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Recently, the National Clinical Programme in Surgery (NCPS) published a document, which looked at the effect Covid-19 has had on surgery. Titled A year like no other: The impact of the SARS-COV-2 pandemic on surgical activity in Ireland, the document states there were 17 per cent fewer emergency surgeries and 30 per cent fewer elective surgeries performed during the pandemic. It also shows that, from April 2020 to April 2021, there was a 153 per cent increase in the number of surgical patients waiting longer than 12 months for their procedures. The total surgical outpatient waiting list increased by 15 per cent.
These are concerning figures. NCPS Co-Lead Prof Deborah McNamara noted the deferral of non-essential surgery was uniformly advised at the beginning of the pandemic. “The waiting lists we see today are the consequence of that deferral. We now need to increase surgical activity across the health service to meet the needs of these patients,” she said.
On the positive side, the document highlights the innovations implemented in response to the multiple challenges brought by Covid-19. For instance, the NCPS published guidance to surgeons on how to deliver virtual outpatient department services in March 2020. The HSE subsequently developed resources to support this transition.
From January to December 2020, HSE acute operations reported a total of 657,415 virtual consultations for both new and return attendances. A care pathway for surgical patient triage and treatment during the pandemic was defined and a GP-Surgeon Connect service, which allowed GPs to rapidly connect with surgical experts, was established, resulting in a greater number of patients being managed in the community.
While these innovations should be welcomed, the surgical waiting list backlog now needs to be tackled with the upmost urgency
A plan aimed at mitigating the impact of the pandemic and the cyberattack on scheduled care activity this year has recently been developed. This immediate short-term plan, which will apply to surgery as well as other areas, is a joint approach by the HSE, the National Treatment Purchase Fund, and the Department of Health to reduce backlogs by the end of this year. This is to be achieved through waiting list management, increased capacity, and improved pathways of care. A longer term multi-annual waiting list plan, which will be overseen by a Ministerial taskforce, will also be developed. It will aim to bring waiting lists in line with Sláintecare maximum waiting times of 10 weeks for outpatients, 12 weeks for inpatient day case, and 10 days for diagnostics, over the coming years.
In this issue of the Medical Independent, we chronicle the problems the Sláintecare project currently faces. Even if introducing these maximum waiting times is long overdue, such a commitment is more than welcome given the uncertainty surrounding the future of the strategy.