rheumatology Stroke Service, Dysphagia, Driver Urological Referral and Stone Assessment Centre Gynaecology Vascular Surgery 5. Trinity College, Dublin - Department of Medicine at the Adelaide & Meath Hospital, Dublin Incorporating the National Children’s Hospital (AMNCH) The Trinity Centre for Health Sciences at the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital includes in-whole or in-part many of the Faculty‟s clinical departments, including Paediatrics, Clinical Medicine, Surgery, Public Health and Primary Care and Psychiatry. These areas combine with a number of key hospital strengths to provide a unique opportunity for interdisciplinary research. Fifty percent of the TCD medical students rotate through the hospital at any one time. In common with all clinical departments, the Professorial Surgical Unit has a significant responsibility both to its students and to its patients at the hospital. The Hospital has a very large local catchment population of approximately 500,000 and has also patients referred nationally. 5.1 Staff The Trinity College Professor and senior lecturers/lecturers based in AMNCH together with their areas of interest is listed below. Academic Head and Dean of Faculty of Health Sciences: Professor Colm Ó‟Moráin Professors/Associate Professors: Cardiology (I. Graham); Age Related (D. O‟Neill), General Practice (T.O‟Dowd); Clinical Public Health Medicine (J. Barry); Clinical General Practice (F. O‟Kelly) 10
  11. 11. Senior Lecturers & Lecturers: Age Related Health Care (R. Collins, T. Coughlan, A. O‟Driscoll, P. O‟Brien); Cardiology (D. Mulcahy, D. Moore, D. O‟Gorman); Dermatology (M Connolly); Emergency Medicine (J. Gray, G. Little, J. O‟Sullivan, M. Rochford); Endocrinology (J. Barragry, J. Gibney, K. Moore); Gastroenterology (N. Breslin, B. Ryan, H. O‟Connor); Gynaecology (P. Crowley, P. Bowman, C. Murphy, G. von Bunau, W. Prenderville); Haematology (H. Enright, N. O‟Connell); Medical Oncology (R. McDermott, J. Walshe); Nephrology (G. Mellotte, C. Wall, A. Watson); Neurology (R. Murphy, D. McCabe); Neurophysiology (M. Alexander); Palliative Medicine (S. Higgins), Respiratory Medicine (S. Lane, E. Moloney, J. Power); Rehabilitation Medicine (J. McElligott), Rheumatology (D. Kane). 5.2 Physical Facilities The Department of Medicine has office space and research space in the Trinity Centre at the AMNCH Education Centre for the Professor and secretary and associated academic staff. 5.3 Departmental Governance and Headship The Head of the Department of Medicine at AMNCH, Tallaght is Professor Colm Ó‟Moráin. The Professor of Nephrology will play a major role in education, research, administration and ongoing audit and development within the Department. Academic Staff and individual consultant hospital staff and heads of specialist departments contribute substantially to the Department as part-time members of the academic staff. Regular departmental meetings are held with integration of its part-time members into the decision making process, good communication and close contact between the staff in both hospitals. 5.4 Teaching The Department of Medicine engages in a wide range of teaching to undergraduates and postgraduates. It makes significant teaching contributions to other departments, to the clinical staff of the hospital and to other institutions both nationally and internationally. Undergraduate Teaching The Departments of Medicine, located at AMNCH and St James‟s Hospital are responsible for the teaching of medical undergraduates of Trinity College, Dublin. Small group clinical bedside teaching is the cornerstone of surgical undergraduate teaching. Wide spread curricular reform has improved the quality of surgical rotations in the hospital. The course content is delivered via a small group clinical bedside teaching, clinical skills laboratory, problem based learning sessions. A research project is encouraged in order to develop scientific methods, analytical skills and encourage student collaboration skills. This is supported by the Health Research Board. Student progress is assessed by continuous assessment, clinical examination, multiple choice examination, case report, individual project, group project, 11
  12. 12. OSCE (Objective Structured Clinical Examination). Currently the final exit exams are organised and managed from the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital. In our undergraduate surgical training we aim to foster a supportive, enthusiastic attitude among staff and students. This has been commented on favourably by the Irish Medical Council. We involve our students in the working life of the hospital and foster an environment where the students are free to express their ideas, ask questions and seek help where needed. Arrangements for elective exchanges have been concluded with several Medical Schools both nationally and internationally. Postgraduate Teaching and Research The Department of Medicine offers the following degree programmes by research: The Doctor of Medicine (MD and Ph.D) The Professor of Nephrology will be actively involved in the development of the undergraduate and post graduate curricula, their delivery, assessment and ongoing development and will also promote and support research. The School of Medicine is continuously reforming the undergraduate curriculum, a process which is being monitored and encouraged by the Medical Council. To date, the first three years have been restructured and a comprehensive course in medical ethics has been introduced commencing in year three. The task of reforming the clinical years and increasing the linkage with the pre-clinical curriculum is still in progress and it is expected that the successful candidate will play a role in this reform. Students rotate equally between the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital and St. James‟s Hospital for their medical and surgical attachments in the third and fifth years thus experiencing the particular features of both hospitals. The School is currently exploring computer based teaching using expertise and resources at the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital. In the past three years there has been an investment in clinical skills facilities located in the Trinity Centre at the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital and this facility is used heavily by students. There is also an emphasis on providing students with good research skills. Foundations are laid in the first year and project work and special study modules are provided in the fourth year. There is still a strong emphasis on clinical bedside teaching in all the clinical disciplines. 5.5 Research The Department of Medicine at AMNCH has developed a successful research programme since the hospital opened in 1998 and is involved in a wide variety of collaborative research projects with many institutions nationally and internationally. Existing research interests and strengths include such areas as cardiovascular, 12
  13. 13. neurosciences and aging, rheumatology, gastroenterology. Potential areas of collaboration for research and education exist due the on-site presence of Departments of Surgery, General Practice, Public Health, Medicine and Psychiatry. With the relocation of the Coombe Women‟s & Infants University Hospital to the Tallaght campus, research opportunities are further enhanced. . There are significant opportunities in our catchment area for important research with practical and useful outcomes and analysis of the specific population characteristics including higher than average birth rate, large numbers of asylum seekers, of the unemployed, and of single parent families. The development of an Institute of Preventive Health has been agreed by the Board of the AMNCH and has been included as part of the School‟s strategic plan in order to promote the early detection and screening and assessment of risk factors for a wide spectrum of medical disease. 5.6 Department of Public Health and Primary Care The department is located at the Trinity College Centre for Health Sciences at the Adelaide and Meath Hospital Dublin, Incorporating the National Children's Hospital (AMNCH). The mission is to foster the study and understanding of health issues through teaching, research, advocacy and clinical care, with particular emphasis on health deprivation and chronic disease, and societal health problems such as alcohol, tobacco, and illicit drug dependency. The Department came into being with the establishment of the Chair of Social Medicine in 1952. The establishment of the Chair recognised the contribution of the social environment to people's health or ill-health, and that medical students needed a perspective beyond their traditional hospital oriented training. Departmental staff form a multi-disciplinary team with public health, general practice, epidemiology, biostatistics, medical ethics and psychology all contributing to our research and teaching agenda. The department contributes to the 5-year medical undergraduate curriculum with courses in the 1st and 4th years. The 1st year course is the Human Development and Behavioural Science Course, incorporating Medical Ethics. This is an early patient contact course, as part of which students are assigned in pairs to visit families with young babies in the families' own homes. The People, Practices and Populations course is delivered in the 4th medical year. As part of this course the students are attached to two different general practitioners for a total of four weeks, where they can observe the wide range of ill health presenting in the community setting. The department incorporates the Small Area Health Research Unit (SAHRU) ( which provides in-house statistical expertise, along with statistical consultancies for external bodies and web based distance learning courses in biostatistics. The TCD/HSE Specialist Training Programme in General Practice is also part 13
  14. 14. of the department, providing us with a network of training practices which contribute to our teaching and research. 5.7 College and Other Funding The Department of Medicine receives a budget from the College designed to meet its teaching and routine administrative commitments. The Department or its members compete for major equipment funding to the Higher Education Authority (HEA), the EU, the Wellcome Trust, the Provost‟s Fund, the Irish Heart Foundation, the Cancer Research Fund, the Arthritis Foundation and the Health Research Board (HRB). The HRB has significantly increased its commitment to a strategic research policy that is expected to increase the level of funding available. The Faculty of Health Sciences is a member of the newly established EUROLIFE EU Network of long established European Medical Schools. The Department of Health and Children has also made a strong commitment to quality in the Health Service, and has introduced a structured programme for speciality training and research infrastructure. The State‟s direct contribution to the Health Research Board has almost doubled in two years which coupled with matching funds creates a positive environment for active researchers. Finally the Faculty and the College are exploring the possibilities of new funding models for the academic developments with the service agencies as well as with the educational authorities. 6 Position of Professor of Nephrology / Consultant Nephrologist & General Physician The College is seeking to appoint an innovator to provide strong leadership in research and teaching. A clinical team with secretarial staff will be available to support the clinical interests of the incoming Professor of Nephrology/ Consultant Nephrologist & General Physician . In addition, Trinity College may contribute to providing essential research equipment. Person Specification The following professional qualifications shall apply to this appointment (a) Registration as a specialist in the Specialist Division of the Register of Medical Practitioners maintained by the Medical Council in Ireland in the specialities of nephrology and general (internal) medicine. The appointee will: co-ordinate the development of an integrated teaching program in Clinical Nephrology that will include integration of undergraduate lectures, tutorials and examinations in the biomedical sciences, together with the teaching of clinical nephrology in the hospital setting. develop and maintain an internationally competitive research group in a recognized area of research in Clinical Nephrology including acquiring the necessary funds and recruiting, supervising, and supporting through to successful completion of post-graduate degrees of research students and/or post-doctoral fellows. be expected to contribute to ongoing curricular reform in the context of an expanding molecular medicine knowledge base and developing a 14
  15. 15. structured teaching programme incorporation an e-learning platform for undergraduates in TCD and IUMC Medical Schools and contribute to the development of a curriculum. represent the Faculty of Health Sciences at Trinity College Dublin, on appropriate national and international advisory boards and professional bodies. be expected to assume a leadership and managerial role within the Faculty of Health Sciences at Trinity College Dublin. work with the officials in the Medical Education, Training & Research (METR) Unit and will collaborate with senior officials throughout the HSE and externally to ensure an integrated and multidisciplinary approach to education, training and research, in line with HSE Board policy. develop interactive teaching programmes for graduates studying for membership of the Royal College of Physicians in Ireland and for those engaged in the Specialist Registrar training schemes in Ireland have an appointment as a consultant at AMNCH and be expected to contribute to the teaching, assessment and research activities in the Hospital have an opportunity to pursue their clinical interest in the department by holding Outpatient clinics, participate in the dialysis unit service and nephrology on call rota. be expected to develop a sub-speciality nephrology clinic in Beaumont Hospital which will be provided on an alternative week basis be expected to take a national role in renal transplantation medicine that will be provided by access to the national transplant centre in Beaumont Hospital be expected to participate in monthly transplant multi-disciplinary meetings held in Beaumont Hospital and actively contribute to and participate in the formulation of policies and protocols governing all aspects of renal transplantation medicine working with the transplant team in Beaumont be expected to contribute to the overall development of National Renal Programme and to support and contribute to the development of multidisciplinary education, training and research within the HSE. The normal duties for the post will include inter alia; Trinity College Dublin 8.5 hours per week for teaching duties 8 hours per week for research activities Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital 3 hours per week for out-patient clinics 3 hours per week for consultation services 3 hours per week for dialysis Participation in the nephrology on-call rota 6.5 hours per week for administrative / management duties and clinical interaction with the national Renal Programme and National Renal Registry 15
  16. 16. Beaumont Hospital 3 hours every second week for out-patient clinics 3 hours per month for multi-disciplinary meetings The foregoing list of duties will form part of the Clinical Directorate Service Plan. The remaining commitments are to be assigned by the employers and may be adjusted by the Clinical Director of AMNCH / Trinity College Dublin in consultation with the Consultant appointed to this post. The Academic Consultant is accountable for the delivery of the clinical component of the post as provided for in the body of the Consultant Contract 2008, and s/he is accountable via the management and governance structures in place in the University in relation to the delivery of their academic commitment. Commencement: by mutual agreement Hourly Commitment: 18.5 Clinical/18.5 Academic (week) Salary Scale New Entrant Academic Consultants on Type B contract: Point 1 - €254,896 (please note candidates must enter at point 1) Further Information Further information on the College may be obtained at the following web address: Further information on the School may be obtained at the following web address: www.medicine.tcd Conditions of Employment: The Consultant Contract 2008 for HSE approved Consultant appointments (Category Type B whole-time) apply to this post. 16
  17. 17. 7. Contact Information Interested applicants should contact in the first instance: School of Medicine, The Adelaide & Meath Staff Office – Trinity Trinity College Dublin Hospital, Dublin College Dublin Incorporating the National Children's Hospital Professor Shaun Professor Kevin C. Conlon Ms Ann-Marie Farrell McCann Chief Executive Officer Recruitment Officer Professor of Academic The Adelaide & Meath House 4 -Staff Office Medicine Hospital, Dublin Trinity College School of Medicine Incorporating the National Dublin 2 Trinity College Children's Hospital Dublin 2 Tallaght Telephone: +353-1-896 Dublin 24 1030 Telephone: +353-1- Email: 896 3069 Telephone: +353-1- Email: 4142845 Email: 8. Applications Applicants should provide the following information in applying for the Chair: A comprehensive curriculum vitae including full data on publications Names and contact details (i.e. addresses, e-mail etc) of five referees Completed applications should be submitted to: Ms. Ann-Marie Farrell Recruitment Officer House 4 – Staff Office Trinity College Dublin 2 Ireland Telephone: +353-1-896-1030 Email: The closing date for receipt of applications for all posts is noon, Friday, 15th January 2010. 17
  18. 18. Consultant Appointments Unit Room 1.32 Dr. Steevens‟ Hospital Dublin 8 Aonad Cheapacháin na nDochtúirí Comhairleacha Seomra 1.32 Ospidéal an Dr. Steevens Baile Átha Cliath 8 Tel / Guthán: (01) 635 2500 E-mail: Appendix 1 – HSE Approval Letter Mr. John Bulfin Hospital Network Manager Our Ref: TTGMNF12 Health Service Executive Arden Road Tullamore Co. Offaly 11th September 2009 Dear Mr. Bulfin, I refer to Ms. A. Larke‟s e-mail of 3rd November 2008, attached application and all related documentation. This letter supercedes the previous letter of 22nd January 2009. The Health Service Executive has approved the appointment of a: PROFESSOR OF NEPHROLOGY / CONSULTANT NEPHROLOGIST & GENERAL PHYSICIAN This is a joint academic appointment on a Type B basis under the Consultants‟ Contract 2008 by the University of Dublin, Trinity College (18.5 hours per week) and the Adelaide & Meath Hospital, Dublin incorporating the National Children‟s Hospital (18.5 hours per week). This is a new post. It is noted that the appointee will be expected to develop a sub-specialty nephrology clinic in Beaumont Hospital, which will be provided on an alternative week basis. The postholder will also be expected to participate in the monthly transplant multi-disciplinary meetings held in Beaumont Hospital, and actively contribute to and participate in the formulation of policies and protocols governing all aspects of renal transplantation medicine, working with the transplant team in Beaumont. Arising from a national programme to increase the number of academic clinicians in Ireland, funding for this post is being provided on a 50:50 basis between the Health Service Executive and the Higher Education Authority. The appointee will be expected to contribute to the overall development of medical education and training from a national perspective and to support and contribute to the development of multidisciplinary education and training within the Irish health service. In particular, the appointee will be expected to actively contribute to the development of a national core curriculum that will be developed by, and available to, all Irish medical schools. The Consultants‟ Contract 2008 provides for a normal working week of 37 hours. This 37 hour commitment will normally be delivered across a span of 12 hours between the hours of 8am and 8pm Monday to Friday. The normal duties for the post as outlined in the documentation and agreed by the HSE, will include inter alia: 18
  19. 19. University of Dublin, Trinity College 8.5 hours per week for teaching duties 8 hours per week for research activities Adelaide & Meath Hospital, Dublin incorporating the National Children’s Hospital 3 hours per week for out-patient clinics 3 hours per week for consultation services 3 hours per week for dialysis Participation in the nephrology on-call rota 6.5 hours per week for administrative / management duties and clinical interaction with the national Renal Programme and National Renal Registry Beaumont Hospital 3 hours every second week for out-patient clinics 6 hours per month for multi-disciplinary meetings The foregoing list of duties will form part of the Clinical Directorate Service Plan. The remaining commitments are to be assigned by the employer(s) and may be adjusted by the Clinical Director / Employer in consultation with the Consultant appointed to this post. If a significant change to this post is contemplated e.g. location, structure, title, contract type etc. the prior approval of the Health Service Executive is required. Approval to this post is subject to the following conditions Total employment remaining within your approved ceiling. That normal recruitment procedures for the filling of consultant posts are applied. That there are no additional non-consultant hospital doctor posts attached. This post may be subject to restructuring in the future to facilitate the reorganisation of acute services in line with new clinical models of acute and community services. The following qualifications shall apply to this appointment:- 1. Professional Qualifications, experience etc Registration as a specialist in the Specialist Division of the Register of Medical Practitioners maintained by the Medical Council in Ireland in the specialties of nephrology and general (internal) medicine. 2. Age Age restriction shall only apply to a candidate where he/she is not classified as a new entrant (within the meaning of the Public Service Superannuation (Miscellaneous Provisions) Act, 2004). A candidate who is not classified as a new entrant must be under 65 years of age on the first day of the month in which the latest date for receiving completed application forms for the office occurs. 3. Health A candidate for and any person holding the post must be fully competent and capable of undertaking the duties attached to the post and be in a state of health such as would 19
  20. 20. indicate a reasonable prospect of ability to render regular and efficient service. 4. Character A candidate for and any person holding the post must be of good character. 5. Entry to competition / recruitment process For the purposes of eligibility for entry to any competition or recruitment process associated with this post, applicants currently in employment as Senior or Specialist Registrars in HSE or HSE-funded agencies may participate in the competition on the basis that, on the latest date for receipt of applications, they are within 6 months (26 weeks) of certification of completion of specialist training and that evidence for same is provided from the relevant recognised postgraduate medical training body in writing. Requirements vis-à-vis approval letter All documentation relating to this post, including the job description, should be consistent with the contents of this letter. The Contract offered to the appointee should be consistent with the Consultant Contract 2008. This letter of approval shall be made available to all applicants for the post. This letter of approval must be attached at Appendix 1 to the contract to be made with the successful candidate as per the Consultants‟ Contract 2008. The regulation of consultant appointments transferred from Comhairle na nOspidéal to the Health Service Executive with effect from 1st January, 2005. In the event of the above post becoming vacant at any future date, whether by reason of resignation, retirement or death, the vacancy must be notified to the Health Service Executive which will then review the position and decide whether to ratify the continuation of the post. I would be grateful if, in due course, you would let me have, for record purposes, details (the name, date of birth and date of appointment) of the person appointed to the above permanent position. Yours sincerely, ---------------------------------------- Andrew Condon General Manager Office of the National Director of Human Resources 20
  21. 21. Appendix 2 - Teaching Facilities in the Trinity Centre for Health Sciences and the Hospital’s Education Centre include: a health sciences/medical library a 300 seat lecture theatre a 130 seat lecture theatre College of Nursing with 4 seminar rooms and three partitionable tutorial rooms four seminar rooms including a clinical skills laboratory a 40 workstation computer teaching laboratory a suite of clinical teaching, observation and treatment rooms for multidisciplinary clinical teaching a canteen and common room area departmental accommodation for Community Health and General Practice, Clinical Medicine, Surgery, Psychiatry, Paediatrics, Clinical Microbiology, Obstetrics and Gynaecology wet and dry research laboratories and associated instrument rooms (300sq.m.) postgraduate study space the Robert Graves Postgraduate Centre for continuing medical education. Audiovisual links between a number of operating theatres and the main lecture theatre(s). 21
  22. 22. Appendix 3 Hospital Statements II.1 MISSION STATEMENT In accordance with the Charter of the Hospital our mission is to be a public, voluntary and teaching hospital operated in the interests of our patients in which we - identify and meet the health care needs of the communities we serve so that our Hospital is a Hospital for everyone provide for all patients the highest quality health care undertake and support research in health care educate all staff and students to highest international standards in health care seek for each member of staff and each student equal opportunity to fulfil their potential in health care Develop voluntary involvement and support for our hospital to the maximum extent possible. II.2 VISION STATEMENT Our Hospital is for Everyone Patients, especially those from minorities, will choose to be cared for in our Hospital because we will approach them as a whole person with our innovative and inclusive pastoral care support. We will be international experts on inclusive pastoral care for patients. A Centre of Quality and Excellence in Healthcare Our Hospital will be the best academic teaching community Hospital with a reputation as a centre of healthcare excellence locally, nationally and internationally. Leading edge technology and patient focused caring systems will be constantly reviewed to provide the best care for patients. World Class Research Our state of the art research facilities will enable us to pursue ground- breaking research in Health Sciences and Health Services earnin0g our Hospital world-wide recognition. 22
  23. 23. Our Staff will be Renowned for their High Standard of Education This Hospital will focus on continuous learning and development for our staff. Our educators will continuously update themselves with new trends to achieve the highest international standards of healthcare education. Students will seek our educational programs above all others. We Will Treat our Staff Respectfully and Equally Our secure, confident and competent staff will meet our patients‟ needs in an exemplary fashion. We will respect and encourage our staff by recognising their input and dedication. The most highly qualified and motivated healthcare professionals from Ireland and abroad will want to work in our Hospital. We Will be Partners With Our Community The partnerships we create with our enthusiastic and motivated community will rapidly materialise through dialogue and voluntary support for our Hospital. Through partnerships with the Department of Health and health providers in our area we will support the health system and achieve lasting respect for our Hospital. We will support and will be fully accessible to healthcare professionals. III.3 VALUES STATEMENT RESPECT I respect myself and value my integrity. Consequently each person I meet, my work colleagues, my patients, their families, and the environment I work in deserves, and will have, that same respect. CARING We wish to provide an excellent standard of care to everyone in our Hospital. Within a supportive and friendly environment we aim to meet the physical, emotional and spiritual needs of:- Our patients Their families and carers Staff members The communities we serve 23
  24. 24. OPENNESS We will always communicate and share information with patients, the public and each other in an open, friendly and truthful manner. By aiming to build and maintain trust at all times. We will ensure an environment that is free of hidden agendas and without fear of speaking the truth. FAIRNESS AND EQUITY We are committed to ensuring that everyone is treated as an individual with fairness and equity. The same high standards of care will be provided for all patients, relatives and staff throughout our Hospital. PARTNERSHIP AND TEAMWORK Co-operation in building a wide range of partnerships will be the hall-mark of our Hospital. This requires combining our effort with voluntary and statutory agencies to raise the health status of the communities we serve. Sharing with others in teams to provide all our Hospital‟s services is essential. This will ensure - effectiveness efficiency accountability in providing the highest quality of care to our patients. 24
  25. 25. Appendix 4 - RENAL DIALYSIS EXPANSION IN DUBLIN MID LEINSTER HSE AREA WITH PARTICULAR REFERENCE TO AMNCH The aim of this submission is to address the medium to long term needs of patients with End Stage Renal Disease (ESKD) in South Dublin, Kildare and West Wicklow with a particular focus on AMNCH (Tallaght) Hospital. OVERVIEW: For the past three years the hospital has been operating at capacity with the result that all newly diagnosed patients have had to be referred to the private sector for their dialysis treatment. There are currently 38 AMNCH patients being treated in Beacon Dialysis in South Dublin. RENAL SERVICES AMNCH: The Adelaide & Meath Hospital (AMNCH) is the principal Nephrology service in the Dublin & South Leinster HSE area. The hospital has a 12 station dialysis unit with two isolation rooms. In additional the unit has to accommodate acute dialysis for in-patients with renal failure. AMNCH provides chronic dialysis services for its own population and for St. James‟s Hospital. The unit is the second largest non- transplant centre in Ireland and as of the end of June 2008 it was treating 190 ESKD patients. It has the largest peritoneal dialysis programme in the country. AMNCH is one of the five most congested Haemodialysis facilities as demonstrated in recent HSE national renal surveys. The unit operates three shifts with all 14 stations fully utilised. International recommendations also advise that the dialysis of chronic stable haemodialysis patients be delivered separately from the treatment provided to acutely unwell patients. This minimises the risk of cross infection and, from a patient perspective, separates stable, well ESKD patients from those acutely ill patients receiving the same treatment as themselves. In the immediate term, over 30 additional haemodialysis stations are needed in the catchment area. Each year will bring a requirement for up to 10 additional stations. In line with national projections it is expected that it will need to treat up to 400 such patients by 2011. The hospital is actively pursuing the establishment of a Regional Renal Medicine Clinical Network with St. Vincent‟s University Hospitals and the Midlands Regional Hospital in Tullamore. In addition has seen the unit has expanded by 300% since its opening ten years ago. RENAL DISEASE The term renal disease typically refers to diseases of the kidney other than cancers of either the kidney or associated organs of the urinary tract. Renal failure refers to the ability of the kidneys to clear blood of waste products per unit of time. Renal replacement therapy (RRT) is the treatment for renal failure in which removal of waste products from the body is achieved by haemodialysis, peritoneal dialysis or renal transplantation. 25
  26. 26. Epidemiology The number of patients suffering from chronic kidney disease (CKD) in Ireland is rising and will continue to rise. As the population ages, the number of patients with chronic kidney disease will escalate further, as the incidence of the disease rises steeply with advancing age. The increase in diabetes in the population is an important determinant of this escalation. Between 20-40% of people with diabetes ultimately develop renal complications. Work undertaken by the as yet unpublished National Renal Strategic Review (NRSR) estimates that the number of people needing dialysis will double by 2011 because of ageing of the population and the current number of people with diabetes and high blood pressure. This increase in the number of patients developing renal disease, coupled with increased survival and improved treatments for those with established disease, poses unprecedented challenges for renal services in this country. DIALYSIS PROVISION: Within the HSE Dublin Mid Leinster region dialysis services are currently provided in the following units. HSE Area Dialysis Unit Satellite/Other Capacity Routine & isolation Stations Dublin Mid Tullamore 10+2 Leinster St. Vincent's 16+2 University Hospital AMNCH/Tallaght 12+2 Beacon 30+1 NATIONAL RENAL STRATEGY REVIEW A National Renal Strategy Review (NRSR) was commissioned by the Department of Health and Children (DOHC), following the publication of the Health Strategy, ‘Quality and Fairness – A Health System for You’ in 2001. The Health Strategy made a commitment that „A national review of renal services will be undertaken‟ (Item 60) . The purpose of this Review was to develop a framework to meet anticipated growth in demand for renal services. Responsibility for delivery was initially with the DOHC and was later devolved to the HSE in 2005. The final report of the National Renal Strategic Review Group was presented to the HSE in December of 2006. It was at the time not endorsed by the Management Team. The Renal Strategy Review Group undertook its work before the commencement of the HSE Transformation Programme. It has since been decided that it is now appropriate that the report would be reviewed by an external expert/consultancy working with the NRSR Chairman to ensure that the Strategy is aligned with the HSE Transformation Programme and that work practice recommendations reflect the integrated model of care particularly in terms of services that people with chronic illness might receive from primary care with disciplines working across the community / hospital divide. This external review is currently under consideration and is expected to be completed by the end of 2008. 26
  27. 27. POLICY ASSUMPTIONS NRSR has reviewed epidemiological data regarding the projected number of patients on dialysis and the need for additional dialysis stations. A priority is to avoid overcrowding dialysis units as the consequences are significant with patients travelling long distances for dialysis treatments often at unsociable hours. Patients are at increased risk of transmission of infection and at increased risk of receiving an inadequate dose of dialysis. While the external review of the NRSR has not yet begun at the time this submission was being compiled, many of the best practice recommendations identified by the NRSR have been used as a basis for this business case. It is unlikely that these assumptions will be changed in any review as they are all in line with international best practice and the HSE Transformation programme. NRSR recommends that HD facilities should avoid exceeding a ratio of 2.5 treatments per HD station per day on 6 days per week. Minimise travel time to achieve target whereby 90% of patients receive dialysis at a facility within a one hour travelling time of their home, and majority of these journeys should be within 30 minutes Each HSE area should have the capacity to provide a haemodialysis service for its own population NATIONAL PROJECTIONS Data from the work of the NRSR Group indicate that the prevalence of ESKD treated by dialysis has increased by 50% in the 4 years to 2007. The prevalence of ESKD treated by haemodialysis has increased by 61% in that interval. On 31st December 2007 there were a total of 1,520 patients with ESKD receiving dialysis treatment, an increase of almost 12% on December 2005. Of these, 1328 were on HD and 192 were on peritoneal dialysis. The incidence of ESKD was 103 per million of the population (p.m.p.) in 2007. The prevalence of ESKD was 741 p.m.p. 1623 (52%) of prevalent patients have a functioning renal transplant (TX), 1329 (42%) are treated with haemodialysis (HD), and 191 (6%) with peritoneal dialysis (PD). Based on analysis of national data and on the observed increment in prevalent dialysis patients between 2004 and 2007 it is probable there will be an annual national increase in haemodialysis dialysis patients of between 20 and 45 per million of the population. However there may be a wider spread in this figure if treatments are focused on smaller population areas. REQUIREMENTS FOR DUBLIN MID LEINSTER It must also be recognised that AMNCH also provides chronic dialysis services for St. James‟s Hospital (SJH). Both hospitals have seen a considerable expansion of their services over the past 10 years. This has been driven by a number of factors including an increase in absolute numbers living in the local area, an ageing population and the establishment of a number of new services. The area served by AMNCH Renal Unit has specific demographic risk factors that are associated with an increased prevalence of renal disease. SJH serves an inner city area with the largest absolute number and the highest 27
  28. 28. percentage of deprived elderly (IMJ 2004) in the Dublin area. Many patients are diabetic. There is also sizeable African and Asian population living locally and these ethnic groups have a higher than average prevalence of renal disease. The Tallaght GP study identified a higher than average prevalence of premature vascular disease and diabetes in Tallaght. Kildare in the 2006 census experienced a 13.5% increase in its population. Predicted future requirement for HD Stations in each HSE Area, 2006 Census Data (adapted from NRSR 2006) Provision 200 201 201 201 Year 2008 9 0 1 2012 3 2014 2015 Dublin NE 90 99 107 116 124 132 141 Dublin Mid Leinster 32 20* 99 110 121 132 143 154 165 South 103 112 122 132 142 152 161 West 92 101 110 119 128 137 146 Total 382 421 459 497 535 573 612 *Virtual equivalent provided by Beacon (was 8 in 2006) Local demand for services has led to the expansion of many services. Certain specialities manage patients who are at an increased risk of developing renal disease. Chief among these are Diabetes/ Endocrinology, Geriatric Medicine, Cardiology, Vascular Surgery, Cardiac Surgery, Urology, Rheumatology, Haematology/Oncology and Genito-Urinary Medicine. In all of the specialities mentioned above, there has been an increase in consultant numbers (in some a 400% increase!) in the past 10 years. While these developments have improved patient survival, it has also increased the need for specialist renal input and for dialysis provision. It is recognised that expansion of renal services will leads to demands on other medical specialities. Other disease processes almost always complicate renal failure either due to the underlying disease (e.g. diabetes) or as a consequence of renal failure itself such as ischaemic heart disease and peripheral vascular disease. An ESKD program placed demands on Urology, Vascular Surgery, Radiology, and Laboratory Medicine. Most patients spend 10 -15 days as inpatients per year. An initiative to identify and prospectively manage patients with renal failure in SJH has been in place since 2002. Screening has identified >600 patients with significant renal failure (stage 3). Currently (2007) 245 patients are attending SJH with severe renal failure (stage 4 or 5), of which at least 100 are likely to require dialysis within 2-3 years. A similar project in AMNCH was recently commenced concentrating on stage 4/5 only due to the larger numbers. Already 372 patients are being monitored with 24 already being worked up for pre-emptive renal transplant. Typically, each year 40-50 patients commence chronic dialysis. Losses to transplantation and death has resulted in a net increase in dialysis number of 10-15 patients per annum. These receive their dialysis in Beacon (35) or Tallaght (100 which is over maximal capacity) with 56 on peritoneal dialysis UNIT ACTIVITY Unit activity in 2007 was 11,625 OPD haemodialysis sessions in Tallaght, 4723 OPD haemodialysis sessions in Beacon Renal, and 1,800 inpatient sessions. 28
  29. 29. The total number of dialysis sessions (in & out patients) in 1999 was 5,574. CAPTIAL REQUIREMENTS The following Capital elements are required. Some are in situ or can be adapted;.  Chronic dialysis unit(s) for well out patients- between 40 - 60 stations are required o This would set out in a number of bays with 3 / 4 stations per bay, with appropriate hand washing and isolation facilities in each bay.  Dialysis machines, water treatment plant, dialysis machine maintenance workshop and Hepatitis dialysis machine storage area.  Appropriate IT systems to monitor dialysis treatments and provide adequate documentation in case of look back requirements for Blood Borne Viruses  Appropriate office space to accommodate the staff employed to run the service  Staffing as per national recommended guidelines. (appendix 1) AMNCH can provide the remaining elements  8-single bedded acute dialysis isolation unit – for acutely ill inpatients, and with patients with blood borne viruses (Hepatitis B, Hepatitis C or HIV) o The current unit can be reconfigured to an 8 station acute dialysis unit.  Dedicated Out-Patient/Day ward treatment area for dialysis related complications (In situ)  A 35 bed inpatient ward in close proximity to the acute dialysis unit for inpatient care. These need to be ring fenced to support the proposed the regional Renal Medicine Clinical Network. (In situ but beds are not protected)  A CAPD Treatment area. – This is to provide outpatient care for patients on peritoneal dialysis. (In Situ) This will allow a total of between 240 – 300 patients to receive dialysis This will require approximately 3,000m2 to accommodate the above and assumes a new build for the chronic unit. This can be physically separate from the inpatient treatment and/or acute dialysis unit. A two phase or two site approach to utilisation could be employed, i.e. additional stations would open when the number on dialysis warrants such expansion. Access to the facility is required by car and taxi, as many patients are not very mobile. Parking facilities will be required for patients who use their own transport. The dialysis company typically deliver consumables directly once- twice weekly and will need a service entrance. RECOMMENDATIONS: In order to address the capacity shortfall for renal patients in AMNCH the following are recommended. 1. The HSE should immediately tender for the provision of a satellite 29
  30. 30. dialysis unit of 16-20 stations in Kildare/Naas. This will accommodate 64 patients (2 shifts) and could immediately facilitate the 38 patients from Kildare to have their treatment locally. Options include use of the existing hospital in Naas stations or allowing the private sector to find a suitable location & secure planning permission (preference for the former). The viability of tendering for this facility on the grounds of Naas hospital is currently being examined by the network. 2. In parallel with this AMNCH needs to embark on an expansion of the existing chronic dialysis facility which would be the main chronic renal facility for the South West Dublin Area. This could be on site or in the immediate vicinity of the hospital. In order to accommodate growth the unit should provide 30 stations. AMNCH are to consider this further in line with the hospital development control plan which is currently being reviewed. There are options to include this unit (which could be a public or privately provided facility) as part of capital expansion programmes which are currently underway. Should this be a commercial unit the existing tender specifications could be used & the tender run by AMNCH itself or by the HSE. 3. The existing dialysis unit should be converted to an acute renal unit with 8 renal stations which would serve as the regional dialysis centre. 4. Further discussions are being progressed to establish a south Dublin dept of renal medicine which would incorporate SVUH, AMNCH, and all associated satellite units. 5. The establishment of a renal south Dublin department/division of renal medicine would provide an appropriate opportunity to address the governance issues relating to Beacon 6. AMNCH should be the regional centre for provision of vascular access for the Dublin Mid Leinster area 7. On an immediate basis additional capacity may be required in the commercial sector pending local expansion 8. Consideration must be given to addressing staffing needs in terms of nephrologist, clinical nurse specialists and dietetic support for both AMNCH as a parent renal unit and the supporting satellite units. 9. Posts of CNSs for management of early kidney disease, dialysis access and vaccinations needs to be prioritised. 30
  31. 31. Appendix 5 – Strategic Plan – Trinity College Dublin The current Strategic plan for the School of Medicine is available via the following link ategic_Plan.pdf 31
  32. 32. Appendix 6 Staff List Head of School and Vice-Provost for Medical Affairs 1.2.06 Dermot Patrick Alfred Kelleher, B.A., M.D., F.R.C.P.I., F.T.C.D. (2004) (first term expires 2009) Professor of Academic Medicine/Director of Teaching and Learning (Undergraduate) (2005-10) Shaun Richard McCann, M.B. (N.U.I.), F.R.C.PATH., F.R.C.P.I., F.R.C.P.ED., HON. F.T.C.D. Director of Teaching and Learning (Postgraduate) (2008-11) Thomas Joseph Connor, B.SC. (N.U.I.), M.A., PH.D. (N.U.I.), F.T.C.D. (2007) Director of Research (2008-10) Aiden Corvin, M.B. (N.U.I.), PH.D., M.R.C.PSYCH. School Administrator 1.12.05 Fedelma McNamara, B.B.S. (LIMERICK) Nephrology Senior Lecturer in Nephrology 1.10.02 * George Joseph Mellotte, M.B. (N.U.I.), M.SC. (LOND.), M.R.C.P.I. Neurology Clinical Professor of Neurology 1.1.07 * Orla Hardiman, B.SC. (N.U.I.), M.B. (N.U.I.), M.D. (N.U.I.), F.R.C.P.I. Senior Lecturer in Neurology 1.10.98 * Raymond Murphy, B.A., M.B., M.R.C.P.I. Clinical Senior Lecturer in Neurology 1.10.07 * Dominick McCabe, M.B. (N.U.I.), PH.D. (LOND.), F.R.C.P.I. Lecturers in Neurology 1.10.92 * Janice Redmond, M.D. (N.U.I.), DIPL.A.B.P.N., DIPL.A.B.E.M., F.A.C.P., M.R.C.P.I. 1.8.05 * Colin Doherty, M.B. (N.U.I.), M.D. (N.U.I.), M.R.C.P.I. 1.2.07 * Ronan Walsh, M.B. (N.U.I.), F.R.C.P.CAN., M.R.C.P.I. 32
  33. 33. Appendix 7 Draft Consultants’ Contract Table of Contents Preamble ...................................................................................................................... 34 Section A - Terms and Conditions ............................................................................ 35 1) Core Principles ................................................................................................................ 35 2) Appointment and tenure .................................................................................................. 35 3) Probation ......................................................................................................................... 36 4) Mutual Obligations ......................................................................................................... 37 5) Contract designation ....................................................................................................... 37 6) Reporting relationship ..................................................................................................... 37 7) Hours of work ................................................................................................................. 38 8) Location and Residence .................................................................................................. 39 9) Scope of post ................................................................................................................... 39 10) Role of Consultant ..................................................................................................... 40 11) Professional Competence ........................................................................................... 41 12) Standard Duties and responsibilities ......................................................................... 41 13) Intellectual Property ................................................................................................... 42 14) Medical Education, Training and Research ............................................................... 42 15) Provisions specific to Academic Consultants ............................................................ 43 16) Advocacy ................................................................................................................... 45 17) Consultative structures ............................................................................................... 45 18) Leave, holidays and rest days ..................................................................................... 45 19) Locum Cover............................................................................................................... 47 20) Regulation of private practice ................................................................................... 48 21) Contract Type .............................................................................................................. 48 22) Change in Contract Type ............................................................................................ 53 23) Salary and other payments .......................................................................................... 54 24) Superannuation............................................................................................................ 56 25) Confidentiality ............................................................................................................ 57 26) Records / Property ....................................................................................................... 57 27) Clinical Indemnity....................................................................................................... 57 28) Grievance and Disputes Procedure ............................................................................. 58 29) Role of Review Body on Higher Remuneration ......................................................... 59 30) Conflict of Interest / Ethics in Public Office ............................................................... 59 31) Review by Employers and medical organisations....................................................... 61 32) Acceptance of Contract ............................................................................................... 61 Section B – Appendices .............................................................................................. 63 Appendix I – HSE Letter of Approval ..................................................................................... 63 Appendix II – Disciplinary Procedure ..................................................................................... 64 Appendix III – Clinical Directorate Service Plan .................................................................... 74 Appendix IV – Clinical Director Appointment and Profile ..................................................... 77 Appendix V – Extracts from Consultants Contract 1997 ......................................................... 80 Appendix VI – Granting of Sick Leave ................................................................................... 81 Appendix VII – Correspondence between the parties .............................................................. 83 Appendix VIII – Special leave provisions for Consultants in non-HSE employment ............. 86 Appendix IX – Committees to advise HSE on Consultant Applications ................................. 87 33
  34. 34. Preamble This document is comprised of the following: a) Terms and Conditions; b) Appendices; c) Correspondence exchanged between the parties as set out at Appendix VII d) Terms expressly incorporated The foregoing, constituting the contract documents, shall be read together and embody the entire understanding of the parties in respect of the matters contained therein. Note 1: Throughout this document the use of the masculine pronoun is intended to also denote the feminine gender, save where the context does not admit of such meaning. Note 2: Job descriptions for new appointees will form part of the Consultants‟ Contract. 34
  35. 35. Section A - Terms and Conditions 1) Core Principles The core principles of this Contract are: a) that both the Consultant and the Employer recognise that the relationship must be founded upon mutual trust and respect for each other and that any differences under the agreement should be processed expeditiously through the grievance and disputes procedure or such other procedures provided for herein; b) recognition of the importance of the role of Clinical Director, which places Consultants within the leadership structure in the management of the health service; c) recognition of clinical independence and the unique nature of the relationship between each Consultant and his/her patients; d) recognition by the Consultant that (s)he must operate within a system in which policy and procedures are determined through the corporate entity in which staff at all levels must be accountable; e) recognition of the Consultant‟s role as an advocate and the concomitant responsibility, in the first instance, to express any concerns within the employment context; f) recognition of the Consultant‟s role in the delivery of education and training and research. 2) Appointment and tenure a) This Contract is a contract of employment between XXXXXXXXXXXX b) A candidate for and any person holding the office must be in a state of health such as would indicate a reasonable prospect of ability to render regular and efficient service. c) The qualifications required for this post are set out in the Health Service Executive‟s Letter of Approval as attached at Appendix 1. d) Should the Consultant be required by the terms of the offer of appointment to comply with specified requirements or conditions (including a requirement or condition that (s)he shall acquire a specified qualification) before the expiration of a specified period the employment shall be terminated unless within that period the Consultant has complied with such requirements or conditions. e) With regard to resignation or retirement, the holder of a joint appointment2 must act similarly in relation to each of his / her component commitments, e.g. (s)he cannot retire or resign from one participating Employer and not from the other(s). f) If the Consultant wishes to terminate this employment (s)he shall provide the Employer(s) with 3 months notice of his/her proposed termination date. g) Except in cases of serious misconduct, the Employer will provide the Consultant 35
  36. 36. with 3 months notice of the intention to terminate his or her employment. 3) Probation a) Appointment to a Consultant post is dependent upon the satisfactory completion of a probationary period of 12 months. The probationary period may be extended at the discretion of the Employer for a period of not more than 6 months. In such event the specific reasons for the extension shall be furnished in writing to the probationary Consultant. b) At the end of the probationary period, the Employer shall either: i) certify that the Consultant‟s service has been satisfactory and confirm the appointment on a permanent basis; or ii) certify, with stated specified reasons, that the Consultant‟s service has not been satisfactory, in which case the Consultant will cease to hold his/her appointment; c) If the Employer should fail to certify in accordance with (b) above, the Consultant shall be deemed to have been appointed on a permanent basis. d) The Employer undertakes to advise the probationary Consultant on a timely basis of issues likely to result in the termination or extension of the probationary period. e) A Consultant who currently holds a permanent Consultant appointment in the Irish public health service will not be required to complete a probationary period should (s)he have done so already. f) A Consultant will not be required to complete the probationary period where (s)he has for a period of not less than 12 months acted in the post pending its filling on a permanent basis. 2 A joint appointment is one which involves a commitment by the Consultant to two or more employing authorities. Consultants appointed on such a basis are entitled to a single contract or interdependent contracts (with reciprocal clauses). The Consultant‟s total commitments should not exceed that which is expected from Consultants in the same specialty who have a full-time commitment to one employer. 36
  37. 37. g) During the probationary period, the probationary Consultant will be subject to ongoing review and a formal review will take place not more than 6 months after the date of first appointment on a probationary basis. h) In cases where an allegation of serious misconduct is made against a probationary Consultant, the matter will be dealt with in accordance with Stage 4 of the Disciplinary Procedure (attached at Appendix II). This does not affect the Consultant‟s statutory rights under the Industrial Relations Acts, 1946-2004 or any other statute. i) In the case of joint appointments, the holding of any one part of the post is contingent on continuing to hold the other part or parts of the post. j) Employment may be terminated by either party during the probationary period. Should employment be terminated by the Employer, the Employer shall set out in writing the specific reasons for such termination. 4) Mutual Obligations a) Both the Consultant and the Employer recognise the need for mutual trust, confidence and respect in giving effect to the terms of this contract. b) Both the Consultant and the Employer shall co-operate in giving effect to such arrangements as are put into place to verify the delivery of the Consultant‟s contractual commitments. c) The determination of the range, volume and type of services to be provided and responsibility for the provision of same within available resources rests with the Employer. Services not provided as a consequence of a resource limit are the responsibility of the Employer and not the Consultant. d) The Employer recognises the Consultant‟s obligations regarding the application of the Medical Council's (or Dental Council, as appropriate) ethical and professional conduct guidance to the clinical and professional situations in which (s)he works. 5) Contract designation This contract is designated as a Type XXX Contract as set out in the HSE Letter of Approval for this post attached at Appendix I. Details regarding Type of Contract and change of Type of Contract are set out at Sections 21 and 22. 6) Reporting relationship The Consultant‟s reporting relationship and accountability for the discharge of his/her contract is: 37
  38. 38. i) to the Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) through his/her Clinical Director3 (where such is in place). The Hospital Network Manager or Assistant National Director HSE PCCC Directorate may require the Consultant to report to him/her from time to time. or ii) in the case of Consultant Psychiatrists, to the Clinical Director and the Local Health Office Manager PCCC Directorate (where the Consultant is employed by the HSE) / Chief Executive Officer (where the Consultant is not employed by the HSE). 7) Hours of work a) The Consultant is contracted to undertake such duties / provide such services as are set out in this Contract in the manner specified for 37 hours per week. This 37 hour commitment will normally be delivered across a span of 12 hours between the hours of 8am and 8pm Monday to Friday. The Consultant will not be obliged to work more than 8 hours in any one day. This will be structured as a single continuous episode. Scheduling arrangements may be changed from time to time within the 8am to 8pm period in line with clinical and/or service need as determined by the Clinical Director / Employer in consultation with the Consultant. b) The aggregation of the Consultant‟s commitments in a given time period shall be on a cumulative basis of 37 hours per week. This does not imply that the Consultant‟s work is organised in equal periods of time. If the time worked consistently and significantly varies from the scheduled commitment, there will be a review of the commitment to ensure that the Consultant is not working regularly in excess of or less than the 37 hour weekly commitment. Where the commitment is being unavoidably exceeded for reasons of a temporary nature, local arrangements will be made to compensate the Consultant concerned. c) In addition to the contracted commitment per week specified at Section 7 (a) above: i) the Consultant may be required to participate in the on-call roster as determined by the Clinical Director / Employer. Payment arrangements for on-call liability are set out at Section 23 (i) and for the provision of call-out services when on-call outside scheduled commitments at Section 23 (j). ii) the Consultant rostered on-call may be required to provide a structured commitment on-site of up to 5 hours on a Saturday and / or 5 hours overtime on a Sunday and / or 5 hours on a public holiday. Consultants on onerous on-call rosters4 shall not be expected to deliver the upper end of this requirement as determined by the Clinical Director. The Consultant‟s liability for on-call outside such structured or other scheduled overtime hours will continue to apply. 3 Details of the Appointment and Profile of the Clinical Director are contained in Appendix IV 4 Only on-call rosters of 1:4, 1:3, 1:2 or 1:1 are regarded as onerous. 38
  39. 39. d) As a senior professional employee, the Consultant may be required, from time to time, to work beyond his/her rostered period in line with the exigencies of the service. The Employer will endeavour to ensure that this will be an exceptional rather than a standard requirement. e) Where there is local agreement to implement different work patterns, (including any arrangements providing for up to 24/7 hour working) the involvement of any individual consultant in any such arrangement(s) shall be subject to his/her agreement. 8) Location and Residence The Consultant‟s appointment shall be to the XXXXXXXXXXXXXXXX a) The Consultant‟s employment location may be changed within the functional area and service range applicable to his/her Employer. In the first instance, this will be within the Hospital Network area / remit of the HSE-funded Hospital / Agency. The Consultant shall be consulted should (s)he be required to change to an employment location outside the (Hospital Network Area / HSE-funded Hospital / Agency). In circumstances where a change of location is required, (e.g. - hospital closures or major changes taking place in the character of the work being carried out there) the Consultant will be offered an appropriate alternative appointment without competition and consideration will be given to any request from the Consultant to change Contract Type or title of post. Subject to the provisions of the removal expenses scheme for the Health Service Executive, removal expenses shall be payable, if claimed. c) The Consultant shall be available to respond readily to clinical or service needs at the location(s) specified above. This will require the Consultant to reside convenient to the hospital / agency in which (s)he holds his/her appointment. 9) Scope of post a) The scope of this post is as set out in the HSE letter of approval for this position at Appendix 1 and the Job Description as issued by the Employer. These describe the Consultant‟s service commitments, accountabilities and specific duties. b) The Consultant‟s annual Clinical Directorate Service Plan will detail how these are to be implemented and will be validated by a series of performance monitoring arrangements. c) Certain decision-making functions and commensurate responsibilities may be delegated to the Consultant by the Employer. These will be documented in the Clinical Directorate Service Plan. 39
  40. 40. d) The Consultant may apply through the Employer to the Health Service Executive to change the structure of this post as set out in the HSE Letter of Approval. Any change in the structure of the post is subject to the determination of the HSE. e) The Consultant may apply for atypical working arrangements under the relevant health service scheme. 10) Role of Consultant a) For the purposes of this contract, a Consultant is defined as a registered medical or dental practitioner who by reason of his/her training, skill and expertise in a designated specialty, is consulted by other registered medical practitioners and who has a continuing clinical and professional responsibility for patients under his/her care, or that aspect of care on which (s)he has been consulted. b) The Consultant is clinically independent in relation to decisions on the diagnosis, treatment and care of individual patients. This clinical independence derives from the specific relationship between the patient and the Consultant in which the patient places trust in the Consultant personally involved in his/her care to make clinical decisions in the patient‟s best interests and to take continuing responsibility for their consequences. c) The Consultant acknowledges that (s)he is subject to statutory and regulatory requirements and corporate policies and procedures. d) The Consultant has a substantial and direct involvement in the medical diagnosis, treatment and delivery of care to patients. Each patient will have a named Consultant who has continuing responsibility for his/her diagnosis, treatment and care. e) The Consultant may discharge his / her responsibilities through: i) a direct personal relationship with the patient; ii) shared responsibility with other Consultants who contribute significantly to patient management; iii) delegation of aspects of the patient‟s care to other appropriate staff. Delegation of responsibility to other doctors or staff by a Consultant is subject to: (1) the Consultant being satisfied that the relevant staff member has the necessary professional capability and (2) the continued provision of a commensurate level of diagnosis, treatment and care to the patient. The Consultant shall retain a continuing overall responsibility for the care of the patient. f) The Consultant will generally work as part of a Consultant team. The primary purpose of Consultant teams is to ensure Consultant provided services to patients on a frequent and continuing basis. In effect this requires that the Consultant provides diagnosis, treatment and care to patients under the care of 40