Tuesday, June 6, 2023

Overcrowding is killing hospital patients and general practice is being overwhelmed

The annual IMO conference, which took place in the Europe Hotel, Killarney, from April 13–16 this year, focused on understaffing across the health service. But the Minister thinks doctors are exaggerating their concerns.

This year’s IMO AGM placed a special focus on understaffing in the health service, which the IMO says is causing both poorer health outcomes and avoidable fatalities.

Speaking to a crowd of doctors from across the country – all of whom gathered for the three-day event in the five-star Europe Hotel in Killarney, County Kerry – IMO President Dr John Cannon said the ongoing capacity crisis now ‘plagues all aspects of the health services’ including Hospitals, General Practice, and Community Services.

“Tragically, it is inevitable that this capacity crisis is contributing to increased avoidable mortality because patients are being treated in overcrowded hospitals, or treatment is being delayed in primary or secondary care settings as capacity cannot meet patient need,” he said during his opening address.

Address by Mr Stephen Donnelly, TD, Minister for Health

In January, the Irish Patients’ Association claimed that up to 1,200 patients may have died due to delayed treatment linked to overcrowding last Winter.

Making matters worse, Dr Cannon added during his speech, is the ongoing recruitment and retention crisis, which has resulted in understaffing across the HSE; there are over 900 consultant vacancies and a growing number of empty roles left by retiring GPs.

L-R: Dr Madeleine Ní Dhálaigh, GP; Dr Syeda Amna Azim, NCHD
and Dr John Paul Byrne, RCSI

Meanwhile, NCHDs continue to work unsafe hours, breaching of the European Work Time Directive, with many young doctors being driven to seek employment abroad.

“There is a shortage of doctors globally and we are simply not doing enough to either retain our workforce or to attract much needed doctors back to Ireland,” said Dr Cannon.

Overstretched EDs, overstretched GPs
The Consultant Committee of the IMO heard from Dr Peadar Gilligan, Head of the Emergency Department at Beaumont Hospital, and a former President of the IMO.

Dr Gilligan expressed his concerns about overcrowding in emergency departments, explaining that a lack of available hospital beds was a ‘direct factor’ in hospitals being overwhelmed. He said that being able to move admitted patients to a ward bed in a timely manner would significantly decrease the crowding of EDs.

He said that the problem would get worse, citing ESRI figures which project a need for between 4,000 and 6,300 additional beds in public and private hospital between 2015 and 2030. Up to 5,600 of these beds are required in public hospitals.

Dr Roisin Morris, Medical Workforce Planning Lead, NDTP

The IMO also warned that the government’s proposed extension of Free GP Visit cards to an additional 500,000 people will ‘overwhelm the service.’

Last year, the government announced that it would be relaxing the means test associated with acquiring a GP Visit Card, making the half-million additional patients eligible.

GP services are already under significant pressure resulting from the capacity crisis, with many GPs saying they can’t take on any more patients. Ireland will need over 1,100 extra GPs to meet future demands, the IMO says. At present, approximately one in ten people in Ireland do not have a GP.

Mr Leo Kearns, CEO, Medical Council

Dr Tadhg Crowley, Chairman of the GP Committee of the IMO, explained that GPs have a critical role to play in the health services – but overwhelming them could lead to those with serious health conditions being unable to access urgently needed care.

“It has been clearly demonstrated that extending the numbers eligible for free GP visits leads to increased demands to see GPs,” he said.

“Without significant additional resourcing, GP services will simply be overwhelmed by the increased demand. Appointments may be free, but they will be harder to access leading to displacement of care for those who need it most.”

Addressing the conference on its final day, Minister for Health Stephen Donnelly TD acknowledged many of the issues raised during the AGM but said that the IMO had lost sight of the progress made by the government and called for ‘a bit of balance’.

L-R: Dr Ina Kelly, Dr Mary Conlon and Dr Ann Hogan

Minister Donnelly disagreed that additional patients would overwhelm GPs and said he had allocated additional money in the last Budget so that GPs have more resources.

A contract for all
Speakers at the AGM additionally criticised the new consultant contract introduced by the government.

Professor Matthew Sadlier, Chairman of the Consultant Committee of the IMO said that the government has ‘missed an opportunity’ to create an ‘attractive common contract that would appeal to all consultants’, existing and new.

Professor Sadlier said that feedback from IMO Consultants across Ireland identified concerns on issues such as rostering, work locations, and the requirement for consultants to provide locum support on top of their own clinical responsibilities.

“Many consultants do currently work in different locations and do work weekends and evenings, and the issue with this contract is to ensure that there are reasonable agreements on how these matters will be dealt with in the future,” he said.

Professor Sadlier added that the ‘lukewarm response’ to the new contract did not bode well for the urgent need to recruit consultants. “With over 900 posts that we need to fill, the HSE has chosen to go to the market with this contract,” he said.

“We are concerned that it may not bode well for their plans to increase urgently needed

All photos: Shane O’Neill, Coalesce.

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