The number of patients on waiting lists has “increased marginally” in August, according to the Department of Health.

The Department was responding to the latest hospital waiting list and activity figures.

According to the figures, approximately 168,000 people were taken off waiting lists in August. However, there were approximately 169,000 additions to waiting lists during the month.

At the end of August, there were 712,821 people on the total acute hospital waiting list, which represents an increase of one per cent in the last year.

“The volume of increased additions was identified as a risk as part of 2024 Waiting List Action Plan, and although the projections for this year considered the experience in previous years, it was acknowledged that uncertainty remained,” according to a statement from the Department.

“However, whilst having an impact on the volume of people on our waiting lists, growth in the number of referrals to our hospital system has a positive aspect in that it is indicative of people accessing the services that they need, an increased awareness of services as well as expansion of services.”

In its statement, the Department pointed out the figures also show “significant reductions” in the number of patients waiting longest.

There has been an approximate 18 per cent reduction in the total number of patients waiting over 12 months since this time last year, and a corresponding reduction of 28 per cent in the number waiting over 18 months.

“Improvements in terms of the length of time patients are waiting can also be seen in the progress achieved towards the Sláintecare targets,” the Department said.

“Since the pandemic peaks, there has been a 22 per cent reduction in the number of people waiting longer than the Sláintecare targets, equating to over 140,000 people.”

The statement also noted there have been improvements in the average length of time that patients are waiting, with the waiting time on the outpatient list reducing from an average 13.2 months in July 2021 to just over seven months.

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.

Consultants

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.”

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.”

Current State funding to train doctors to be specialists in psychiatry is at least €600,000 short of what is needed, the President of the College of Psychiatrists of Ireland has warned.

Dr Lorcan Martin, a Consultant in General Adult Psychiatry, added that overall funding and staffing levels for mental health services were unacceptably low and failed to ensure patients had access to the modern, fit for purpose mental health services nationwide they need.

 Speaking ahead of his address to NCHDs in psychiatry at the College’s conference, which takes place in Dublin today, Dr Martin noted that the total budget for national mental health services was 5.6 per cent of the overall health budget and current funding for training doctors to be specialists in psychiatry was at least €600,000 short of what is needed.

He said these figures were wholly inadequate to serve the needs of some of the most vulnerable people in society who have moderate to severe mental illness. He said that there is widespread acceptance that a minimum of 10-12 per cent of the health budget (approximately €2.4 billion) should be provided for mental health services.

 Dr Martin said that there were only circa 500 specialist (consultant) psychiatrist posts in Ireland and just three-quarters of these are filled on a permanent basis by specialists. Ideally, there should be a minimum of 835 posts filled to meet growing demand.

 “At present, we do not have nearly enough doctors in psychiatry to meet patient demand. This extremely worrying resourcing crisis is a symptom of our difficulty in both recruiting doctors to the services and retaining those already working here. If we can put a meaningful plan in place to improve working conditions for doctors in psychiatry – specialists, trainee specialists and other NCHDs – supported with a plan to address our current perilously low funding, then an adequate number of appropriately trained professionals to resource services should follow,” he said.

 He said that the lack of specialist consultant psychiatrists has a direct negative impact on the training of NCHDs and could lead to significant crises such as the revelations surrounding South Kerry CAMHS. He stressed that NCHDs have a fundamental role in providing patient care in psychiatric services.

Dr Martin said that NCHDs needed to see demonstrable change. “Our NCHDs are the future of our health system and are a significant priority. The College’s training programme has seen steady growth in applications from doctors in the last number of years. It is clear they want to stay and practise in Ireland, so the Government and HSE should be doing everything in its power to make that decision an easy one by providing a well-staffed, well-funded, and appropriate working environment. That is what our patients deserve.

 “The Government must urgently implement the national plan to ensure services have adequate numbers of consultant psychiatrists for patients, but crucially too to support and supervise trainee specialists. NCHDs need to work in a positive environment promoting best practice and innovation if we are to avoid losing another generation of doctors to emigration.”

Improvements to transparency and communication with patients should be made to the HSE’s drug reimbursement process, a new report prepared by Mazars has found.

According to the Department of Health, the report found that the HSE process “is operating in line with the legislation and that it is delivering results in keeping with international norms”.

However, the report concluded that there is scope for improvements in a number of areas, including: The transparency of the process; communications with, and the availability of, information to patients; and tracking the progression of medicines through the process.

“I want to see improvements in the overall transparency of the process, and I have asked the HSE to bring forward proposals in that regard as a matter of urgency,” said the Minister for Health Stephen Donnelly. “Greater engagement with stakeholders, including patient groups, will ensure that patients are aware of the process and have sight of various steps and timelines.”

The Minister has asked the HSE to introduce an application tracker on the HSE’s website, detailing how applications progress through the process. He has also asked the HSE to introduce indicative timelines for a medicine to complete the application/approval process.  

An implementation plan is being published and an implementation working group is being established between the Department of Health and the HSE. This group will consider and progress the various recommendations contained in the Mazars Report.

The HSE has confirmed that the first part of the ‘build and test’ stage for its planned integrated financial management system (IFMS) was completed on schedule at the end of 2022.

As previously reported in the Medical Independent (MI), the project has been beset by numerous delays, such as the termination of contract with the former system integrator, DXC Technology, last year.

A public procurement process was conducted for a new system integrator to build, test and implement the approved IFMS design, and IBM was engaged in July 2022.

A HSE spokesperson told MI that following the on-schedule completion of the design validation and review stage in October 2022, the IFMS project progressed to the build and test stage which runs to May 2023.

“The first milestone for build and test stage (Sprint Group 1) was completed to plan in December 2022,” according to the spokesperson.

The build and test stage also includes: The development of detailed functional specifications; management of change activities for implementation group 1 (IG1); IG1 ‘go-live’ preparation activities, including establishment in December 2022 of the IG1 steering group and local working groups; and IFMS data readiness for IG1 ‘go-live’.

Other elements of this stage are the development of a shared services operating model, including the establishment of the master data unit; the development of a procurement support model; playback demonstrations; system integration testing; and user acceptance testing.

“The project is due to progress to implementation and ‘hypercare’ stage in June 2023, with the first two of five implementation groups on track for go-live at half-year (July 2023) and at year-end (December 2023), respectively,” according to the spokesperson.

Hypercare is the period of time immediately following a system ‘go-live’ where an elevated level of support is available to ensure the adoption of a new system.

The spokesperson said the project is advancing on schedule to achieve the target of having 80 per cent of the expenditure of the health service transacted on the IFMS in 2025.