A Surgeon in…Melbourne

Specialty Spotlight

Plastic Surgery

AS HIS TERM AS PRESIDENT OF THE IRISH ASSOCIATION OF PLASTIC SURGEONS COMES TO A CLOSE, PROFESSOR BRIAN KNEAFSEY TELLS US OF THE SPECIALTY’S STRENGTHS AND CHALLENGES

rofessor Brian Kneafsey is an in uential leader in the eld of Plastic Surgery in both practice and training in Ireland. He was responsible for developing Plastic Surgery services to the RCSI Hospital Group over more than 20 years, following his appointment as the sole Consultant Plastic and Reconstructive Surgeon in Beaumont and Connolly Hospitals in 1998. Professor

Kneafsey’s career began a er he quali ed with honours in surgery in UCD in 1986 and was appointed to the three-year Basic Surgical Training Programme in Cork University Hospital (CUH), obtaining the FRCSI in 1990. He then commenced in the specialty of Plastic & Reconstructive Surgery, spending two years in Cork before continuing his training in the UK. He was appointed Senior Registrar in the Northern Ireland unit in Belfast in 1995. A er obtaining his Intercollegiate Specialty Fellowship Examination in Plastic & Reconstructive Surgery in 1996, he spent a year on a fellowship in Reconstructive Plastic Surgery/Craniofacial Surgery in the Australian Craniofacial Unit & Dept of Plastic & Reconstructive Surgery in Adelaide, Australia in 1997.

A er his appointment in 1998 as the only Consultant Plastic & Reconstructive Surgeon in Beaumont & Connolly Hospitals, the following nine-year period was spent establishing and developing Plastic Surgery services to both hospitals, including the introduction of microsurgery in the areas of head & neck/craniofacial cancer and trauma reconstruction, breast reconstruction, major lower limb trauma, hand surgery, facial palsy as well as a service for hand and facial injuries. Professor Kneafsey developed close working relations with many di erent specialties to build up these services including Neurosurgery, ENT Surgery, Breast Surgery, General Surgery, Orthopaedics, Dermatology and Oncology. In 2007, a second consultant was appointed but there remained just two consultants in Beaumont/Connolly for another seven years until 2014 when a third consultant was appointed. e number of consultants in Beaumont/Connolly/RCSI Hospital Group has now grown to seven. e Plastic Surgery Department in Beaumont/Connolly/RCSI Hospial Group provides 24-hour services in trauma (especially hand surgery) and cancer reconstruction and other areas of Plastic Surgery to the entire RCSI Hospital group – a population of almost one million, incorporating Beaumont Hospital, Connolly Hospital and Our Lady of Lourdes Drogheda as well as Cavan, Monaghan and Dundalk hospitals.

Professor Kneafsey has always been involved in teaching and training locally, nationally and internationally. He was Programme Director of the Irish Plastic Surgery Training Scheme from 2003-2008, and served on multiple RCSI committees over the last two decades. “I am currently the Irish SAC (Specialist Advisory Committee) representative in Plastic &

Professor Brian Kneafsey, RCSI Fellow (1990)

Reconstructive Surgery, which deals with all intercollegiate training matters in each specialty, based in RCS, London,” he explains. “I have also been involved Professor Brian Kneafsey for many years in European training in Plastic Surgery and am a member of the European Board of Plastic Surgeons (EBOPRAS) and the the Irish national delegate on the Plastic Surgery Section of the European Specialist Bodies (UEMS).” He is an examiner in EBOPRAS European examinations and sits on the European Leadership Forum of the European Society of Plastic, Reconstructive & Aesthetic Surgery (ESPRAS). He is also a council member of the British Association of Plastic Reconstructive & Aesthetic Surgeons (BAPRAS), and a member of the American Society of Plastic Surgeons(ASPS), representing Ireland on the ASPS Global Leadership Forum.

As Clinical Lead for Skin Cancer in Beaumont, Professor Kneafsey is closely involved with the NCCP (National Cancer Control Programme) Skin Cancer Clinical Leads Group in melanoma and non-melanoma skin cancer (NMSC) and chairs the NCCP working group committee looking at the management of complex NMSC. “In 2019, I was appointed to the HSE SIMT (Safety Incident Management Team) which addressed the new entity of Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) associated with certain breast implants. I am also on to the expert review group of the HSE to review BIA-ALCL with the aim of establishing a National Breast Implant Registry and developing guidelines for follow of patients with breast implants”.

HOW MANY CONSULTANTS?

Approx 32 (public), with a further ten in private practice. HOW MANY TRAINEES? About 24 SpRs.

HOW MANY FELLOWSHIPS ARE

AVAILABLE IN IRELAND? A number of Fellowships have been developed over the last number of years – the RSCI Fellowship in Microsurgery / Breast Surgery (Beaumont Hospital), the Aspire Fellowship in Upper Limb & Microsurgery (Mater Hospital), the Hand Surgery Fellowship (Irish Hand Surgery Society) and the Cle Lip & Palate Fellowship (CHI – Children’s Hospital Ireland) IS THERE A GAP

BETWEEN THE NUMBER OF CONSULTANTS IN THE SPECIALTY AND THE NUMBER REQUIRED?

Yes, there is a gap between the number of consultants in the specialty and the number required to provide an adequate, equitable service. e number of consultants in public practice in Ireland (32) is well below international norms. Countries with very similar populations to Ireland such as Scotland [53 consultants], New Zealand [72 consultants], Finland [100 consultants] or Denmark [150 consultants] have far more consultants in public practice. International data consistently shows the ratio of Plastic Surgeons per head of population is way below norms in Ireland, where the ratio is currently about 1:150,000. e current ratios are about 1:100,000 in Scotland & England, about 1:70,000 in Australia & New Zealand, about 1:50,000 in Scandinavia and in much of Europe. e recommended ratio advised by BAPRAS is 1:80,000 and currently the ratio in Ireland is about twice this. HOW MANY CONSULTANT

POSTS ARE LIKELY TO BECOME VACANT OVER THE NEXT TWO, FIVE,

TEN YEARS? Over the next three years there are likely to be three consultants retiring and in the following ve years, a further three retirements, making at least six in total over the next ve years. ere are likely to be six more retirements in the ve years a er that, making a total of twelve posts vacant in the next ten years. is does not take into account the new posts required to develop the services in both the existing six units as well as the two cancer centres which currently do not have a Plastic Surgery service [Limerick and Waterford]. WHAT ARE THE STRATEGIC INITIATIVES FOR THE SPECIALTY? Expansion of the specialty in the six existing centres and development of existing centres including “hub & spoke” arrangements with peripheral Model 2 and 3 hospitals. Many of these are already running: for example, the main Plastic Surgery unit in Galway University Hospital has associated

peripheral units providing service in Roscommon; Beaumont Hospital/ RCSI Group provides Plastic Surgery trauma services for the whole RCSI Hospital Group including Drogheda, Cavan, Dundalk, Monaghan in Connolly Hospital and with new Plastic Surgery services commencing in Drogheda. e Cork unit is based in both Cork University Hospital and South In rmary/Victoria Hospital and provides services in Kerry General Hospital. Each centre requires sub-specialty expertise to a varying degree in the di erent areas of Plastic Surgery, such as hand surgery, skin cancer, breast surgery, head & neck reconstructive surgery, lower limb trauma, burns, cle lip & palate, craniofacial surgery, facial palsy etc. is requires adequate manpower and facilities in each centre. e establishment of new Plastic Surgery units is also a strategic initiative. Plastic Surgery services are not available or provided in many parts of the country. While there are eight cancer centres in Ireland, there is no Plastic Surgery unit in two of the cancer centres – Waterford and Limerick – and the Mid-West Hospital Group has no Plastic Surgery service at all. us, in the absence of a Plastic Professor Brian Kneafsey Surgery department providing services for trauma, skin cancer, complex cancer reconstruction and other

“International data consistently shows Plastic Surgery services, these patients currently have to be referred elsewhere the ratio of Plastic Surgeons per head of to a Plastic Surgery unit or managed population is way below norms in Ireland.” locally by other surgeons. Most other surgical specialties have units in Limerick and Waterford (e.g. ENT, Urology, Vascular Surgery, Orthopaedics, General Surgery). ere is also a need to establish a local Plastic Surgery unit for the northwest such as Letterkenny.

YOUR KEY OBJECTIVES/PRIORITIES WHILE IN OFFICE, WHICH

COINCIDED WITH THE COVID-19 PANDEMIC? e worldwide pandemic greatly reduced the ability to meet face-to-face, thus maintaining virtual communication with Plastic Surgeons and other colleagues was a key priority. Our Association members have not met face-to-face since February 2020. I participated in many virtual meetings with numerous international Plastic Surgery organisations including the European (EASAPS), American (ASPS) and Global (ICOPLAST) associations, societies and confederations to discuss similar issues for Plastic Surgery during the pandemic. Other objectives and priorities included the following: Cancer Care Plastic Surgery provides cancer care services both in skin cancer