New approach called for to tackle lung disease in Ireland

University Hospital Limerick, where Dr Aidan O’Brien is a consultant in respiratory medicine

A leading doctor has called for a new healthcare approach to tackle respiratory disease diagnosis and treatment.

It comes as the number of people waiting to see a respiratory consultant stands more than 21,000.

Dr Aidan O’Brien, a consultant in respiratory medicine at University Hospital Limerick and president of the Irish Thoracic Society, and the Irish Hospital Consultants Association (IHCA) are proposing a new strategy in response to the growing number of respiratory patients awaiting diagnosis and treatment.

They say that one is needed to combat the country’s worsening rates of lung cancer mortality, and the after-effects of the Covid-19 pandemic.

Dr O’Brien said a 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.

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 since the start of the year. 

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.

The ICHA say that more staff is needed to tackle the waiting lists. 

They say that latest figures show Ireland has just 3.3 specialists in respiratory medicine per 100,000 population compared to an EU average of five.

They added that a 122% increase in the number of respiratory consultants is needed to address current shortfalls and meet HSE-predicted demand by 2028.

To meet this staffing level, the ICHA say that it will require the recruitment of 94 additional consultants, or almost 12 respiratory physicians per year from now until 2028.

Dr O’Brien has also warned that Covid-19 has restricted the ability “to address the burden of lung disease in Ireland”.

He and the ICHA state that around 450,000 people suffer from asthma and over 500,000 from chronic obstructive pulmonary disease, giving Ireland a high proportion of lung disease.

Covid-19

They say that 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,” said a statement.

“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.” 

Dr O’Brien said that because of Covid-19 restrictions clinics cannot be staffed as well as was previous and “the number of patients we can assess and our diagnostics have been greatly reduced.

“When our clinics did reopen, they were greatly restricted.” 

The ICHA has also called on the Government to end the “recruitment and retention crisis”.

The association 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”.

Dr O’Brien stated: “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.” 

Dr O’Brien said that 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.”