Palliative care services ‘curtailed’ for new patients in north east

Palliative care services have been “curtailed” for new patients across four counties in the north-east of the country, to deal with a large backlog of referrals built up due to Covid-19 staff absences.

The Health Service Executive (HSE) has said the decision will affect services in Louth, Meath, Cavan and Monaghan.

Health officials wrote to General Practitioners in the affected counties in recent days, stating the HSE would be “unable to respond” to any new patients referred for specialist palliative care.

The correspondence stated the decision followed an “unprecedented” increase in referrals from GPs, alongside a “surge” in referrals from hospitals as well.

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The letter said the increase in referrals from hospitals was “presumably as they try to discharge patients in preparation for the fifth wave of Covid-19”.

“Given the volume of referrals at this time, combined with staff that are self-isolating due to Covid-19, I regret to inform you that we will be unable to respond to any new referrals with immediate effect, until our backlog is dealt with,” the letter said.

The correspondence from the HSE advised if family doctors had an “urgent” case, they should contact a consultant in palliative medicine.

Dr Ilona Duffy, medical director of North East Doc out-of-hours GP service, said the pause in referrals was "shocking".

The service was for patients who had reached the “dying phase of their life in the community,” who wished to remain in their homes and “die in a comfortable and easy fashion,” she said.

The impact of Covid-19 related absences, as staff were infected with the virus or self-isolating as close contacts, had shown up the weaknesses in the system, which was “understaffed and undermanned,” she told RTÉ News at One.

The “premise” of community palliative services “meant that people didn’t have to die in hospital as they did many years ago,” she said.

“You can die anywhere but it’s about dying comfortably and knowing that all your symptoms will be managed and will be dealt with, so the shortness of breath, the pain, the anxiety, all of those things; not only for the patient themselves, but also for the loved ones who are looking on,” she said.

Curtailing the specialist support around the Christmas period would mean patients would either be more likely to stay in hospital and die there, or die at home “without their symptoms being fully controlled and fully managed,” she said.

In a statement, a HSE spokesman said palliative care services had been “curtailed for new patients,” due to a high number of referrals in the last 10 days, and the impact of Covid-19 on staffing levels.

Professor Dominic Ó Brannagáin, consultant physician in palliative medicine, said the service had received “in excess of a month’s referrals in the past week,” with a number of staff self-isolating at the same time.

“But there is no suggestion that we are not providing a palliative care service and I would like to reassure patients that we are continuing to operate,” he said.

“We will continue to provide palliative care in the community for existing service users and we will prioritise those over new patients,” he said.

If new patients needed to be seen urgently GPs could contact their relevant on-duty hospital consultant to discuss the case, he said.

“We would ask our GP colleagues not to refer any new patients without first having contacted the consultant on duty,” he said.