The IMO has given “a cautious welcome” to the reports that 125 new consultants have been appointed under the terms of the new consultant contract (POCC23) since it was introduced in March.
However, the Organisation has warned that the number was only “a fraction” of the number of new consultants that the Irish health services require.
Prof Matthew Sadlier, Chair of the Consultant Committee of the IMO, said: “We welcome every new consultant that joins the health services but we have to be realistic that the number of new consultants to join under the new consultant contract (125) is a fraction of the numbers we need and we still have over 900 vacant posts in the system. We are short a further 2,000 consultants based on population at the moment, so the scale of the challenge is clear. We remain very concerned at the growing waiting lists and the intolerable conditions for patients and staff within our services where resources are stretched and there are insufficient staff across all grades.”
Regarding confirmation that 293 consultants already employed have moved to the new contract, Prof Sadlier said: “It’s a very personal and individual decision for consultants whether to move to the POCC23 or not. When we have more numbers confirmed it will be helpful to understand which specialties and which locations are seeing higher or lower numbers moving over and where we have significant challenges to recruitment of new consultants.
“Consultants continue to express concerns not about salary levels under the new contract but on other key issues including uncertainty around working hours, location of work, their ability to do their jobs given the lack of resources and pressures within the working environment. Neither the HSE nor the Government should play a ‘wait and see’ game when it is already crystal clear there are significant challenges in addressing the underlying issues when it comes to both retaining existing consultants in the system and recruiting new consultants.”
It has been announced that an inquiry into the historical licensing and use of sodium valproate in women of child-bearing potential in the State will be established.
Government approval to progress the inquiry has been received.
In a statement, the Department of Health said while valproate is an effective and essential treatment for some patients, valproate-containing medicines can cause birth defects and developmental disorders in children whose mothers take such medicines during pregnancy.
The purpose of this inquiry is to provide a voice to persons with a diagnosis of foetal valproate spectrum disorder, their mothers and other family members, according to the Department.
The inquiry will also seek to document the evolution of sodium valproate regulation and the practices around the control of this product.
The Chair of this inquiry will be tasked with assessing the health service’s current capacity to respond to safety issues relating to use of anti-seizure medications in women of child-bearing potential.
Minister for Health Stephen Donnelly said:
“Today I was delighted to secure Government approval for the establishment of an inquiry which will examine the licensing and use of sodium valproate in women of child-bearing potential in the State.
“When I met with the patient groups involved with this issue, I supported their call for an inquiry, and I am very pleased to be able to progress this. This inquiry will be designed to give a voice to patients and their families while looking at the use of sodium valproate in Ireland since it was first licensed.
“There is work to be done before the non-statutory inquiry can commence, but this is an important milestone, and my officials will now work to bring this forward”.
Minister Donnelly added:
“Sodium valproate continues to be an essential part of the treatment plan for some patients and is an effective medication. It is important that people who are currently taking sodium valproate do not make any changes to their treatment without discussing any concerns they have with their doctor in the first instance.”
The IHCA has called on the Government to commit the estimated €4 billion in capital funding needed to build and open new hospital developments that have previously been announced by the Minister for Health.
In its pre-Budget submission 2024, published today (11 July), the Association said a minimum of 5,000 additional public hospital beds should be funded and opened by the end of 2030 – or 700 extra hospital beds each year for the next seven years.
The Association said this must start with the rapid delivery of the 1,500 acute beds the Minister Stephen Donnelly committed to open across 15 hospital sites in 2023 and 2024 at a cost of €1 billion.
In addition, the IHCA estimates that €3 billion could be required for the four elective hospitals in Cork, Dublin (two sites) and Galway, which are not expected to become operational until 2028 at the earliest, despite being first proposed in Sláintecare in 2017. A further €100-€120 million in capital funding is required for the planned six surgical hubs, the first of which is due to open before the end of this year. The IHCA highlighted that no capital funding has been provided as yet for these developments, which are likely to cost over €4 billion to deliver.
There are almost 900,000 people on some form on National Hospital Treatment Fund waiting list, while a further 250,000 people are waiting for an essential diagnostic scan such as an MRI, CT or ultrasound.
The IHCA stated this means the total number of people now on public hospital waiting lists to over 1.1 million.
In its submission, the IHCA warned an additional 160,000 people are expected to attend emergency departments this year compared with 2019.
A proportion of these are likely to require a follow-up outpatient appointment or inpatient or day-case procedure, the Association outlined.
The IHCA also stressed there is also an onus on the Government to ensure that the required funding is included in Budget 2024 to address the ongoing staffing crisis in public hospitals.
This includes filling 930 permanent consultant posts which remain vacant or filled on a temporary basis and appointing 2,000 additional consultants by 2030 – or around an extra 300 consultants annually.
IHCA President, Prof Robert Landers, said: “Successive health budgets have failed to address the root causes of the rationing of care to patients and unacceptable public hospital waiting lists, caused by significant hospital capacity deficits and shortfalls in consultant staffing, both of which are having a detrimental impact on patients and healthcare staff alike.
“As predicted, we are witnessing a significant increase in the number and acuity of patients who may have deferred their care during the pandemic and are now presenting for assessment and treatment, often through emergency departments, resulting in further pressure on already overstretched public hospital facilities and staff.
“The increasing number of emergency admissions is contributing to the cancellation of thousands of hospital procedures every month, pushing waiting lists up even further in a continuing ‘vicious cycle’ in our health service. We are facing the real prospect of 250,000 hospital cancellations and a record 135,000 patients treated on trolleys in 2023 if public hospital capacity is not expanded urgently to match growing patient demand for care.
“It is imperative that the 2024 health budget provides credible, funded, time-bound plans to increase public hospital and mental health service capacity, to ensure timely care for patients and to adequately address the challenges presented by demographic changes, technological requirements, unmet health need, cost increases and other pressures on the system.
“We are urging the Government to increase frontline hospital and community capacity and staffing levels to provide timely hospital care, and transfer medically discharged patients to community step-down facilities and services. Together, the key actions outlined in our pre-Budget submission focus on the development priorities our hospitals need urgent Government commitment and delivery on, so practical, workable solutions are put in place without delay. The health budget must inspire confidence, energy and momentum.
“Obvious and straight-forward solutions like this have been promised for a long time but never delivered on. We cannot afford yet another budget which amounts to more words and inadequate action.”
A new national clinical guideline for the treatment of breast cancer has been published by the National Cancer Control Programme (NCCP), which will mean shorter treatment time for some patients.
Under the new guideline, for some patients, the total radiotherapy dose can be provided over a revised, shorter timeframe, i.e. within one week compared with three to five weeks.
For others, the new techniques recommended will reduce the burden of attending hospital for radiotherapy treatment.
The guideline was developed in consultation with oncology patients and doctors and aims to improve the standard and consistency of clinical practice in line with the best and most recent scientific evidence available.
Prof Risteárd Ó Laoide, National Director, NCCP, said: “This is welcome news for patients undergoing treatment for breast cancer. The guideline sets out recommendations that will mean shorter treatment time for some patients, and therefore fewer in-hospital appointments. This will create some additional capacity in the service, meaning more patients can be treated in the same timeframe than previously.”
The guideline was developed by a multi-disciplinary group chaired by Dr Eve O’Toole, Head of Evidence and Quality Hub, NCCP.
Dr O’Toole said: “We worked with radiation oncology clinicians and engaged with patient representatives to develop this evidence-based guideline. We integrated their clinical experience and patient values with the best current evidence to formulate recommendations for clinical practice. The patient focus group provided views of those who are most impacted by its recommendations, and their valuable feedback shaped the overall guideline.”
Breast cancer is the second most commonly diagnosed cancer in Ireland, and the most common cancer among females (National Cancer Registry Ireland (NCRI), 2022). According to the NCRI, there was an average of 3,392 cases of invasive breast cancer diagnosed in Ireland annually between 2018–2020.
A breast cancer survivor and participant in the patient focus group, Ms Kathleen O’Connor, said: “It is fantastic to see these new recommendations. I was delighted to be involved in the patient focus group as I feel that incorporating the patient’s perspective when developing guidance is really valuable.”
The HSE has launched its Climate Action Strategy 2023-2050. This health service-wide strategy aims to reduce the negative climate impacts of the health service, achieve net-zero emissions for the HSE by 2050, and deliver healthcare that is environmentally and socially sustainable.
The healthcare sector is a notable contributor to greenhouse gas emissions, accounting for an estimated 5 per cent of total emissions globally and is also responsible for responding to people’s changing health needs affected by climate change.
Mr Dean Sullivan, HSE Chief Strategy Officer, said: “This programme of work responds to and supports the Government’s Climate Action plans and provides actions and targets to reduce the environmental and social impact of the delivery of healthcare in Ireland. Our health service will be showing leadership and commitment to sustainable actions and principles across areas such as buildings, green space development, transport, greener models for health care, procurement and more.”
The HSE actions will be focused on 10 areas:
1. Reducing energy-related greenhouse gas emissions
2. Developing green spaces
3. Decarbonising its fleet of vehicles
4. Promoting low carbon and ‘active travel’
5. Aligning purchasing of goods and services with decarbonisation and sustainability goals
6. Baselining supply chain emissions
7. Developing greener models of healthcare delivery
8. Reducing and managing waste
9. Conserving and reducing water use
10. Protecting people’s health and wellbeing.
Dr Philip Crowley, National Director, Strategy and Research, said: “Developing this programme of work is an important and exciting step for the HSE. We are here for the long-haul, with a multi-year, sustained programme. Our workforce of over 100,000 people is central to the successful development and delivery of this strategy. We hope to enable and support staff and service users to act as sustainability and climate action activists and lead the transformation to make the health service a more sustainable provider.”
Mr Peter Smyth, Assistant National Director Capital and Estates, added: “The HSE Climate Action Strategy builds on existing work with our built environment and reducing energy-related emissions. By 2021, the HSE achieved a 9% reduction in energy-related emissions and our new target is a 51% reduction by 2030. We will seek to build on this progress going forward working closely with colleagues across the HSE.”
A total of 20 Sláintecare initiatives fell significantly behind target last year, according to the newly published Sláintecare Progress Report 2022.
There was a total of 120 ‘deliverables’ in the Sláintecare Action Plan 2022.
According to the progress report, 100 deliverables (83.3 per cent) were delivered or have progressed as planned or with minor delays.
However, 16 deliverables (13 per cent) experienced “significant delays” and four deliverables (3 per cent) have “been impacted by external dependencies”.
Two projects to fall significantly behind schedule were an interim ICT solution to support patient information and real time reporting, and the delivery of additional home support hours.
Both projects were within enhanced community care.
Another was the development of a new National Physical Activity Plan (NPAP).
“Due to the prioritisation of the development and launch of the free contraception scheme, development of the new NPAP had to be deferred and will now be finalised in quarter 4 2023,” according the report.
Major delays also occurred in the development of an adult safeguarding policy; an action plan based on the disability capacity review; a national mental health services research and evaluation strategy; and a policy paper on the future direction of long-term residential care infrastructure and financial sustainability.
One of the four initiatives to experience a “significant delay due to external dependency” was the complete implementation of the 2022 Waiting List Action Plan (WLAP) .
“Significant reform actions in the 2022 WLAP were intended to be progressed in tandem with delivering extra activity. However, recurrent funding was deemed required to deliver key reform actions in the coming years, including sustainably resolving capacity gaps and implementing the modernising of 37 acute scheduled care pathways. €123 million was included in Budget 2023 and the HSE is progressing planning for the implementation of these care pathways on this basis. Details have been included in the 2023 WLAP, published in quarter 1 2023.
“While not all the ambitious targets set out in the 2022 plan were achieved, positive progress was made in reducing long waiters. The overall number of patients exceeding the Sláintecare maximum wait time targets decreased by 11 per cent, or 56,000 people in 2022, and, since the peak of the Covid-19 pandemic, there has been a 24 per cent reduction in the number of people waiting longer than the Sláintecare targets.”
Another of the four areas to fall behind due to external factors was the review and enhancement of the the model for industrial relations in the health sector.
“This work has been delayed due to priority of Sláintecare consultant contract,” the report stated.
At the publication of the progress report, the Minister of Health Stephen Donnelly stated: “In 2022 and 2023 central elements of Sláintecare have and are being achieved, including the new public-only consultant contract, a new community-based service, enhanced community care (ECC), and certain eligibility measures. Many Sláintecare measures have been achieved, or are progressed at pace, while some require significant additional focus, such as e-health. At the same time, important new Programme for Government measures, also essential to universal healthcare, and which move beyond Sláintecare, are also progressing well. These include clinical strategies and services, acute and critical care capacity and new eligibility measures.”
The Irish Association of Emergency Medicine (IAEM) has heavily criticised a recent letter from the RCPI to hospitals calling for end of the practice of medical trainees evaluating patients coming through emergency departments (EDs) before they are assessed by an ED doctor.
The letter in question was written by Prof John McDermott, Associate Director, Basic Specialist Programme, RCPI, on 13 March.
“It has come to my attention that a number of hospitals are now triaging patients presenting to emergency departments as ‘medical’ and referring them for evaluation by BST trainees without them first having been reviewed and appropriately worked up by emergency department doctors,” according to the letter.
“I would be grateful if you could ensure that this is not happening in your hospital – the practice may initially have arisen as a response to the Covid pandemic, but hospitals where it is still occurring are at risk of having their status as BST training sites removed. The RCPI Institute of Medicine will be reviewing training sites in the coming academic year to ensure compliance.”
In a statement issued today (24 March), the IAEM referred to the letter as “tone deaf”.
The Association pointed out the letter comes during a period “of unremitting, unprecedented demand, manifested as excessive wait times to be seen by a doctor for patients presenting to our hospitals with an emergency or urgent medical problem”.
The IAEM argues that the ‘traditional’ pathway is overwhelmed when the numbers of patients presenting and their acuity or complexity exceeds the capacity of the ED medical staff to see, treat, discharge or refer in a timely fashion.
The streaming of suitable patients from triage to acute medical assessment units to avoid this ‘bottleneck’ occurs in many hospitals to alleviate the situation, according to its statement.
It states this model is described in the Acute Medicine Report in 2010 and has historically been strongly supported by RCPI.
Furthermore, in the recent Christmas and New Year period, where hospitals were inundated with emergency presentations, the IAEM points out how the HSE’s Chief Clinical Officer (CCO) advised that a system of distributing patients to on-call teams happen earlier in such patients’ care in response to large numbers of very sick (triage category 2) patients not being seen in a timely manner.
“Unfortunately, it would seem that RCPI has very inappropriately targeted these important patient-centred patient safety developments in their threats to hospitals of withdrawing medical trainees. It must be remembered that such trainees and training programmes are actually funded through the HSE by the tax payer,” according to the IAEM.
“The Association is aware that the HSE CCO has since written to hospitals advising that his guidance remains in place, notwithstanding RCPI’s intervention and the Association therefore calls upon RCPI to withdraw its ill-considered missive and focus on the needs of patients.”
To provide context to the letter, the RCPI has commented that trainees in the Institute of Medicine BST and HST programmes provide care for patients who have been assessed in the emergency department and are deemed to require a medical assessment or admission.
The trainees also provide care within a medical assessment unit structure for patients with acute medical issues.
“Internal medicine training is focused on inpatient care and follow up and not on the initial assessment of unselected patients referred to the emergency department,” according to the RCPI.
“The letter clarifies that doctors on the Institute of Medicine training programme work with patients who have been triaged for admission to hospital. They do not assess patients for admission in the ED. As the letter states, this practice may initially have arisen as part of the response to the Covid pandemic.
“Where it is still occurring, it points out, that these training sites are at risk of having this training status removed in a future review.”
The Institute of Medicine is the largest accredited specialist medical training body within the RCPI. There are currently 560 doctors on the basic specialty training programme working at accredited hospital sites.
New hospital waiting list figures, published by the National Treatment Purchase Fund (NTPF), show that 515,280 people on the active waiting lists are waiting longer than the Sláintecare maximum wait time targets.
The 2017 Sláintecare Report recommended maximum wait times of no more than 12 weeks for an inpatient / day case (IPDC) procedure or GI scope and 10 weeks for a new outpatient (OPD) appointment.
At end of February 2023, 53,847 people were exceeding the 12-week IPDC target; 11,315 were exceeding the 12-week GI Scope; and 450,118 people were exceeding the 10-week OPD target.
The February data is the first time the NTPF is reporting on the number of patients on waiting lists exceeding Sláintecare recommended wait times.
In a statement to coincide with the publication of the data, the Department of Health said the 515,280 figure represents an 18 per cent (111,971) decrease compared to the waiting list peaks experienced during the Covid-19 pandemic in 2020/21, and a 9 per cent (50,841) decrease compared to February 2022.
“This also represents a 12 per cent (72,150) decrease compared to the start of the multi-annual approach to addressing waiting lists in September 2021.”
The 2023 Waiting List Action Plan was published earlier this week (7 March).
It allocates €363 million, as the next stage of the multi-annual approach to sustainably reduce and reform hospital waiting lists and waiting times.
Another €80 million was allocated in Budget 2023 for various community/primary care waiting list initiatives.
The Department pointed out that 1.56 million patients were removed from hospital waiting lists in 2022 following interventions by both the HSE and NTPF through the 2022 Waiting List Action Plan.
“1.53 million people were added to waiting lists during this same period, so these removals in 2022 resulted in a net reduction of 30,000 people (4.1 per cent), the first annual reduction in waiting lists achieved since 2015,” according to the Department.
The HSE has also commenced publishing hospital activity data on the volumes on patients seen and treated in hospitals.
According to the Department, this is to provide further “context for the waiting lists data”.
An audit of December 2022 calls received by acute oncology nurses showed that 84 per cent of patients with cancer who contacted the service did not require emergency department (ED) attendance or admission.
In response to the Covid-19 pandemic, the National Cancer Control Programme (NCCP) funded 26 acute oncology nurses in hospitals nationwide. Patients undergoing active cancer treatment who become ill at home can contact the acute oncology nurses via a dedicated phone service instead of ending up in the emergency department. This programme of work is supported by the Department of Health’s cancer policy unit.
The specialist nurses assess the patient’s symptoms using an evidence-based tool and advise on the most appropriate care and management required.
A total of 1,383 calls were received, during the 8am to 4 pm service, in December 2022.
Of the patients who required further assessment in hospital, where possible, they were seen in the medical assessment unit or oncology day ward. In some instances, where clinically appropriate following assessment by the acute oncology nurse, some patients had to attend the ED because of the seriousness of their symptoms.
Ms Terry Hanan, National Clinical Lead for Cancer Nursing, NCCP, said: ‘’During recent pressures in emergency departments, the NCCP nursing team received feedback from services highlighting the valuable impact that the Acute Oncology Nursing Service has made. This service ensures that vulnerable cancer patients are assessed, and where possible, avoid ED attendance.’
“The service is currently available from 8am to 4pm, Monday to Friday. We also link in with community services such as community intervention teams , GPs and public health nurses to provide additional support to patients where required. Our aim is to build resilience to expand this service further, beyond Covid, so that more patients being treated for cancer can avail of the service.”
The IMO will ballot its consultant and NCHD members on the new consultant contract; however, the Organisation will not be making a recommendation on the vote, the Medical Independent (MI) has learned.
In a message sent today to members, the IMO encouraged all consultants and NCHDs to vote before the deadline next Tuesday (7 March). The ballot will be conducted online.
“Following receipt of final documents, incorporating the Department’s responses to the clarifications we sought, the IMO will now commence a ballot of members on the terms of the new consultant contract,” the Organisation stated in the message.
“Ballots will issue to all consultants and NCHDs as future consultants. This will be an online ballot.”
The IMO said that the ballot will close on Tuesday, 7 March at 5pm, “following which we will advise the Minister for Health as to the outcome.”
“We encourage all members to vote; however, the IMO consultant committee will not be making a recommendation in this regard given the contract was not an agreed document and recognising that each current contract holder will need to make an individual decision based on a number of factors.”
The Department of Health is to develop a new national rare disease plan, it has been announced.
The announcement was made to coincide with Rare Disease Day and is in line with a commitment in the Programme for Government.
There has been increased funding for new innovative medicines for rare diseases in recent years, with €100 million invested over the last three Budgets.
During this time, more than 100 new medicines have been approved, including 34 orphan medicines to treat rare diseases.
Minister for Health Stephen Donnelly said: “I understand that patients living with rare diseases and their families face huge challenges in managing and treating their conditions, and these challenges are heightened by the lack of information and research into these diseases.
“As a health service, we are working to change this. Personalised treatments will help transform healthcare provision in Ireland, and this vision has already been laid out with the recent launch of the National Strategy for Accelerating Genetic and Genomic Medicine in Ireland.”
Links have already been developed with EU partners in the area. Last year the HSE was nominated as the National Competent Authority in an EU Joint Action of European Reference Networks for Rare Diseases, which enables greater coordination and sharing of best practices in key areas such as genetic testing.
Highlighting the importance of this EU-wide approach, the Chief Medical Officer Prof Breda Smyth said: “This collaboration has allowed us to enter into 18 European Reference Networks on Rare Diseases. These ERNs include representation from five academic hospitals and three universities and is coordinated by the National Rare Disease Office.
“This represents a significant achievement by the health service, to drive innovation, training and clinical research for highly specialised care.”
The Mental Health Commission has welcomed the announcement by the Minister for Children, Equality, Disability, Integration and Youth, Roderic O’Gorman, and Minister of State for Disability, Anne Rabbitte, that 26 April has been selected for the full commencement of the Assisted Decision-Making (Capacity) Act 2015.
The full operationalisation of the Decision Support Service (DSS) will take place following the commencement of the Act.
The core element of legislation is to support all persons to make their own decisions as far as is possible. Key reforms include the abolition of the wards of court system for adults under the Lunacy Regulation (Ireland) Act of 1871, and the discharge of adults from wardship within three years.
Wardship, under which a person may be declared to be ‘of unsound mind’ and incapable of manging his or her affairs has long been recognised as a blunt instrument and it will now be replaced by the new graduated framework of supports aligned to a person’s need.
The Chair of the board of the Mental Health Commission Dr John Hillery said: “We have all been waiting on the commencement of the 2015 Act that will change the lives of thousands of people in this State for the better.”
In welcoming the announcement, the Chief Executive of the Mental Health Commission, Mr John Farrelly, said: “This Act provides a legal basis for people who may have difficulty with their decision-making capacity. It also provides important tools for all of us, for advanced health care planning, and by way of enduring powers of attorney. So, the Act puts in place a regulated system of support that will match people with the support that meets their needs.”
The Director of the DSS Áine Flynn also warmly welcomed the announcement by the Minsters and thanked all those people who have worked hard over the years to bring this new service, and the legislation underpinning it, to fruition.
“This is a vitally important piece of legislation that many people have been waiting on and they can justifiably celebrate this morning, knowing that we now have a definite date to start the new service,” Ms Flynn said.
“The DSS is ready to open its doors, and we look forward to beginning to help people access the new service and all of the supports set out under the Act.”
Signed into law at the end of 2015, the 2015 Act will come into effect on 26 April 2023. It is rights-based legislation, which reforms how adults who have difficulties exercising their right to make decisions interact with services. Full commencement of the 2015 Act is critical to obligations under the United Nations Conventions on the Rights of Persons with Disabilities.
The primary focus and intent of the 2015 Act is to support all persons to make their own decisions as far as possible.
The Act introduces a statutory functional (time-specific and issue-specific) assessment of capacity and guiding principles which emphasise dignity, autonomy, bodily integrity and the centrality of a person’s will and preferences as opposed to a ‘best interests’ standard.
There are enhanced tools to allow all people to plan ahead by way of enduring powers of attorney and advance healthcare directives. The Act also establishes the DSS with duties to promote awareness of and confidence in the new statutory framework, to regulate and supervise the support arrangements and to promote organisational change.
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