Cancellation of essential scheduled care cannot be ‘go-to’ solution to hospital capacity deficits - say Consultants

• IHCA calls for the urgent publication of ambitious yet practical HSE National Service Plan 2022 to put in place sustainable longer-term solutions; 
• Capacity for outpatient and inpatient/day case hospital care in 2022 must be increased in order to effectively reduce unacceptable waiting lists; 
• Improved staffing levels and increased bed capacity critical to managing the health service out of current crisis; 
• Almost 1 million people waiting to see a hospital Consultant or receive treatment in acute public hospitals. 

President of the IHCA, Professor Alan Irvine: “There is continuous commentary about the health service being under pressure but other than short-term solutions, like cancelling essential scheduled care, there is not enough being done to make our public hospital services more resilient. This cannot wait for this or the next wave of Covid to end; it has to be a priority now.”

Today, 11 January, the Irish Hospital Consultants Association (IHCA) has called on the HSE to publish its National Service Plan for 2022 without delay and commit to delivering on long-promised extra public hospital capacity and additional Consultant numbers.

Pointing to the increasing challenges faced by acute public hospitals in balancing Covid and non-Covid care, the IHCA says that the overdue Service Plan needs to be ambitious yet practical, to both manage the service out of the current pressures while also starting to tackle head-on more long-standing hospital capacity deficits.

They say that the cancellation of scheduled care is due not only to the current number of patients with Covid in hospital, but also due to decade long deficits in bed capacity, Consultant staffing and inadequate investment in services which predate the pandemic. 

Consultants have also called on the Government and health service management to set out concrete plans to effectively increase public hospital capacity to sustainably reduce the country’s unacceptably long waiting lists. 

With updated hospital waiting list figures due to be published on Friday, the IHCA said that while the Government’s four-month action plan* for September to December 2021 may achieve its modest target of reducing some waiting lists by around 36,600, this will not make the inroads needed to tackle increases elsewhere, such as for planned procedures, pre-admissions or suspensions lists.

According to the IHCA, such short-term waiting lists initiatives fail to acknowledge the staffing needed to deliver longer-term sustainable gains and to provide care to the almost 1 million people currently waiting to see a hospital Consultant or receive treatment across the country.  

Ambitious yet practical plan for 2022
The HSE National Service Plan 2022 has yet to be published despite the new year having come and gone. In the IHCA’s view, a number of key issues must form the fundamental pillars of future planning if the health service is going to be steered out of crisis this year, including: 

• Increase public hospital capacity for outpatient and inpatient/day case hospital appointments. It is expected that there has been around 900,000 fewer patient appointments and procedures carried out in public hospitals in 2020 and 2021 combined compared with pre-pandemic activity in 2019. The IHCA says public hospital capacity must be increased significantly to address decade long capacity deficits and the postponement of scheduled care during the pandemic and in particular this winter. 
• Bed capacity commitments must be delivered. The IHCA says that increased bed capacity is urgently needed to avoid a situation where patients have to wait for essential care. They believe that 6,000 additional public hospital beds and 4,500 community step-down and rehab beds are required in order to alleviate pressure on the system – and that half of these need to be opened within the next three years. This is recommended alongside a doubling of critical care capacity to over 640 ICU beds to just reach the EU average number of critical care beds on a population basis. This is crucial if we are to avoid delays in ICU admission, cancellation of essential surgery, and to cater for emergency and Covid-19 cases. 
• Urgently address staffing levels to create a resilient system. In order to sustainably reduce unacceptable waiting lists and provide timely hospital care, the IHCA is urging the HSE and Department of Health to prioritise staffing in its plans. The persistent hospital Consultant recruitment and retention crisis continues to result in one in five permanent posts left vacant or temporarily filled. Meanwhile, insufficient progress has been made in fulfilling the HSE’s recommended consultant staffing levels by 2028**, leaving the health service exposed to further staffing crises. Speeding up the recruitment process and ending the ongoing 2012 pay discrimination are critical to these additional consultant numbers being achieved. 

Health service at a critical crossroads
President of the IHCA, Professor Alan Irvine, said: “We’re very much at a crossroads now. We have the opportunity to steer our way out of this crisis and towards a fit-for-purpose system through well based ambitious and practical plans, which have clear public and professional support. But to do this, we need collaborative engagement combined with political will and commitment. Otherwise, we will see public hospitals taking the same old route back into crisis mode again and again. 

“There is continuous commentary about the health service being under pressure but other than short-term, unsustainable solutions, like cancelling scheduled essential care, there is not enough being done to make our public hospital services more resilient. 

“No hospital consultant wants to tell a patient waiting for essential hospital care that their critical treatment has been cancelled and, worse still, that they are not in a position to tell that patient when it will be provided. 

“No one could have prepared for this pandemic, but we could and should have been in a better position to meet it head on – and we have not seen adequate action taken over the past two years to bolster our public hospitals against subsequent waves. Building more effective hospital services cannot wait for this or the next wave of Covid to end; it has to be a priority now.

“Cancelling essential surgery cannot credibly be a go-to solution to the ongoing lack of capacity and overcrowding at our acute public hospitals. Describing it as a solution, even in the face of the current Covid wave, suggests it is solving a problem when in truth, it is removing access to life enhancing treatment for patients with very complex needs and will only increase record waiting lists even further. 

“It is now the second week of January and we still do not have a plan for our health service this year. This should have been prepared and consulted on while we had the chance at the end of last year and before this latest, inevitable winter wave occurred. We all need to be working off a common, clear and considered strategy now.” 

ENDS 

Notes to editors 
Professor Alan Irvine is President of the Irish Hospital Consultants Association, a Consultant Dermatologist at Children’s Health Ireland at Crumlin and at St James’s Hospital, Dublin, and is Professor of Dermatology in Trinity College Dublin.
* Department of Health ‘Acute Waiting List Action Plan, September - December 2021’: https://www.gov.ie/en/publication/c37dd-the-waiting-list-action-plan/

** 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. 

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