Ireland needs new long-term strategy and additional consultants to combat chronic respiratory conditions
- More than 21,700 people waiting to see a respiratory consultant, up 7% since start of the year; paediatric respiratory inpatient/day case waiting list up 39% in 2020;
- 122% increase in number of respiratory consultants needed to address current shortfalls and meet HSE-predicted demand by 2028;
- Leading respiratory physician and Irish Hospital Consultants Association (IHCA) member calls for new healthcare approach to respiratory disease diagnosis and treatment;
- Covid-19 having direct and indirect negative impact on provision of respiratory disease care to patients;
- IHCA calls on government to end consultant recruitment and retention crisis and fill over 700 vacant permanent posts.
One of Ireland’s leading respiratory physicians has called for a dedicated long-term national respiratory strategy to address the unmet needs of the growing number of chronic lung disease patients, combat the country’s worsening rates of lung cancer mortality, and the after-effects of the Covid-19 pandemic.
Dr Aidan O’Brien, a consultant in respiratory medicine at University Hospital Limerick and president of the Irish Thoracic Society, says that the strategy would need to be grounded in both community healthcare and through essential resourcing of dedicated respiratory units in each of our acute hospitals, where congestion is occurring.
Such investment would allow a teamed approach to managing respiratory care where those patients whose condition allows for community treatment, can avail of it in their community and those patients with the more severe forms of the disease can be treated in specialised respiratory units in each of the acute hospitals.
The proposed strategy comes in direct response to the growing number of respiratory patients awaiting diagnosis and treatment.
According to latest figures, at the end of November 2020 there were 21,767 people on inpatient/day case and outpatient waiting lists for respiratory medicine and paediatric respiratory medicine, an increase of 1,330 people (7%) since the start of the year.1 The paediatric respiratory medicine inpatient/day case waiting list increased by an additional 281 (39%) in 2020, with more than 1,000 children now awaiting hospital treatment for lung conditions.
Ireland has just 3.3 specialists in respiratory medicine per 100,000 population compared to an EU average of 5 – a third less.2 According to the HSE’s ‘Demand for medical consultants and specialists to 2028’ report, there will be a need over the next 8 years for Ireland to more than double (122%) the current number of respiratory medicine consultants to address current shortfalls and meet increased patient demand.3
Meeting this level of staffing will require the recruitment of 94 additional consultants, or almost 12 respiratory physicians per year from now until 2028.
Lung disease and Covid-19 in Ireland
Ireland has a high proportion of lung disease. Approximately 450,000 people suffer from asthma and over 500,000 from chronic obstructive pulmonary disease, or COPD, a progressively worsening condition whose symptoms include severe shortness of breath and an ongoing productive cough.
Hospital admission rates for asthma and COPD together in Ireland is 329 per 100,000 population (49.6 for asthma and 288 for COPD), which is 46% above the OECD average.4 Ireland has the highest hospitalisation rate for COPD of all OECD countries, and COPD is the most common disease-specific cause of emergency hospital admission among adults.5
EU figures suggest that this year Ireland will have the second-highest incidence of lung cancers per 100,000 population, with an estimated 3,271 cases. The same figures project that as many as 2,232 deaths from lung cancer will occur, the seventh highest mortality rate on a population basis in the EU.6
Ireland’s respiratory disease crisis has been worsened by Covid-19, which can have lasting effects on the lungs. So-called ‘long Covid’, about which much remains to be learned, can lead to, among other things, a shortness of breath, a feeling of chest tightness, and a lingering cough for weeks or months after initial infection.
The lockdown itself is also having a material impact on the health service, resulting in even greater delays in access to care for patients with lung conditions or suspected lung disease.
“The ability to address the burden of lung disease in Ireland has been even further restricted by Covid-19 guidelines, because we cannot have our clinics staffed the way we previously did, the number of patients we can assess and our diagnostics have been greatly reduced,” said Dr O’Brien. “When our clinics did reopen, they were greatly restricted.”
Ending the recruitment and retention crisis
The IHCA has repeatedly warned the government that Ireland’s ongoing consultant recruitment and retention crisis has left the health service unable to provide timely, quality care to patients.
The IHCA has called on the Government and HSE to immediately fill the 728 hospital consultant posts that are now vacant (or filled on a temporary, locum, or agency basis), across all medical specialties, and fast-track the opening of thousands of beds needed across the public hospital system.
“We had significant waiting lists before Covid-19 even happened, these have increased even further and now our ability to deal with it has been greatly reduced,” said Dr O’Brien.
Through a long-term national respiratory strategy in place, Dr O’Brien argues, additional consultants in the acute hospital system could further support community-level respiratory hubs across Ireland, increasing the speed of access to care and the overall quality of patient outcomes.
“This approach to healthcare provision would lead to a meaningful impact on quality of patients’ lives and also on the patients themselves by empowering them to deal with their disease,” said Dr O’Brien.
Dr O’Brien’s comments were made in a new video released today by the IHCA as part of its #CareCantWait campaign.
Notes for editors
1. National Treatment Purchase Fund, Waiting List Data, November 2020: https://www.ntpf.ie/home/nwld.htm
2. Eurostat Physicians by medical specialty:
3. Demand for medical consultants and specialists to 2028, HSE Report 2020: click here
4. OECD Health Statistics 2019: https://doi.org/10.1787/888934016113
5. National Healthcare Quality Reporting System Annual Report 2019, Department of Health: https://assets.gov.ie/36031/6eab12022e2c4b05947dfd7761ca3d1a.pdf
6. JRC European Cancer Information System, Estimates 2020: https://ecis.jrc.ec.europa.eu/explorer.php?$0-0$1-All$2-All$4-1,2$3-22$6-0,85$5-2008,2008$7-7$CEstByCountry$X0_8-3$X0_19-AE27$X0_20-No$CEstRelative$X1_8-3$X1_9-AE27$X1_19-AE27$CEstByCountryTable$X2_19-AE27
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