Health services failing most critically ill patients, as our Intensive Care Units (ICUs) lack Consultants and other key resources

Consultant shortage impacting healthcare delivery, as a lack of or delayed access to ICU services resulting in rationing of life support and poorer patient outcomes.

Leitrim Observer Reporter

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Leitrim Observer Reporter

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Our health services are failing our most critically ill patients.

Intensive Care Units in our acute hospitals, treating our most ill patients, lack specialist staff - consultants and nurses - and enough beds and life-saving equipment, according to #CARECANTWAIT campaigner, Dr. Tom Ryan Consultant in Intensive Care and Anaesthesia.

Over the last decade, the Government has failed to increase consultant staffing of our ICUs or to expand the bed capacity, despite the findings of a HSE sponsored report in 2009, which recommended that this would happen.

On consultant staffing, we have less than half (43%) of the intensive care consultants needed to provide the highest standards of specialist care for critically ill patients across our hospitals – with currently only 35 wholetime equivalent consultant posts rather than the 82 which are required. 

Our population is growing and living longer making it an imperative that the number of IC consultants working in our health service meets this demand.

Not only are we woefully under resourced with IC consultants, we also lack sufficient ICU beds. A HSE commissioned expert report published in September 2009, recommended that ICU beds increase from 289 to 579 beds. Yet a 2019 HSE report on the number of ICU beds found that there are currently only 249 beds – 40 less than 10 years ago. This places Ireland below most other European countries for the provision of critical care beds.

 

An audit of ICU services, undertaken by the National Office of Clinical Audit concluded that the shortage of ICU beds meant a level of bed occupancy which was “above the recommended levels for safe patient care and are likely to make staff retention more difficult”.

The Irish Hospital Consultants Association (IHCA), has released a new video today (Tuesday, 6 August) of Dr. Tom Ryan, Consultant in Intensive Care and Anaesthesia, discussing inadequate ICU staffing and facilities across our public health service.

According to Dr. Ryan: “Intensive care really involves patients at their most critically ill and vulnerable yet, despite this, our intensive care services are operating with less than half the consultants they need.

“There are so many knock-on effects of under resourcing of our ICU services. During hospital surge periods, such as winter, there are often no ICU consultants or beds available for patients. Instead, critically ill patients are cared for in our Emergency Departments, or in theatre recovery areas while they await an ICU bed.

“ED’s are not the appropriate care setting for seriously ill patients and this practice increases the risk that these patients will die. Inadequate ICU consultant staffing and beds is driving longer wait times for surgery, particularly cancer surgery. Currently, almost one in four patients (22%) requiring cancer surgery do not have their procedure, within the national targeted timeframes for such surgery[3].

“Many require ICU care post-surgery and frequently there are not enough consultants or beds available to provide such care. As a result, too often, cancer surgery may be cancelled on the morning of the proposed surgery, because a patient with a life-threatening illness must be prioritised. Such rationing of intensive care services undermines the quality of care provided to both critically ill patients and patients who need major cancer surgery.

“Patients with sepsis also suffer when their access to intensive care is delayed. In wintertime, when the ICUs are particularly stretched, consultants are obliged to choose which patient will receive appropriate care.

“Many junior doctors do not want to continue to work in a system which forces such choices. They are responding by emigrating en masse to work abroad in health systems that prioritise patient care and patient safety.

“The Government’s current approach is that consultants must “muddle through”. However, the mismatch between the resources and the actual clinical need means that IC services are inconsistent and do not reach the standards of excellence that patients deserve”. 

Addressing this issue, according to Dr. Ryan means that: “Firstly, we must have an adequate number of intensive care consultants. These specialists must have enough beds, ready access to scanners and enough support services to provide the excellent care that their patients deserve.

“Our Minister for Health, Simon Harris, last weekend, indicated that he is prepared to sit down with the IHCA and IMO to address these issues from September. While welcome, we need Minister Harris and Government now to honour this commitment.  Patients need to see issue resolved quickly, none more so that our intensive care patients.”.

Public, patients and other stakeholders can follow the campaign and add their voices via Twitter by following #CareCantWait and through the IHCA website www.ihca.ie.

Support the IHCA campaign at: #CARECANTWAIT.