Extra ED consultants ‘will not resolve’ cancer capacity deficit

Challenges faced by cancer services will not be addressed by the appointment of additional emergency medicine consultants or increased availability of other medical consultants, according to the National Cancer Control Service (NCCP).

The comments were made in a document sent by NCCP Director Prof Risteárd Ó Laoide to HSE Chief Clinical Officer Dr Colm Henry in January in the context of bed capacity pressures impacting on cancer services.

As with the general population, high rates of respiratory illnesses were being seen among patients on cancer treatment, stated the document. It outlined concerns that some of these patients were not contacting hospitals if they were unwell, due to anxieties about attending a crowded emergency department (ED).

Even where patients had been assessed by the oncology service as requiring admission, there were often no beds available for direct admission.

“These patients then need to go via ED, in order to be prioritised for a bed,” according to the correspondence obtained under Freedom of Information law.

“Inpatients identified as requiring transfer to a cancer centre for treatment from a level 2/3 hospital are similarly unable to transfer directly due to lack of beds and are being diverted to ED for prioritisation.”

Elective cancer surgery was being prioritised, but some delays and deferrals were occurring.

The NCCP added there was “no known cancellation of systemic therapy” due to the bed crisis. “But day wards and acute oncology services are being challenged to find sufficient and appropriate isolation areas in which to clinically assess unwell patients.”

The document stated that the appointment of additional emergency medicine consultants would not “resolve” the capacity problems experienced by cancer services.

“As outlined in examples above, the lack of protected bed availability for cancer services is increasing the need for ED presentation.”

The NCCP pointed out that some mitigation initiatives were occurring, including acute oncology triage services assessing patients without the need to attend an ED.

“Where possible, patients on treatment are being proactively contacted, given the concerns re: Non-presentation.”

The document added that designated rooms for unscheduled assessments were “working well” even though these were “at capacity in places”.

“While patients may still need to go to ED if requiring admission, at least they have already been assessed and have a management plan in place.”