New HSE service plan will face challenges delivering hospital capacity precisely when more is needed

IHCA analysis of HSE Service Plan for 2021 points to 200,000 fewer patient appointments this year 

• 153,000 fewer outpatient and 50,000 less inpatient/day case appointments now expected in 2021
• More than 900,000 fewer public hospital patient appointments in 2020 and 2021 as impact of pandemic continues 
• Concern planned bed expansion will not be sufficient to meet built-up demand and infection control requirements
• No targets to fill additional consultant posts or the existing 728 unfilled permanent consultant posts
• Collaborative approaches have seen the health service through the worst of pandemic, similar approaches and engagement are needed now to deal with backlog

Plan includes positives but with 860,000 people on waiting lists, pressure continues to build—IHCA President 

Analysis by hospital consultants of the recently published HSE Service Plan for 2021 has raised concerns about the capacity of public hospitals to address existing waiting lists and meet the built-up demand created by the COVID-19 pandemic. 

The Irish Hospital Consultants Association (IHCA) estimate that the HSE Plan, published last week, means over 200,000 fewer patients hospital appointments this year in public hospitals. 153,000 of these are outpatient appointments and 50,000 inpatient and day cases. 

It is now anticipated that 2021 will be the second successive year of reductions in public hospital appointments as the impact of the pandemic continues to impact hospital care. 

According to HSE data, in 2020 there were 248,000 fewer inpatient/day cases than in 2019, with almost 475,000 fewer outpatient appointments. 2020 and 2021 figures combined mean there will likely be more than 900,000 fewer patient appointments in public hospitals compared with pre-Covid activity. 

With a record 860,000 people on waiting lists and hospital bed occupancy rates due to be reduced for to infection control measures, the IHCA continues to be concerned about bed capacity deficits. 

IHCA has also signalled concerns with a continued lack of targets to hire hospital consultants, including the 728 permanent hospital posts unfilled. The Association also pointed to the budgetary approach to other key areas, including mental health, eHealth, recruitment, ICU capacity and equipment. 

Commenting, Professor Alan Irvine, President, IHCA said:

“HSE frontline and management staff deserve huge credit in the management of the pandemic to date. Collaborative working during the worst of the pandemic has been a key success factor. Similar approaches are now needed to tackle the massive backlog of scheduled care. 

“Compiling a Service Plan amid a pandemic which is causing immediate and knock-on impacts is a huge challenge. The government has stepped-up in terms of additional investment but how we channel this investment is key. We are in effect attempting to service a moving vehicle. Striking a balance between short and medium-term objectives is key and central to this is collaborative planning. 

“Reducing levels of community infection with Covid-19 certainly helps but the stubborn nature of COVID and knock-on suspension and cancellation of patient care means backlogged cases build-up. Our ability to respond involves many factors, with beds and recruitment the principle two.  Without addressing these twin deficits, the structural mismatch between capacity and demand will continue to increase rather than decrease waiting times.

“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.”

On mental health, Professor Irvine said: 

“Of the almost €1.7 billion extra funding due to the pandemic, less than 1% has been earmarked for mental health. Healthcare professionals are seeing more and more mental health presentations. People themselves are seeing and experiencing the unfolding effects of Covid on mental health. Given this, the funding response is grossly inadequate. This is a problem set to dominate all of us in healthcare for some time.”

ENDS

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