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Dr Gabrielle Colleran, IHCA Vice President said, “We are deeply saddened to learn of the passing of our colleague and friend, Dr Keshav Sharma last week.

Commenting on the latest National Treatment Purchase Fund (NTPF) waiting list figures, Professor Alan Irvine, President, Irish Hospital Consultants Association, said: 

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.

9,248 added to adult general surgery outpatient waiting list in 2020; 4,133 more waiting over a year to see a consultant since start of year, an increase of 152%;  Paediatric surgery outpatient list has more than doubled since start of the year, with 2,107 more children waiting to see a hospital consultant; 2,419 (25%) additional patients waiting for inpatient/day case general surgery; 40% increase in paediatric surgery inpatient/day case waiting list since the start of the year; More than a fifth of all hospital consultant posts are now vacant or not filled as needed.  IHCA President Prof Alan Irvine: “Today’s NTPF waiting list figures again highlight the impact of hospital consultant shortages and capacity constraints on those waiting for an outpatient appointment and related surgery and treatment. Each statistic represents a person waiting for the care they desperately need, while potentially deteriorating clinically or living in pain.” 

In same week HSE confirm 728 unfilled permanent consultant posts, Medical Council report finds:  

More than a fifth of all consultant posts are now vacant or unfilled on permanent basis; 612,000 people — 12% of the population of Ireland — are now waiting for an outpatient appointment with a consultant;  More than a quarter of a million have been waiting longer than a year for an outpatient appointment, Irish Hospital Consultants Association data analysis reveals; Patients in all parts of the country impacted by significant consultant deficits with the South/South West and Western regions with the highest number of unfilled posts;  IHCA says worsening wait times can be traced back to a 2012 decision to cut pay of hospital consultants appointed thereafter, calls for immediate reversal. New data from the HSE's National Doctors Training and Planning unit confirms that over a fifth of all permanent consultant posts, 728 in total, are now vacant or filled on a temporary, locum, or agency basis.    It comes as 612,000 people — 12% of the population of Ireland — are now waiting for an outpatient appointment with a consultant. Over quarter of a million, 255,000, have been waiting longer than a year, five times the 2014 number. A further 75,000 people are awaiting inpatient/day-case treatment.   The new HSE figures, analysed by the Irish Hospital Consultants Association (IHCA), confirm that as of 4 November 2020, of the 728 posts, 554 are at hospital level with 174 at community level (see below). A total of 237 permanent consultant posts are vacant, with two of unknown status and likely vacant. A further 406 permanent consultant posts are filled by temporary and locum consultants, with an additional 83 posts filled on an agency basis. It was previously believed approximately 500 consultant posts were vacant or unfilled on a permanent basis.    The specialties with the largest percentage of permanent consultant posts that are either vacant or filled on a temporary/locum or agency basis are:    Psychiatry — 32%, 153 posts Emergency Medicine — 29%, 33 posts Intensive Care Medicine — 27%, 9 posts Medicine — 22%, 176 posts Paediatrics — 21%, 49 posts Pathology — 20%, 60 posts Radiology — 19%, 60 posts Surgery — 17%, 93 posts

79,000 added to waiting lists since start of 2020, as 844,719 patients now wait for care; 612,817 outpatients are waiting for a consultant appointment, an increase of over 235,000 compared with 2014 and 59,383 during 2020; Direct correlation between record number of people waiting for outpatient appointments and long-standing hospital consultant vacancies. Increased wait times adversely impact patient outcomes in key areas of care;  Over 18,000 patients now waiting over a year for essential inpatient/day case treatment – more than double the number at the start of 2020. IHCA President Professor Alan Irvine: “Key to bringing down wait times continues to be more consultants and hospital capacity to care for patients.”

Almost 150,000 less people seen by main cancer screening services in the first six months of this year as a result of the reduction in non-COVID-19 care during the first wave of the pandemic; 12,400 more people waiting for an inpatient/day case GI endoscopy since last year; Over 2,400 people on the urgent cancer wait list for endoscopy services, almost a quarter (24% or 580 people) of whom have been waiting more than 3 months for a referral; Urgent recruitment of 73 additional consultant oncologists over the next eight years needed to tackle current acute hospital and cancer services waiting lists and future demand;  St Vincent’s Oncologist, Professor John Crown: “There is a lot of apprehension as to what it will be like to be a patient or a healthcare worker in the hospital system in Ireland over the next 6 months”. The Irish Hospital Consultants Association (IHCA) has today raised concerns about a lack of consultants and capacity in Ireland’s oncology services that is leaving many cancer patients waiting months to see a specialist. 

Commenting on Budget 2021, Professor Alan Irvine, President, Irish Hospital Consultants Association (IHCA) said:   “We welcome much of what is contained in Budget 2021. The importance of the healthcare system to our society and economy has never been clearer. While we are playing catch-up, investment of an additional €4 billion in healthcare deserves to be recognised and provides much needed backing at a crucial time.    “We are pleased to see that many of those patient care areas we have been campaigning for through #carecantwait are recognised along with supports for those of us on the frontline.    “Dedicated funding on cancer care, maternity services and trauma are hugely significant and will benefit thousands of people. We commend Minister Donnelly on achieving agreement for these key initiatives.   “Financial backing for beds at acute, community and intensive care levels is positive. Moving quickly to use this funding while in tandem providing transparency on bed delivery numbers at hospital level will give confidence to patients and healthcare professionals alike.    “Signals to finally address the deficit in hospital consultant numbers is one we all want to see realised. Addressing the consultant deficit is a three-legged stool of funding, enabling legislation to reverse the damaging 2012 decision in full, and agreement. On all three, we are finally seeing a chink of light. There is no time to lose given winter is upon us, the added pressure of the pandemic, and over 840,000 people continue to wait for care. We must now move quickly to get times in the diary to commence discussions with Minister Donnelly and health service management to ensure workable solutions are agreed.”   ENDS  

“COVID-19 reveals co-dependency that exists between a sustainable economy and properly resourced health system”