Lack of long-term vision is failing patients with chronic care needs, says Rheumatology specialist
Focus solely on trying to tackle waiting lists in the short term means public hospitals lack the capacity to treat people who need ongoing care for chronic conditions
Critical questions to be asked of Government and health service management on service delivery failings, capacity shortages and lack of sustainable plans to treat patients on time;- Improved outpatient units, additional inpatient beds, theatre and other facilities, staffing levels and Electronic Patient Records among key elements needed to provide long-term care to all patients;
- Hospital Consultant recruitment and retention crisis worsens with more than 830 permanent posts not filled as needed;
- Dr Laura Durcan: “We put a really big spotlight on the waiting lists, which is completely valid. But we also need to put energy into seeing where the capacity is within the system for people to be provided with chronic care."
The Irish Hospital Consultants Association (IHCA) has today (27 May) urged Government and health service management to publish sustainable plans to treat patients on time as part of a long-term vision for investment in public hospital capacity and Consultant staffing.
With nearly 900,000 people now facing lengthy waits for an appointment with a hospital Consultant or access to essential care and treatment1, concerns have been raised that short-term, piecemeal plans to tackle waiting lists and capacity is failing to deliver timely access to ongoing care for thousands of patients with long-term, chronic conditions.
Dr Laura Durcan, a Consultant Rheumatologist and Physician at Beaumont Hospital, said that as attention is concentrated on trying to tackle waiting times to access care, the system lacks the inpatient capacity, outpatient facilities, Consultants and other medical staff to provide ongoing quality care once a patient is in the system.
Speaking on behalf of the IHCA as part of its Care Can't Wait campaign, Dr Durcan highlighted the need for Government and health service management to set out a sustainable multi-annual plan that not only seeks to reduce the unacceptable delays in getting assessed or treated, but also addresses the need to improve the experience of patients with long-term health needs.
She believes there are a number of key elements needed in any long-term plan, in order to improve medicine in Ireland and “do a better job of looking after people”.
Caring for chronic conditions
As a specialist Rheumatologist, Dr Durcan says the majority of those she sees are repeat patients who, once they receive a diagnosis, will be receiving treatment for many years – in most cases, for the rest of their lives.
As such, the Associate Clinical Professor at the RCSI believes that not enough emphasis is being put on reforming and improving the longer-term care needs of patients with chronic conditions – such as rheumatoid arthritis, psoriatic arthritis, osteoporosis or tendonitis.
“We put a really big spotlight on the waiting lists, which I think is completely valid. But we also need to put some energy into seeing where the capacity is within the system for those people to be provided with chronic care,” says Dr Durcan.
To ensure continuity of care over time, she believes that additional outpatient facilities are urgently needed. “In my case, if somebody phones me and says that they need to see me, I have no physical space in which to do that. I have an outpatient department where I have so many hours for certain appointments, but increasingly going forward the specialties that provide ongoing chronic care for patients will need additional space in which to do that.
“We need additional dedicated capacity within outpatient units to see patients as needed - and part of that is bricks and mortar.”
Increased inpatient capacity
“Ireland is a massive outlier internationally in terms of our number of acute beds per head of population. It’s really horrible to be in a situation where you are constantly squeezing people closer to the door because there is no bed capacity within your hospital.
“It is absolutely a requirement – we have to have more beds, so that the people who are sick can be looked after in a compassionate way,” says Dr Durcan.
The IHCA’s analysis of the HSE’s National Service Plan 2022 points to serious concerns over a lack of extra capacity being delivered in public hospitals. The Consultants say that the Plan’s commitment to only open approximately 300 additional acute beds this year falls well short of what is required and will not deliver any additional capacity already promised in last year’s Service Plan, which pledged to add an additional 1,146 acute beds by end of 2021 compared with the number at the start of 2020.2
But with less than 850 of these beds opened over the past two years, patients are already feeling the effects of the much more significant shortage of consultants and acute hospital beds – with recently released HSE figures highlighting that 40% of patients waited 12 hours or longer in emergency departments for hospital admission in the first three months of the year due to severe public hospital bed capacity deficits across the country.3
Need for greater Consultant staffing levels
According to IHCA figures, 1 in 5 permanent Consultant posts are currently vacant or filled on a temporary basis.
Ireland has the lowest number of medical specialists per 1,000 population in Europe at 1.48, 42% below the EU average of 2.54. The IHCA says the severe shortage of Consultants is the main contributor to the unacceptable delays in providing care to patients and that addressing this shortage through a sustainable and longer-term plan is vital, both to attract new Consultants and to retain those already within the system.
Dr Durcan said, “Ultimately, we need more Consultants to be able to see patients. Existing Consultants are then going to need to see energy brought to improving the system so that they can say ‘right, I am part of something that is getting better.’”
“I think that that’s going to be a huge part as we rise from the ashes of the pandemic – that we see that Health is getting better on a larger scale.”
Dr Durcan added that critical to that improvement process is the adoption of a national Electronic Patient Record system for the health service.
The IHCA has long campaigned for the Government and health service management to work with Consultants to implement the practical solutions needed to fill the over 830 permanent Consultant posts that are vacant or filled on a temporary basis. Ending the ongoing pay discrimination imposed on by Consultants contracted after 2012 is vital if these vacant posts are to be filled and waiting lists are to be brought under control.
Talks on hospital Consultant contracts have stalled since December 2021 and the Association says there has been no effort in the interim by the Minister for Health to appoint a replacement Independent Chair in agreement with the representative organisations to oversee what is an urgent and critical process to restore trust between Consultants, the Government and health service management.
ENDS
Notes:
Dr Laura Durcan’s comments were made in a new video released on social media today by the IHCA as part of its #CareCantWait campaign. The video is available here: https://vimeo.com/712925627
Dr Laura Durcan is a Consultant Rheumatologist and Physician at Beaumont Hospital and an Associate Clinical Professor at the Royal College of Surgeons in Ireland.
1. Analysis based on latest NTFP waiting list data as at 28 April 2022
2. HSE 2021 National Service Plan
3. HSE PQ response 19304 22 to Deputy David Cullinane
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