‘No child should have to wait more than six weeks for care’, says leading Paediatric Consultant
More children presenting to Emergency Departments for care due to lack of access to Hospital Consultants and Child & Adolescent Psychiatrists in the community
- 1 in 12 children in Ireland now on a hospital waiting list – more than 97,000 children across the country; 37,700 children waiting over 12 months for care, with 27,700 of these waiting more than 18 months;
- Almost 3,000 children on Child & Adolescent Mental Health Services (CAMHS) waiting lists in September - a 6 year high; 195 (7%) waiting longer than a year to be assessed by a Consultant;
- Concerning increasing trend of children presenting for emergency care, particularly those with mental health crises – a 9% increase in emergency mental health patients across Dublin’s paediatric hospitals;
- Long waiting times for children can lead to more protracted health conditions and hamper social development;
- Dr Ike Okafor, Consultant in Paediatric Emergency Medicine: “Historically children’s health hasn’t been adequately funded in this country. We’re playing catch up. All stakeholders need to come together to make healthcare better, more accessible and more equitable.”
A leading Consultant Paediatrician has warned that the long waiting lists being faced by children for specialist care risks causing long-lasting damage to children’s physical and mental health.
Speaking today (20 December 2021) on behalf of the Irish Hospital Consultants Association (IHCA), Dr Ike Okafor, a Consultant in Paediatric Emergency Medicine at Children’s Health Ireland (CHI) at Temple Street, said that a lack of access to paediatric and mental health specialists and resources is leading to many children presenting for emergency care across our public hospitals.
As part of a new video released today, Dr Okafor said: “It’s not good enough and we need to do better as a country. There is a lack of access to appropriate and expeditious care for some children, meaning they are not receiving the treatment they need.
“Children’s care can’t wait. No child should have to wait more than six weeks to get any kind of healthcare intervention. The longer they wait, the more protracted their condition actually becomes. Long waiting times are not just an issue for children’s physical or mental health, it’s about their social health as well – often they are not able to play with their peers, they’re not spending time in school and these are really fundamental parts of their lives.”
His comments came as latest waiting list figures reveal there are now 97,387(1) children waiting to see a hospital consultant or receive treatment (1 in 12 children in Ireland), with some 37,725 waiting longer than 12 months for hospital care. Of these, 27,725 have been waiting longer than 18 months.
Children’s mental health is suffering
Dr Okafor raised children’s mental health as a particular concern. He says that children who should be receiving care for mental health issues through primary care psychology services or Child and Adolescent Mental Health Services (CAMHS) are being forced to present to his Emergency Department (ED) in Temple Street for urgent care. This is due to the pressure these services are under.
“There are certain specialties where there are significant pressure points, not having enough staff and resources to be able to see patients. Mental health is one clear example of this.
“The pandemic has led to a massive increase in children presenting with acute mental health problems, especially eating disorders and self-harm. A system that was already under pressure, not just in hospitals, but in the community has suddenly gone into crisis mode.
“Children are waiting longer and longer to see psychologists and psychiatrists and that’s a problem.”
HSE data confirms that the number of patients waiting to be assessed by a Consultant Child & Adolescent Psychiatrist nationally in September was at a six year high, with 2,948 children on the CAMHS waiting list.(2) This is an increase of 811 (+39%) in the past year. The last time the CAMHS waiting list was this high was back in May 2015.(3)
Of the almost 3,000 children waiting to see a Consultant Psychiatrist, 843 (29%) were waiting longer than 6 months, with 195 (7%) waiting longer than a year.
Across Children’s Health Ireland’s three paediatric hospitals in Dublin (Temple Street, Tallaght and Crumlin), there was an overall decrease in attendance of young people to ED of 34% during the first year of the pandemic; but in sharp contrast ED presentations for mental health reasons increased by 9%.(4) Temple Street, known to be one of the busiest paediatric EDs in Europe, has seen an 8-fold increase in mental health presentations since 2006.(5) In 2020, more than 520 young people presented with mental health crisis to Temple Street ED.
In recent weeks, however, an earlier than expected winter surge in ED presentations of children with seasonal respiratory illness has seen overall activity at the three Dublin paediatric hospital EDs reach its highest level in four years. This has further impacted on the number of cancelled and postponed operations and will push waiting list up even further.
Fundamental infrastructure and resources needed
Dr Okafor said that a whole-of-service approach is critical in reducing children’s waiting lists.
“Historically children’s health hadn’t been adequately funded in this country. We’re playing catch up. All stakeholders need to come together to make healthcare better, more accessible, more equitable so that if a child needs care, they can get it.
“The solution is not just having adequate staffing resources, but we have to create the necessary physical infrastructure as well, and that means looking at the bigger picture. Staffing is a big issue - not just consultants, but also other healthcare professionals – we need to not only improve recruitment, but also the retention of staff. If we improve all these things together, I believe we can deliver the healthcare in this country that our children deserve.”
The call for adequate staffing comes after recent warnings by the IHCA that the recruitment of Paediatric Consultants must be made an urgent priority. According to an HSE report(6), an additional 207 consultants are needed across the specialties of paediatrics, neonatology and paediatric surgery by 2028 to address current shortfalls and meet increased patient demand. That would mean recruiting some 30 consultants every year over the next 7 years.
With more than 97,000 children now on a waiting list across the country, the IHCA says that urgently addressing the consultant recruitment and retention crisis is critical to the survival of the health service into the future – and to protecting children’s long-term physical and mental health.
The IHCA says the success of the ongoing consultant contract discussions must deliver on the ‘unambiguous commitment’ made by the Minister for Health to resolve the pay inequity issue for all consultants contracted since 2012. This is vital in order to fill the one in five approved permanent consultants posts that are vacant or filled on a temporary basis and address Ireland’s shocking waiting lists.
Dr Ike Okafor’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/657956596/ab13f9f77e
1. Analysis based on latest NTFP data as at 25th November 2021: https://www.ntpf.ie/home/nwld.htm.
2. HSE PQ response to Deputy Pauline Tully, 27th October 2021: https://www.hse.ie/eng/about/personalpq/pq/2021-pq-responses/october-2021/pq-49213-21-pauline-tully.pdf.
3. In May 2015 there were 3,110 children on the CAMHS waiting list; Health Service Performance Report December 2015: https://www.hse.ie/eng/services/publications/performancereports/dec15pr.pdf.
4. Increased Mental Health Presentations by Children Aged 5-15 at Emergency Departments during the first 12 months of COVID-19, Ir Med J; Vol 114; No. 5; P356: http://imj.ie/wp-content/uploads/2021/05/Increased-Mental-Health-Presentations-by-Children-Aged-5-15-at-Emergency-Departments-During-the-First-12-Months-of-COVID-19.pdf
5. Trends in Mental Health Presentations to a Paediatric Emergency Department, Ir Med J; Vol 113; No. 2; P20: https://imj.ie/wp-content/uploads/2020/02/Trends-in-Mental-Health-Presentations-to-a-Paediatric-Emergency-Department.pdf
6. Demand for Medical Consultants and Specialists to 2028, HSE NDTP, 2020: https://www.hse.ie/eng/staff/leadership-education-development/met/plan/high-level-demand-report.pdf.