Respiratory services could buckle under pressure without urgent action on capacity

The Covid-19 pandemic is causing delays in the diagnosis and treatment of patients with respiratory conditions 

Hospital respiratory services could buckle under pressure unless urgent action is taken to increase capacity and boost diagnostics, the Irish Thoracic Society has warned.

The warning follows a recent survey of respiratory consultants, who have expressed concern over the impact of Covid-19 on services, in particular on growing waiting lists, delays in diagnosis, treatment, and care, inadequate staffing and insufficient bed capacity.

More than half (60) of all respiratory consultants working on the Covid-19 frontline in hospitals in Ireland and Northern Ireland responded to the survey carried out last month.

An overwhelming majority of respiratory doctors (95%) said the pandemic was having a negative impact on services for non-Covid patients, by either delaying care, diagnosis or treatment.

The majority of doctors surveyed (79%) also reported seeing fewer patients between March and October this year compared to last year, with a quarter saying they had seen less than half the number of patients with lung problems during the pandemic period.

Half of all doctors surveyed also confirmed that the number of procedures carried out between March and October, such as lung function tests, bronchoscopies and sleep studies, was also less than half that in the same period last year.

Waiting lists for routine care was also growing, in some cases by more than 50%.

Official figures from the National Treatment Purchase Fund show that 20,000 adults and children were waiting for a respiratory medicine outpatient appointment in October. A further 1,800 adults and children were waiting for inpatient or daycare treatment in October.

Around half a million people over 40 have chronic obstructive pulmonary disease and 400,000 people have asthma in Ireland.

The medics have called for increased investment in services and staff and increased access to bronchoscopy, radiology investigations and pulmonary function tests to deal with demand.

President of the Irish Thoracic Society Dr Aidan O’Brien warned that services could “buckle under pressure” unless “urgent action” is taken and that, while welcome, additional funding announced under the €600m health service winter plan did not go far enough.

He said services were already overburdened and under “significant strain” pre-Covid but were now facing additional challenges.

“The introduction of respiratory integrated care teams and community hubs will help to ease the burden on respiratory healthcare services at community level, however, this must be implemented in full without delay,” Dr O’Brien said.

“We are concerned though that this is not enough. Unless we take urgent action, respiratory hospital services will continue to buckle under the pressure of trying to catch up with the backlog of patients with non-Covid lung problems and the increasing volume of new patients presenting with post-Covid syndrome,” the Limerick-based respiratory consultant said.

There are also concerns that the diagnosis and treatment of lung cancer (the biggest cause of cancer death in Ireland) is being delayed.

“There are less people presenting with cancer, and the people who are presenting with cancer tend to be at the more advanced stages of the cancer,” Dr O’Brien said.

“Time is critical, early presentation and treatment is essential,” he said.

Ireland has the fourth-highest death rate from lung disease in Europe, with mortality rates 40% higher than the EU average.

The need for hospital treatment for respiratory disease is also high, accounting for 14% of all hospital admissions.

Dr O’Brien said dedicated respiratory units should be developed in hospitals to diagnose and treat all lung diseases as well as dedicated clinics for patients presenting with post-Covid symptoms.

An overarching strategy for respiratory diseases akin to that for cardiac disease was also needed.

“We need to see investment in upgrading and adapting existing diagnostic facilities with additional equipment and increased space to take account of infection-control protocols while also beginning to try to meet demand in a timely manner,” Dr O’Brien said.