Health system needs a government urgently
THERE are lots of reasons we need a government this weekend. One of them is to stop a meltdown in public healthcare. Covid-19 has compromised an embattled healthcare system so much that unless urgent and radical action is taken, there will be a loss of life many times higher than the already devastating death toll.
Doctors are talking about undiagnosed and untreated cancers, lack of care for people with chronic conditions, longer waiting lists for urgent surgery, patients with time-critical illnesses unable to see specialists for years, sick children unable to access diagnostics and lots more.
The pandemic is a perfect storm. Covid19 patients need treatment. Measures including personal protective equipment, testing, and tracing require a lot of money. The cancellation of treatment during the surge has led to a large jump in waiting lists. And, critically, the need for new infection-control measures means a massive fall in our capacity to provide care.
Estimates suggest between 15pc and 30pc of hospital beds must now stay empty. We have around 11,000 in-patient hospital beds in the public system. Sláintecare planned to add 2,600 over several years. Covid-19 may have just wiped out a similar number in a matter of weeks.
Some surgeons are estimating they’ll be able to perform around half the number of procedures they previously could in the same time. A similar fall in capacity is suggested for diagnostics like MRIs, with even bigger falls for more invasive diagnostics like scopes. It’s going to take longer, and cost more, to do less.
Before Covid arrived, Ireland had the longest waiting lists in Europe, the lowest level of consultants and the second lowest level of hospital beds. Safe staffing levels were not being met. Three times more doctors deregistered last year than in 2016. The number of vacant consultant posts has been going up for several years.
When Covid-19 arrived here, our healthcare workers responded with extraordinary skill and effectiveness. Yet on Tuesday we heard that Ireland has the highest rate of Covid infections in healthcare workers in the world. A sign of a healthcare system under too much strain.
Systems with spare capacity are resilient to shocks. Systems already stretched to breaking point are not. It’s like hitting a big pothole driving a well-serviced car below the speed limit, versus hitting it when driving a car with bald tyres and dodgy suspension at well above the speed limit. The pothole might damage the first car, but it could write off the second one.
Which brings us back to the pressing need for a new government.
The programme for government contains impressive healthcare goals and policies. It has the potential to be transformative. But all of that is contingent on dealing with the impact of Covid and this lost capacity. To do this, at least three things need to happen at the same time.
First, temporary capacity needs to be sourced from outside the public system. This means forming strategic partnership with private providers. It means funding the National Treatment Purchase Fund to secure treatment for patients and expanding its remit to also secure diagnostics and mental health care.
We should also look at extending the timeline of care. For example, a surgeon’s duty of care could extend beyond the operating theatre into recovery.
Second, we need to adapt the public system to help our clinicians get more from it. This includes running diagnostics suites and operating theatres longer. Which means urgent hiring requirements, which in turn necessitates tackling the reasons why there are so many vacant posts and why we struggle to retain locally trained healthcare workers.
It means cutting out wasteful practices, like patients having to stay in hospital for days just to be on a priority list for an MRI.
Third, we need to accelerate Sláintecare. Telemedicine was used successfully during Covid – that needs to be expanded. New technologies need to be deployed, like monitoring patients with chronic conditions at home. Care pathways need to be tightened up to connect GPs and other community-based healthcare professionals directly to specialists and diagnostics.
Electronic patient records need to be launched. The new regional organisation needs to be rolled out. A workforce plan needs to be published with hiring and staffing targets set and met. New contracts need to be signed with GPs, pharmacists and consultants.
The primary care centres need to be fully utilised, including community-based diagnostics and specialist care. The new mental health strategy needs to be implemented. We need to move on the new maternity hospitals. Long-term residential care and respite care need new supports and investment.
And much, much more. The clock is ticking.
Doctors are talking about undiagnosed and untreated cancers, longer waiting lists for urgent surgery, and sick children unable to access diagnostics