Almost one million could be on hospital waiting lists by year-end, consultants warn

Almost a million people could be on waiting lists for hospital care by the end of this year unless the Health Service Executive (HSE) addresses the lack of beds and need for greater recruitment, the Irish Hospital Consultants Association (IHCA) has warned.

The consultants’ group warned on Tuesday that public hospitals are on track to suspend more than 900,000 patient appointments by the end of this year when 2020 and 2021 figures are combined and when compared with pre-Covid times.

The group expressed concern about public hospitals’ capacity to address these waiting lists and meet this built-up demand created by the Covid-19 pandemic, despite assertions by the HSE last week that unprecedented funding by Government would provide a once-in-a-generation opportunity to change how healthcare is delivered in Ireland.

Based on the plan’s projections, there will be more than 200,000 fewer patient hospital appointments – 153,000 outpatient and 50,000 inpatient – this year in public hospitals, according to the consultants’ body.

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HSE data shows there were 248,000 fewer inpatient/day cases and 475,000 fewer outpatient appointments in 2020 when compared with the previous year, said the group.

Combining these figures reveals more than 900,000 appointments will have been cancelled in 2020 and 2021 by the end of this year, the group concluded.

The consultants group also warned of the “continued lack of targets to hire hospital consultants” to fill the the 728 permanent hospital posts which are currently lying empty.

This warning follows repeated calls from non-EEA doctors working in Irish hospitals to be allowed enter training programmes for these consultancy positions. Most are unable to secure a training spot for consultancy roles because of a preference system that places Irish and EU doctors before those trained outside Europe.

“With a record 860,000 people on waiting lists and hospital bed occupancy rate due to be reduced for information control measures, the IHCA continues to be concerned about bed capacity deficits,” it said on Tuesday. It also underlined shortfalls in the HSE’s approach to mental health, the eHealth technology project, recruitment, ICU capacity and equipment.

IHCA president Prof Alan Irvine paid tribute to frontline healthcare staff during the pandemic and acknowledged the Government had “stepped up in terms of additional investment”. However, how the HSE channels this investment will be key, he added.

‘Striking a balance’

“We are in effect attempting to service a moving vehicle,” said Prof Irvine. “Striking a balance between short and medium-term objectives is key and central to this is collaborative planning.”

While reducing levels of Covid-19 community infection is important, the knock-on suspension and cancellation of patient care means a backlog of cases building up, he said. Unless the lack of beds and recruitment are addressed, the “structural mismatch between capacity and demand will continue to increase rather than decrease waiting times,” he said.

“We are heading for a waiting list of almost one million people. We continue to tinker around the edges on recruitment despite knowing that over 700 permanent consultant posts remain unfilled. Unless and until we tackle root causes, no amount of good intentions will be enough.”

Prof Irvine said 1 per cent of the €1.7 billion extra funding made available because of the pandemic had been earmarked for mental health, describing this support as “grossly inadequate”.

“Healthcare professionals are seeing more and more mental health presentations. People themselves are seeing and experiencing the unfolding effects of Covid on mental health. This is a problem set to dominate all of us in healthcare for some time.”

The HSE said last week its new service plan for 2021 would see 1,146 additional acute hospital beds provided by the end of the year as well as 66 more critical care beds, bringing the total for adults to 321.

It also said an additional €3.5 billion would be set aide for the health service in 2021, a 21 per cent increase on the amount provided originally to the HSE last year prior to the Covid-19 pandemic. Overall, the organisation is to receive €20.6 billion this year.

The HSE said the new plan provided for additional spending to improve many services including those in the areas of cancer, maternity and mental health.

It said it would allow for an addition of 16,000 staff above the number employed at the end of 2019 including more than 1,100 medical and dental staff, in excess of 3,500 nurses and midwives, and 4,000 health and social care professionals.

Within the additional allocation of €3.5 billion, some €1.68 billion is being earmarked for spending on Covid-19 requirements, while €1.8 billion will go on non-Covid areas, according to the HSE.