'Structural failures' in health system will lead to more cancelled operations, say medics

Cork University Hospital had the highest number of people on trolleys, at 49, on Tuesday. File picture Dan Linehan

Patients are facing more cancelled operations unless structural failures in the health system are urgently addressed, medical unions warned, following a scathing report by the health watchdog.

The Healthcare Overview Report 2020 from the Health Information and Quality Authority (Hiqa) found hospitals were hampered in managing Covid-19 by long waiting lists, overcrowding and staff shortages as well as ageing buildings.

This overview of the monitoring and regulation of healthcare services in 2020 found the onset of Covid-19 put “extreme pressure on every service”.

Irish Hospital Consultants Association vice-president Professor Rob Landers said: “This pandemic and more recently, the cyberattack have exposed deep fundamental deficiencies in our health system which we always knew were there, but which have now been exposed in a way previously unseen.” 

'Lack of strategic leadership'

Prof Landers said the “lack of strategic leadership” has hampered delivery of care for patients, leading to a startling rise in numbers on trolleys this month.

He warned that without immediate action, such overcrowding will also result in the further cancellation of scheduled care, "which has already been decimated as a result of the pandemic". 

Cork University Hospital had the highest number of people on trolleys, at 49, on Tuesday, followed by Limerick at 44.

“Today’s trolley figures are one greater than the 384 described in 2006 by then minister for health Mary Harney as a ‘national emergency,” Prof Landers said on Tuesday.

The lack of meaningful action or urgency today to address this issue demonstrates a complete lack of understanding of just how bad things have gotten.”  

Prof Landers called for urgent action on the issues raised by Hiqa, saying recruitment is urgently needed.

“The ongoing hospital consultant contract negotiations are critical to this and must be successful in finding workable solutions to the root causes of our recruitment and retention crisis,” he said.

'Despair and foreboding'

The Irish Medical Organisation echoed these concerns, and warned doctors are looking ahead to the winter with “a sense of despair and foreboding”.

The IMO estimated the HSE “urgently needs” 2,000 medical specialists across acute hospital and psychiatry services. Up to 1,660 additional GPs are also needed.

“We cannot continue to treat and react to healthcare spending in a crisis mode and must make significant, sustainable investment now and for the years ahead,” IMO president Dr Ina Kelly said.

We have seen how dependent our nation is on a properly functioning health service, if we do not address this now when will we?” 

She said the public had come to accept overcrowding as normal but said this was instead a sign of “structural failure”.

“Tragically these problems have been ongoing for so long that the public has learnt to accept the unacceptable when it comes to waiting lists and access to timely care,” she said.

The Hiqa report found that while hospitals had “some success” managing the additional burden of Covid-19, their efforts were “hindered” by underlying challenges.

Hiqa director of regulation Mary Dunnion said plans for reform through Sláintecare were to be welcomed. She said: "This has the potential to ease pressure on our acute hospital system. We also believe it will better enable an integrated model of care."

Ageing hospital buildings

Researchers acknowledged record funding funnelled into the health service in response to the pandemic. However, they said the hard work by many staff was "negatively impacted" by the ageing hospital buildings in which they work, hampering change. 

Overcrowding in hospitals has been shown to increase the risk of spreading infection. During the third wave of the pandemic, 1,972 patients acquired Covid-19 during a hospital stay between December 28 and April.

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The Department of Health reported a further 1,508 cases of Covid-19 on Tuesday There were 206 people in hospital with Covid-19, including 33 in ICU.