Four to five consultants need to be appointed to the National Centre for Hereditary Coagulation Disorders to deliver a "safe and effective" service for haemophiliacs, the centre's sole consultant and director said yesterday.
Dr Owen Smith, a paediatrician and haematologist, told the Lindsay tribunal that insufficient consultant manpower was the biggest obstacle to improving services in the State.
On facilities, he said, the "state-of-the-art" centre, which opened at St James's Hospital, Dublin, last August, was on a par with the top three to five centres in the US and ahead of anything in the European Union. However, he said more specialists were needed to promote research and paediatric and adult care, as well as to assist in drawing up treatment protocols.
The centre, which replaced the National Haemophilia Treatment Centre and was part-funded by a £500,000 donation from pharmaceutical companies, has an estimated 2,000 patients, including 335 haemophiliacs. Dr Smith said this number was increasing all the time as the diagnosis of haemophilia and related conditions improved, and better treatments for those infected with HIV and hepatitis C came on stream.
Dr Smith, who succeeded Prof Ian Temperley at St James's in 1995, agreed "quite dramatic" progress in developing services had been made.
In early 1998, all adult haemophiliacs were moved onto a synthetic "recombinant" factor treatment, which was safer than conventional plasma-derived treatments in terms of viral transmission. Until then, only children had been able to avail of the more expensive therapy.
Dr Smith said this change came at considerable cost. In 1994, St James's spent £1.7 million on products for haemophiliacs, equivalent to 2.5 per cent of the hospital's budget. In 1999, it spent £13 million, or 12 per cent of the budget. Due to a worldwide shortage in recombinant product, adult haemophiliacs were two weeks ago moved back onto plasma-derived concentrates. However, Dr Smith said he hoped to be able to reverse this move within two months.
Among the other advances was an increase in the number of consultant haematologists appointed to regional centres. Each health board area would shortly have at least one such consultant, he said.
In Dublin, he said, services for children were being relocated from the National Children's Hospital in Tallaght to Our Lady's Hospital for Sick Children, Crumlin, and St James's. However, a number of deficiencies remained in the system, including the absence of an audit of treatment material in trauma hospitals. There were also no formal arrangements for the reporting of test results and treatments administered regionally to a central register.
On the need for extra consultants, Dr Smith agreed, under cross-examination by counsel for the Department of Health Mr Ian Brennan SC, that his requirements would be met by the appointment of two new consultants at St James's and the reassignment of two consultants to Crumlin. He agreed progress was being made on the issue.
