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Action from Government will speak louder than words

By Mindo - 24th Sep 2023

hospital capacity

IHCA President Prof Robert Landers argues that the Government needs to prove to consultants and patients that action will follow its welcome intention to expand hospital capacity

Professor Rob Landers, University Hospital Waterford.

The outcome of next month’s Budget will go a long way towards informing us whether this Government’s actions on health will speak louder than its often repeated words. Consultants are naturally frustrated by, and cynical about, repeated political announcements on promised capacity and additional consultant posts when delivery of the physical infrastructure and various capital and ICT projects are frustratingly slow and demands are not being met. We have had the commitments, what we now need is delivery on these commitments. 

We need approximately 5,000 additional acute hospital beds by 2030 and a doubling of our operating theatre capacity. Ireland has just 5.2 operating theatres in public hospitals per 100,000 population, which is half the European average of 10.3 and the second lowest in the EU20.  

Capital projects

But there is an inability to deliver major capital projects on time. Words are easy, but we need action rather than words. We need to see cranes in the skies around our hospitals and blocks and mortar on the ground. We have a promise of six sites for elective surgical facilities, including purely elective hospitals and surgical hubs. But nothing is happening on the ground on these hospital sites and consultants are wondering if anything is ever going to happen.

The major difficulties affecting the Irish health service are clear: A shortage of beds and diagnostic equipment along with a worsening consultant recruitment and retention crisis.

The solution is all about building extra capacity, giving people the tools to work with. Historically, successive governments have made various announcements about building hospital bed capacity. But despite the promises and commitments over the past decade, we have seen only a minimal increase in the actual number of hospital beds delivered.

While vision and announcements are very welcome, what we are lacking is the capacity on the ground to get patients into the system and treat them in a timely, efficient, and safe manner. 

And yet, frustratingly, there seems to be some ability to deliver capacity when the will is there. For example, the Government was able to find the new money for the 98-bed extension, including 16 intensive care beds and the national isolation unit to the Mater Misericordiae University Hospital, Dublin, at a cost of over €100 million. We do seem to be able to deliver the occasional healthcare project on time and on budget, but more needs to be done.

It is abundantly clear that the trolley crisis in our emergency departments and hospital wards is a direct result of capacity deficits in the acute hospital system

Emergency departments

It is abundantly clear that the trolley crisis in our emergency departments and hospital wards is a direct result of capacity deficits in the acute hospital system. Yet year after year, all the system seems to be able to come up with are Winter {lans that are, generally speaking, ineffectual and will remain so until we address the underlying lack of capacity. The solution to the trolley crisis is to provide the capacity.

Consultant contract

The Association was disappointed that discussions on the new contract were terminated before they were completely finished. I believe that a little more discussion would have produced a better and more attractive contract for potential consultants and one that the IHCA would have been able to endorse. The proof of the pudding has been the relatively small number of people who have signed up. A total of 294 consultants had switched to the new contract by the end of August. The take-up by consultants on the new contract has certainly been at a far slower rate than that of the previous contract. In contrast, around 85 per cent of the existing consultants had signed up to the 2008 consultants’ contract within a similar number of months.

The vast majority of those who have transitioned from existing contracts to the new 2023 contract are existing consultants who were on much lower salaries than their counterparts who had signed contracts prior to 2012. The second cohort are those approaching retirement. However, the critical metric is not so much who is or is not switching, but the number of unfilled consultant posts. In other words, is the new contract going to solve the problem of the 900-plus vacant consultant posts? There is no evidence that it has or that it will. Currently, the number of unfilled posts is actually increasing.

Health Regions

We learned during the height of the Covid-19 pandemic that when authority is devolved to individual hospitals they can re-organise, restructure and re-configure services themselves to great effect and with great efficiency. This is why it is vital that authority will be delegated to the new Health Regions when established early next year. 

Throughout the developed world, it has been shown that command and control management is not capable of reacting sufficiently to ensure the patient benefits. The HSE has become a very slow and inefficient bureaucratic institution, where decision-making is far removed from the frontlines of patient care and diagnostics. We need to devolve authority down to the individual regions. They must have the authority to act, to plan, to build increased capacity to meet the health needs of the population.

To date, in the Irish health system, we have not seen the required level of authority devolved to the hospitals, with the exception of the time during pandemic, when the shackles were taken off. In the IHCA, we would like to see more of this. The system needs to trust its senior clinicians within the health services to plan, run and develop their services.

Likewise, the lack of digital health initiatives and services is significantly hindering our capacity to deliver timely and efficient care. It is almost incredible that, in 2023, we do not have an electronic patient record. Until one is implemented, it is going to hamstring our efforts to deliver timely and effective care. There is really no excuse for this.

There is equally no excuse for the way we look after our doctors in training. We need to treat them with the professional respect they deserve as they are the consultants of the future and the senior decision-makers our health services will be depending on in years to come. Yet they are still having major difficulty with their employers in terms of timely pay, taxation issues, and getting their appropriate training needs fulfilled. It is no surprise then that vast numbers are heading overseas. We need to change the way we deliver their training. Employers need to look after them better and make Ireland an attractive place in which to train.

Mental health

We also need to look after our patients accessing mental health services. First and foremost, our mental health budget needs to be approximately 10 per cent of our overall health budget, as promised in Sláintecare. Yet the Government currently commits just a little over 5.7 per cent, which is half the European average. This needs to significantly increase. The Mental Health Commission’s recent reports on child and adolescent mental health services alone are evidence of the urgent need for realistic funding.

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