Ireland needs to almost double the number of Orthopaedic Consultants to reach a national target set nearly 20 years ago and meet demand
The Hanly Report, published in 2003, recommended that Ireland needed 4 Orthopaedic Consultants per 100,000 population – today, there are still only 2.4 per 100,000
In contrast, UK and New Zealand health services have over 6 Orthopaedic consultants per 100,000 population;- According to IHCA analysis, 11,700 patients are waiting for Orthopaedic surgery; 76,000 are waiting for an Orthopaedic outpatient appointment;
- Ms Eimear Conroy, Consultant Orthopaedic surgeon at University Hospital Kerry, said having a patient wait more than 18 months for care is “heart-breaking";
- People forced to wait “definitely have worse outcomes", she said;
- IHCA calls for immediate Government action as hospital Consultant recruitment and retention crisis worsens.
The HSE needs to almost double the number of Orthopaedic Consultant posts to reach the recommendation of a major health report published in 2003, almost two decades ago, and meet current and projected demand.
The Hanly Report1, published when Bertie Ahern was still Taoiseach and Micheál Martin was Minister for Health, made it clear that Ireland needed at least 4 Orthopaedic Consultants per 100,000 population to provide a minimum standard of care.
Today, in 2022, there are just 2.4 Orthopaedic Consultants per 100,000 population.2 In contrast, in the UK and New Zealand, there are more than 6 Orthopaedic Consultants per 100,000 people.3
The HSE has estimated that the number of Orthopaedic Consultants will need to almost double to around 230 posts by 2028 to address current shortfalls and meet increased patient demand.4
Ms Eimear Conroy, Consultant Orthopaedic Surgeon at University Hospital Kerry, said that the chronic lack of orthopaedic consultants, available hospital beds, and theatre operating space are the main causes of the unacceptable delays in providing care. This is resulting in very serious consequences for patients.
There are currently over 11,700 patients nationally waiting for Orthopaedic surgery and 76,000 waiting for an orthopaedic outpatient appointment.5 This represents an increase of 24,700 (48%) over the past 7 years, and of 7,300 (11%) since the beginning of the pandemic. In Kerry alone, Ms Conroy said, there are more than 2,000 people waiting for an orthopaedic outpatient appointment.
“Having someone wait for more than eighteen months to be seen so that we can provide them with a solution is heart-breaking,” said Ms Conroy.
“Excessive wait times can lead to the development of chronic pain. If a patient with a rotator cuff injury hasn't used their arm properly for a year, they'll have a huge amount of dysfunction, making recovery from any intervention extremely difficult. People in these situations definitely have worse outcomes, on top of a standard nine to 12-month recovery.
“I recently had a lady in her eighties who, until six months ago, had been living independently. Debilitating hip arthritis means that she now walks with her frame, has lost her ability to drive, and needs home help for activities of daily living. Being able to see her in a timely fashion in outpatients and provide a hip replacement for her may well have prevented the significant deterioration she experienced.
“Ultimately, we need more Consultants. These Consultants also need support from other staff and access to outpatients and theatre.”
Pandemic backlog, triaging, and consultant numbers
Ms Conroy, speaking on behalf of the Irish Hospital Consultants Association (IHCA) as part of its Care Can't Wait campaign, said that Orthopaedic medicine has been seriously affected by the pandemic. She said that her team had performed “very few" elective cases over the past two years due to Covid-related clinic closures and cancellations.
“Not all referrals need to see an orthopaedic surgeon immediately. We are streamlining the triage system and referral process, which means that patients appropriate for physiotherapy review are referred accordingly before accessing an Orthopaedic Consultant,” said Ms Conroy.
According to IHCA figures, 1 in 5 permanent Consultant posts are currently vacant or filled on a temporary basis. In Surgery, which includes the specialty of Orthopaedics, 1 in 7 Consultant posts are not filled as needed.6
Professor Alan Irvine, President of the IHCA, said: “When the Hanly Report was published almost twenty years ago, its author said that failure to implement its recommendations was “not an option”.7
“In 2022, the results of that failure are clear. Sick patients are waiting longer, outcomes are worsening, and we are still no closer to ensuring a minimum standard of timely orthopaedic care due to the severe shortage of Orthopaedic surgeons and the hospital facilities they need. Given the backlog of care caused by the pandemic and the continuing Government policy which discriminates against new Consultants contracted since 2012, this problem is simply going to get worse.
“The solution to this problem is clear and very well communicated by hospital Consultants across Ireland: we must quickly appoint additional permanent Consultants and address the long-standing issues of pay inequity and poor working conditions. The longer this Government reneges on its commitments to Consultants and dithers on a resolution, the more frustrated and ill hundreds of thousands of Irish patients will become.
“This should not be an issue in twenty-first-century Ireland. The UK and New Zealand, the latter with a population similar to ours, are able to appoint a sufficient number of Orthopaedic Consultants. Other developed countries consistently provide timely, effective care to patients, as well as reasonable, efficient, and empathetic working environments for their doctors and other healthcare staff.
“There is simply no reason we cannot do the same in Ireland.”
Notes:
Ms Eimear Conroy’s comments were made in a new video released on social media today by the IHCA as part of its #CareCantWait campaign. The video is available here https://vimeo.com/684212967/94c9691850
Ms Eimear Conroy is a Consultant Orthopaedic Surgeon at University Hospital Kerry
1. Report of the National Task Force on Medical Staffing (Hanly Report), June 2003: https://assets.gov.ie/39348/634e7cea7b764923957698865ea66003.pdf.
2. There were 118 WTE orthopaedic surgeons employed by the HSE and Section 38 hospitals on 30th September 2020; HSE PQ response to Deputy Sean Sherlock, 18th November 2020, https://www.hse.ie/eng/about/personalpq/pq/2020-pq-responses/november-2020/pq-37219-20-sean-sherlock.pdf.
3. HSE Specialty Workforce Review in Surgery: https://www.hse.ie/eng/staff/leadership-education-development/met/plan/specialty-specific-reviews/surgery-2014.pdf.
4. HSE Demand for Medical Consultants and Specialists to 2028 Report, November 2020: https://www.hse.ie/eng/staff/leadership-education-development/met/plan/demand-for-medical-consultants-and-specialists-to-2028-november-updates-v2.pdf
5. Analysis based on latest NTFP waiting list data as 31st January 2022: https://www.ntpf.ie/home/nwld.htm.
6. HSE PQ response to Deputy David Cullinane, 24th February 2021: https://www.hse.ie/eng/about/personalpq/pq/2021-pq-responses/february-2021/pq-8669-21-david-cullinane.pdf.
7. https://www.irishtimes.com/news/hanley-report-will-take-years-to-work-1.388109.
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