Senior doctors have painted a stark picture of a seriously underfunded health service that faces lengthening waiting lists as it tries to deal with staff shortages, obsolete equipment and limits on the number of patients it can treat.
In a submission to the Government the Irish Hospital Consultants Association said that billions of euro in additional funding was required to repair the healthcare system after a decade of retrenchment. The report, sent on Friday, added that there was clear evidence the Republic's acute hospitals were "beginning to fail". Patients at one hospital were waiting almost a decade for an appointment with a urologist, it said.
In addition to problems of waiting lists, patients on trolleys and vacant consultant posts, the submission warned of worsening cancer services. It said the waiting time for chemotherapy to start, once a consultant oncologist had decided it was necessary, was now five or six weeks at some hospitals. National and international guidelines set a limit of two weeks. Failure to meet key targets was “resulting in significant delays and potentially poor outcomes for patients”.
The association also said that a shortage of beds had led to a dramatic fall in elective surgery, as hospitals prioritised patients who came through emergency departments or other acute units. It put the drop at 54 per cent between 2012 and 2016 and said nearly 41,000 elective operations were cancelled last year, “further adding to in-patient and day-case waiting lists”.
Cancelled operations
According to the report, cancellations were an ongoing problem at University Hospital Waterford, where about 30 transurethral resections of the prostate – operations to treat an enlarged prostate – have been cancelled in the past six months. "A large number of older catheterised male patients are languishing on waiting lists with no realistic prospect of being operated on in the short or medium term."
It said that theatre closures at Cork University Maternity Hospital were a major difficulty and estimated that more than 100 operations had been cancelled there this year because of a shortage of staff.
At Beaumont Hospital in Dublin staff shortages have led to "protracted theatre closures, with one in four theatre lists cancelled on an ongoing basis".
The report said that the Royal College of Surgeons in Ireland group, which includes Beaumont and Connolly hospitals in Dublin as well as Our Lady of Lourdes, in Drogheda, and Cavan & Monaghan Hospital, had limited to 440 the number of joint-replacement operations, "despite the fact that one hospital within the group has capacity to do well in excess of 700".
At University Hospital Waterford just two consultant urologists served a population of 500,000 people. “Presently there is a nine-year waiting list for an outpatient appointment. At a minimum, the service requires an additional three consultants, three registrars, three SHOs” – senior house officers – “and two interns in the immediate short-term.”
Hospital equipment
The consultants’ association also said the health service needed to invest significantly more in hospital equipment, given that a confidential HSE report earlier this year found 9,000 aged or at-risk items that needed to be replaced.
The submission maintained that, as University Hospital Limerick's Dexa bone-density scanner was not available, patients diagnosed with cancer in its rapid-access prostate clinic had to be referred to Midland Regional Hospital in Tullamore, where they were put on an ever-lengthening waiting list. "This is delaying their treatment significantly."
It also said that at Merlin Park University Hospital, in Galway, the regional Dexa service had not been available for about two years, "impacting adversely on the treatment of cancer patients and patients with rheumatology conditions".
The submission said that Cork University Hospital’s lack of a vascular laboratory had led to an unnecessary increase in the number of patients using outpatient clinics and radiology facilities.
In addition, the Irish Hospital Consultants Association said the failure to attract enough consultant psychiatrists had resulted in significant shortfalls in the Republic's mental-health services.
“Significant time and energy is spent on the recruitment of consultants and non-consultant hospital doctors. Reliance on agencies is unhelpful, as staff are increasingly transient, and considerable time is devoted to vetting and organising work visas only for a significant portion of these staff to move to other parts of the country.
“As a result of the vacancy levels, there is a lack of continuity and there is a risk of systems failure as agency doctors cannot be inducted properly or on a sufficiently regular basis.”