Children’s hospital care ‘a ticking time bomb’: over 200 additional consultants needed within next 7 years

• Over 97,000 children now on hospital waiting lists across the country—1 in 12 children in Ireland;
• 38,600 children waiting over 12 months for care, with 29,000 waiting more than 18 months; 
• Children waiting excessively long for care could suffer life-long health and developmental issues;
• IHCA President, Professor Alan Irvine: “We must make the recruitment of additional paediatric consultants a priority now. Conditions which could have been reversed or mitigated against are deteriorating. We’re facing a ticking time bomb of children suffering health and developmental issues due to delays in accessing care.”

The Irish Hospital Consultants Association (IHCA) has today (9 December 2021) called on health service leaders to address the severe consultant shortages in paediatric care, warning of a ‘ticking time bomb’ in children’s hospital care. 

The call comes after successive weeks of cancelled and postponed operations across the three Dublin paediatric hospitals that make up Children’s Health Ireland (CHI) - Crumlin, Temple Street and Tallaght - due to an earlier than expected winter surge in Emergence Department (ED) presentations of children with seasonal respiratory illness. The number of ED presentations at the hospitals is at its highest level in four years.

Latest analysis* shows that there are now 97,400 children waiting to see a hospital consultant or receive treatment (1 in 12 children in Ireland), with some 38,600 waiting longer than 12 months for hospital care. Of these, 29,193 have been waiting longer than 18 months. 

More than four in 10 (42%) children waiting to be assessed or treated by a hospital consultant are waiting longer than one year, with almost one third (32%) of those awaiting inpatient or day case treatment across the country left on a waiting list for longer than 12 months.

The three Dublin paediatric hospitals have seen a five-fold increase since 2015 in the number of children waiting longer than a year for an outpatient appointment.

Waiting for care has the biggest impact on the youngest patients

Consultants say that the adverse impact of waiting this long for care can mean some children’s conditions may significantly deteriorate, hampering their development and quality of life and potentially their future healthcare outcomes. 

However, many children’s conditions are straightforward to treat and could be managed quickly, often without requiring any stay in hospital. 

The IHCA projects that without empathetic health service management leadership that engages constructively with frontline hospital staff, current rates of growth could mean it will take healthcare staff and hospitals as long as 14 years (to 2035) to reduce waiting lists to manageable levels and clear the backlog of care built up over the past two years of the pandemic. 

Ms Mary Bresnihan, a Consultant ENT surgeon at Sligo University Hospital, said: “In ENT, some of the longest lists are for procedures like tonsillectomies, where surgery could be managed through day-case procedures. But we face challenges even getting to see and assess the patient in the first place. When we do, and we schedule treatment, patients can unfortunately be at the mercy of emergency or other priorities taking theatre slots at the last minute. 

“In the meantime, children of all ages are missing a lot of school due to being off sick regularly with tonsillitis or other infections meaning their education is set back. Some children are not able to hear properly and this can his affect their overall development - and yet these are problems that are quick and straightforward to resolve given adequate resources. This is a tragedy for those patients and should not happen.”

Consultant crisis 
According to an HSE report**, 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.

Ireland has just 9.38 paediatric specialists per 100,000 population compared with and EU-27 average of 18.65 – in other words just 50% of the EU average.*** As at 1 February 2021, 39 of the 232 approved consultant posts in Paediatrics were either vacant (20) or filled on a temporary basis (19). This is 17% of the total approved posts.

Around 1 in 5 approved permanent hospital consultant posts across all specialties are either vacant or filled on a temporary or agency basis, with around 720 posts not filled as needed across our acute public hospitals and mental health services. 

The IHCA says that ongoing talks between the Department of Health, HSE and Consultant representatives are pivotal and must result in the implementation of unambiguous commitments from the Minister for Health to resolve the root causes of recruitment and retention issues, including reversing the pay discrimination imposed on Consultants contracted since 2012. 

Commenting further, IHCA President Professor Alan Irvine said: “One in every 12 children in Ireland is currently on some sort of hospital waiting list. Waiting lists continue to increase because of years of underinvestment and persistent discrimination by the State against consultants appointed since 2012 which is driving the specialists we need away from our public hospitals. These deficits are adversely impacting the scheduling of essential care for children at hospitals across the country, as clearly witnessed over the past month.”

“The HSE’s own analysis shows that we need to recruit hundreds of consultants between now and 2028 if we are going to reduce the current unacceptable waiting lists and meet future demand for health care.

“Hospitals must be empowered to tackle their waiting lists and deliver services to their patients, be that through additional dedicated theatre slots for certain procedures or by the creation of additional hospital consultant posts in order to ‘staff the team’, and by filling the 720 consultant posts vacant or not filled as needed.

“We must make the recruitment of additional paediatric consultants a priority now. Conditions which could have been reversed or mitigated against are deteriorating. We’re facing a ticking time bomb of children suffering health and developmental issues due to delays in accessing care.”

ENDS

Notes: 
Ms Mary Bresnihan is a Consultant ENT Surgeon at Sligo University Hospital and operates a regional ENT service at Letterkenny University Hospital.  

Professor Alan Irvine is 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.

* Analysis based on latest NTFP data: https://www.ntpf.ie/home/nwld.htm 

**Demand for Medical Consultants and Specialists to 2028, HSE NDTP, 2020: Available here

*** Eurostat: https://ec.europa.eu/eurostat/databrowser/view/HLTH_RS_SPEC__custom_1671410/default/table

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