Consultant workforce deficits across pathology disciplines, IHCA warns

The Irish health system has a deficit of hundreds of pathology consultants, required to provide the link between cancer diagnosis and treatment, a leading haematologist has warned.

Dr Áine Burke, Consultant Haematologist at Sligo University Hospital, commented: “We are the interface between analysis, diagnosis and treatment decisions but are under-resourced in many areas. Staffing to support a multi-disciplinary approach is key to improving the overall outcome for patients.”

Speaking in a video released by the IHCA on World Cancer Day (4 February), Dr Burke highlighted the need for adequate staffing across pathology services, to support the timely delivery of quality care for all patients in Ireland.

Pathology, the study of the causes and effects of disease or injury, involves consultants and health care professionals from multiple specialties, working collaboratively to bridge the gap between disease analysis, diagnosis, and subsequent treatment.

As specialists in one of the key pathology disciplines, haematologists analyse, diagnose, and treat diseases related to blood and bone marrow such as blood cancers including leukaemia, lymphoma and myeloma, bleeding and clotting conditions, anaemia, stem cell and bone marrow transplantation, and transfusion. They also provide critical specialty support to other specialties including surgery and maternity care, among others.

Haematologists perform a pivotal role in treating childhood leukaemia, the most common childhood malignancy accounting for 30 per cent of all cancers diagnosed in children under 15 years of age.

Irish haematologists analyse and provide expertise on the evolving landscape of genetic blood conditions and blood types in Ireland which has developed as a result of the increasingly diverse population. Dr Burke indicates that this understanding is crucial in informing colleagues of the best methods of treatment and care.

However, there is a growing deficit of consultant haematologists to provide the services needed – a gap that is having a domino effect across the delivery of multi-disciplinary patient care, says Dr Burke.

This key workforce capacity deficit is resulting in longer delays for patients waiting for treatment. There were 7,411 adults and 257 children on an outpatient hospital waiting list to see a consultant haematologist at the end of December 2020, with 2,198 of these waiting over a year for an appointment.

The total number awaiting an outpatient appointment with a consultant haematologist has more than doubled in the past six years, with an additional 4,246 (+124 per cent) adults and children now waiting for an appointment.

According to the HSE’s ‘Demand for medical consultants and specialists to 2028’ report, there will be a need for a 50 per cent increase (or 131 additional consultants) in the current number of consultant pathologists (from 262 to 393 consultants) to address current shortfalls and meet increased patient demand over the next seven to eight years.

Ireland has just 4.58 specialists in pathology per 100,000 population compared to an EU average of 5.87 – more than a fifth less.

This workforce gap exists across the pathology specialties, with the number of haematologists, immunologists, and microbiologists in Ireland 18 per cent, 41 per cent and 53 per cent respectively below the EU average number of specialists on a population basis.

According to Dr Burke, one of the biggest challenges faced in Ireland’s acute hospitals is patient access to multi-disciplinary services. As a result, patients are facing barriers to their full treatment pathway from diagnostics (scans, blood analysis) to follow up care (physiotherapy, dieticians).

“So much of our time is spent on managing blood cancers, that other areas can be left without the full attention and resources that they need to be properly resourced. We need to be able to plan specifically for cancer care and include all the services required for those patients, but also ensure there are adequate resources allocated for the other areas of haematology such as non-cancerous genetic diseases and bleeding and clotting conditions.”

The IHCA has repeatedly warned the Government that Ireland’s ongoing consultant recruitment and retention crisis has left the health service unable to provide timely, quality care to patients.

The Association has called on the Government and HSE to immediately fill the 728 hospital consultant posts that are now vacant (or filled on a temporary, locum, or agency basis), across all medical specialties, and fast-track the opening of thousands of beds needed across the public hospital system.

In pathology, 20 per cent (60) of approved consultant posts are either vacant or filled on a temporary or agency basis, half of which (30 posts) are vacant. Almost a quarter (seven) of these vacant posts have been vacant for more than three years. The new video is part of the IHCA’s #CareCantWait campaign