‘Up to 350 patients dying due to lack of ICU capacity’

Up to 350 patients are dying each year as a result of capacity constraints in intensive care units, the annual conference of the Irish Hospital Consultants Association has been told.

Dr Fergal Hickey, consultant in emergency medicine at Sligo General Hospital, also said that capacity deficits in neurosurgery was leading to deaths thatcould be avoided or disability that could be avoided.

He said Ireland was spending a lot of money on the health service. He said he was not arguing that more money was not needed, but rather he wanted to highlight that the country was not getting good outcomes from the funding currently being provided to the health service.

Dr Hickey said OECD figures showed that Ireland was one of the top-spending countries on health but that outcomes were “quite consistently poor”.

“Most of this comes down at the end of the day to severe capital under-investment. We have a history of dreadful decision making and very politicised decision making.”

He said when the Fine Gael/Labour coalition came to power one of the first things it did was to change the HSE capital plan to include new emergency departments and ancillary services in Kilkenny and Wexford to facilitate two Government ministers. He said both locations needed new emergency departments and other facilites but they probably didn’t have the greatest need.

Dr Hickey told the conference that “we should stop lusting after false gods” including that much more work can be performed in primary care.

“It can’t and it won’t,” he said.

He said the other false god was that if additional doors into the hospital were created that this would in some way improve capacity.

“It does not matter how many assessment units you create, that is simply creating a door and not creating capacity. It is not achieving anything.”

Dr Hickey said there was a severage shortge of critical care beds in hospitals.

“That results in cancellation of planned major surgery and also causes significant delays to acute intensive care unit admission. That comes at a cost. So patients end up being detained in emergency department resuscitation rooms or, not infrequently, end up being admitted, inappropriately to a regular ward bed without the interventions that should have taken place.”

“And we know that if your admission is delayed by more than six hours to an intensive care unit bed, your mortality goes up significantly.”

Dr Hickey said delayed admissions lead to poorer outcomes for patients or significantly longer lengths of stay in hospitals.

He also said it had been known for years that there was inadequate capacity in the coutnry's national neurosurgical unit in Beaumont.

“The calculation from the critical care perspective is that we are probably killing 300 -350 patients as a direct result of our ICU capacity constraints,” he said.

Dr Hickey said the dysfunctionality of the system was resulting inthe “burning of money”.

Meanwhile, the conference also heard that a significant cohort of doctors are not fulfilling their professional competency requirements.

The chief executive of the Medical Council Bill Prasifka said, most significantly, they were doctors who were registered in the Medical Council’s general division, as distinct from its specialist register.

He said that “in terms of the general division certainly upwards of 20 per cent are not fulfilling their requirements”.

He said they were largely younger doctors, non-consultant hospital doctors who were not in training programmes and doctors working through agencies and doing locum appointments.

Mr Prasifka said this was a matter of concern for the Medical Council.

He said the Medical Council firstly was preparing a report on this issue which it planned to publish by the end of the year.

“We are also engaging with the stakeholders, with the employers, with the indemnifiers.”

“Clearly what we plan to do when we get a definitive list of those not fulfilling their requirements is to write to them individually to confirm what the issue is there.”

“The only thing we can do formally is to bring them to fitness to practise but the goal at this point is to get them all enrolled and to get them into the schemes.”

He said the critical thing was for the Medical Council to work closely with stakeholders to come up with a solution.