Capacity of ‘six Croke Parks’ on out-patient waiting lists, doctors told

The State is condemning acutely ill patients to unacceptable delays in securing treatment which is leading to avoidable deaths, the president of the Irish Hospital Consultants Association (IHCA) has said.

Dr Tom Ryan told the annual conference of the association on Saturday that the main problem in the health service was "a chronic lack of capacity" and this had to be addressed by the Government.

He strongly criticised the new Sláintecare health reform plan, which urges the elimination of private treatment in public hospitals. He said it failed to deal with the reality that there just were not enough hospital beds and frontline staff to deliver the services that it advocated.

"In our view the report ignores the reality that Ireland has a hybrid public and private system. Instead of proposing pragmatic solutions to our current health care problems, it advocates health care solutions deemed appropriate for another society in a bygone era. "

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“We must face the reality that we have a hybrid health system with both private and public funding, and move on from there.”

He told the conference there had been a persistent policy by the State to ration healthcare for patients.

Six Croke Parks

Dr Ryan said the equivalent of the capacity of six Croke Parks were currently on waiting lists for a hospital out-patient appointment.

“Our acute hospitals are short of the most basic resources that we need to treat patients, that is hospital beds, operating theatres, and ICU beds, and hospital consultants.”

“As a result, more than 90,000 patients, many elderly and frail, received some part of their acute hospital care on trolleys last year, and this number looks very likely to increase this winter.”

He said there were insufficient staff to provide mental health services to a recognisable contemporary standard.

“We do not have an adequate rehabilitation service for patients recovering from a disabling illness. We have yet to roll out and implement a national trauma strategy.”

“Our intensive care service, for critically ill patients, is under resourced and haphazard. Many shocked unstable patients wait in hospital wards, receiving inadequate care, when they should be in an ICU bed, because we don’t have enough ICU beds. “

“Critically ill patients admitted through emergency departments may stay on a life support machine in emergency departments for hours while waiting for an ICU bed.”

Set up to fail

Dr Ryan said the country’s acute public hospitals were being “set up to fail”.

“Then when they fail to meet reasonable expectations they are criticised for failing. This no-win situation poisons the work atmosphere in the acute hospitals, it undermines the morale of front line staff and they leave.

Dr Ryan warned that unless current trends were reversed “our acute hospitals will stop performing elective surgery altogether within the next few years”.

“Waiting lists for surgery are now in excess of 80,000. Why so?

Well, elective surgery in our acute hospitals has halved in the last 4 years. So in 2016 we performed about half the number of hip replacements of the OECD average, and much less than half the knee replacements. That’s half the OECD average, not half the best OECD country.

He said unlike the private sector, public acute hospitals were not keeping up with international developments.

“There is an international trend towards robotic assisted surgery, to deliver better patient outcomes, and shorten hospital stay for patients. In Ireland robotic -assisted surgery is mostly available in the private sector, with only one such robot in an acute hospital - here in Limerick.”

Dr Ryan maintained that the argument of the Sláintecare report that the phased elimination of private care from public hospitals would expand capacity was “flawed”

He said if implemented, it would actually reduce hospitals’ income as the State was unlikely to fully compensate for the loss of the € 650 million annual revenue generated from insurance companies and fee-paying patients.

Dr Ryan said private patients would continue to come to acute hospitals with acute overwhelming illness, for cancer care and for complex care that required multidisciplinary teams that could not be delivered in the private sector.

“Clearly the proposition, to remove private funding but not private patients from public hospitals, at a time of when the public hospitals are short of cash, does not help to deal realistically with the size and complexity of the problems that our acute hospitals face.”

“On the basis of pragmatism alone it’s just not on.”