Public health system reliance on outsourcing cannot continue, say consultants

Dr Catherine Motherway, intensive care consultant at UHL, said: 'One thing I would do differently is I would let people come in to see dying relatives. It was one of the hardest things that I’ve done in my life. We prevented them for a period of time, short but it was dreadful.' Picture: Leon Farrell

Sending public patients to private hospitals instead of investing is causing harm to public health services, a seminar on the pandemic’s impact heard yesterday. 

Speakers from University Hospital Limerick and University College Cork were among an international gathering at the National Healthcare Outcomes Conference, hosted by the Royal College of Surgeons Ireland (RCSI).

During the pandemic, a ‘safety-net’ agreement saw thousands of HSE patients treated in private hospitals in response to spiralling Covid-19 numbers in public hospitals.

 St James’s Hospital chief executive Mary Day said public services are “constantly” relying on outsourcing now.

“It is not the solution,” she said. “I think it was a quick-fix in relation to an emergency situation but two years later, that we are still relying on that as a solution to the problem is doing harm to what we are trying to achieve.” 

Describing pent-up demand and growing waiting lists, she called for “a rethink” on how to deliver care in the post-pandemic era, including more investment in construction and recruitment.

'Do we continue or do we invest in our infrastructure?'

Dr Jerome Coffey, chair of the board of the National Cancer Registry, said: “The safety net and all of that sort of stuff we never thought we would be allowed to do before, we’ve done it. The question is do we continue or do we invest in our infrastructure to take a more long-term view?”

The pandemic will have a long tail with cancer services among those still waiting to understand the full impact, said Dr Coffey.

“The big question is what is the impact on survival? We will have to wait 2020 plus five years, 2021 plus five years to have five-year survival data,” he said.

Professor Deborah McNamara, clinical professor in surgery at the Royal College of Surgeons in Ireland, also called for investment in HSE structures.

“There are six-bedded units, with six beds and one bathroom. I don’t want to sleep there healthy and I sure don’t want to go there to have an operation or to come in as an emergency,” she said.

UCC professor of epidemiology Patricia Kearney said we need to focus more on public health. “It is now time for a national conversation around what we value. It has uncovered all sorts of inequalities, in our nursing homes or for our migrant workers,” she said.

She said ICU figures and deaths are “extraordinarily important” but some countries managed these without stopping dying people from having visitors or closing schools for as long as Ireland did.

Dying relatives

Dr Catherine Motherway, intensive care consultant at UHL, said: “One thing I would do differently is I would let people come in to see dying relatives. It was one of the hardest things that I’ve done in my life. We prevented them for a period of time, short but it was dreadful.” 

Anders Tegnell, the former state epidemiologist for Sweden, also addressed the event, saying that his country had restrictions in place but also relied heavily on individuals’ sense of responsibility.

“I think we have a lot to learn,” he said, referring to nursing homes, which were also closed to visitors in Sweden. 

“We really need to think about what are the priorities you have when you close to the end of your life,” he said. 

“I think many of these people would have much rather met their grandchildren and taken the slight risk of getting Covid-19 instead of dying alone.”