Use empty hospitals to get screening back on track
THE State acted quickly to prevent many thousands of deaths from coronavirus, but the threat of increased mortality from cancer and other serious illnesses now looms large.
Last week, we learned that GP referrals to hospital clinics, for patients with suspected cancers, have dropped by more than 50pc since the start of the Covid-19 crisis.
The HSE said it was a “cause of concern” that people who have cancer symptoms are failing to seek timely medical advice. The reduction in numbers is evident across every speciality – referrals for suspected breast, lung, prostate and skin cancers have all collapsed.
While symptomatic patients are deferring receiving treatment, the cancer-screening programmes we rely on to detect latent cancers in the community have all been suspended for nearly two months.
In April 2019, nearly 14,000 mammograms were carried out by BreastCheck. Last month, that figure was zero. Meanwhile, the number of smear tests being sent for analysis has fallen by a whopping 96pc – from 21,037 in April 2019 to 937 last month.
According to Dr Robert O’Connor, director of research with the Irish Cancer Society, in any given week 3,400 women are typically screened for breast cancer, 5,600 are screened for cervical cancer and 2,300 are screened for bowel cancer.
Every week the suspension in these screening programmes continues, the backlog of cases rises by more than 11,000 patients.
Even when women who have previously been assessed as being at high-risk of developing cervical cancer obtain a smear test, there are reports of long delays in those tests being processed.
Claire Healy, from Kenmare, Co Kerry, told ‘RTÉ News’ that she had a smear test on April 24 but was advised it would be a minimum of 24 weeks before she received the results. Given Ms Healy must present for a smear test every three to six months, a delay of this magnitude is totally unacceptable.
With the State under pressure to reach 100,000 coronavirus tests a week, is it the case that cancer screening is being put on the long finger and that lab capacity is now being devoted solely to Covid-19 cases? If so, given what we know about the importance of early intervention in the treatment of cancer, this is extremely alarming.
One recent UK study outlines what is at stake in stark terms. Researchers there have projected a 20pc increase in deaths among cancer patients this year, given urgent referrals by GPs for cancer tests have fallen by up to 76pc.
If that figure were to be replicated here, it would equate to an additional 1,800 deaths from cancer this year. These are deaths that are preventable, provided patients receive early diagnosis and prompt treatment.
When the HSE was preparing for a potential huge surge in coronavirus cases in March, it is understandable that cancer-screening programmes were paused. However, now that the numbers of Covid19 cases in hospitals, and the community, are receding, it is time to urgently plan for their reintroduction.
The HSE also needs to do more to encourage patients, who are experiencing symptoms of cancer and other serious illnesses, but are fearful of engaging with the health service, to present to their GPs and have those symptoms assessed.
As far back as April 10, Health Minister Simon Harris was warning that, in the absence of a vaccine, we would have to learn to “live alongside the virus” for the foreseeable future. This advice is especially apposite for the health service, which now has to learn to divide its resources between Covid-19 and other serious and chronic illnesses.
To date, that division of resources has not been as well managed as possible. The State assumed temporary control of 19 private hospitals in March, in a deal that is costing €115m per month.
Despite this hefty price tag, bed occupancy levels in some of these hospitals are at just 25pc. According to a group representing private consultants, Independent Medical and Dental Consultants, bed occupancy levels in some private hospitals are even lower, just 10pc.
Part of the reason for this underutilisation is that the State, while it leased the hospitals for €115m per month, had to enter into separate agreements with consultants to staff the premises.
To date, out of 600 consultants who work full-time in the private system, more than 50pc have yet to sign a ‘public only’ contract with the HSE.
These consultants are now at home twiddling their thumbs, unable to work, while waiting lists and backlogs exponentially increase.
Some of these consultants, while refusing to sign a contract which they say would lead to their existing patients being abandoned, had been working pro bono in these hospitals as they were indemnified under the State’s Clinical Indemnity Scheme.
However, that arrangement expired at the start of this month and those consultants do not now have any insurance cover to allow them to operate.
Given the masses of money that has been spent leasing these hospitals, theatres, diagnostic tools and outpatient clinics, these facilities should be running at full capacity. The fact that many are lying largely empty is a travesty and means many thousands of patients are being failed.
The deal to lease private hospitals was initially entered into for a period of three months, extendable until the end of August. With the deal due for review before the end of this month, the manner in which the use of these facilities can be maximised, to take the pressure off public hospitals, urgently needs to be addressed.
The danger is the State will, having spent nearly €350m leasing private hospitals for three months, abandon the agreement at a time when extra capacity to deal with non-Covid-19 cases is urgently required.
Patently, it makes no sense to lease hospitals which are largely empty, but it should not be beyond the wit of those negotiating with consultants to come to some kind of arrangement that would see them return to work – and assist the health service in managing the treatment of serious illnesses, among public and private patients alike.
Thanks to the sacrifice of the Irish people, the Covid-19 surge we all feared has not materialised.
It would be utterly tragic if, after all of the hardship endured by so many to prevent deaths from Covid-19, the number of people dying from other serious or chronic conditions ultimately exceeded those who succumbed to the virus.
Private consultants are now at home twiddling their thumbs, unable to work, while waiting lists and backlogs increase