Irish Hospital Consultants Association Pre-Budget Submission 2020

Quality and safety of patient care deteriorating due to continuous underinvestment in public hospitals

  • Significantly increased public hospital funding is needed in Budget 2020 to address the rationing of care, record waiting lists and the unacceptable number of patients being treated on trolleys
  • Government expenditure on acute hospitals almost 20% less than EU15 average and spend 29% less than Scotland, on a population adjusted basis
  • Government announcement of increased capital spend on health services welcome, but investment in beds falls short of NDP promises

IHCA President Dr Donal O’Hanlon: “Our acute hospital system is at breaking point due to a severe shortage of consultants and a lack of beds and other facilities. The quality and safety of patient care is deteriorating further due to persistent underinvestment.

“We cannot expect patients to continue to wait for the ‘promised land’ of Sláintecare. The IHCA urges Government, in Budget 2020, to prioritise the implementation of measures to address consultant shortages and inadequate bed capacity.”

With record numbers of a million people on a myriad of hospital waiting lists nationally, the Irish Hospital Consultants Association (IHCA), in its pre-Budget 2020 Submission published today (Monday), has called on the Government to address the consultant shortage and other capacity deficits across our public hospitals.

Funding

The body, which represents over 95% of hospital consultants, urged the Government to significantly increase investment in our acute hospital and mental health services in Budget 2020 to address the rationing of care, record waiting lists and the unacceptable number of patients being treated on trolleys.

In Budget 2019, Exchequer funding for public hospitals increased by only €225 million, far short of what is required to address the demand for care presenting and cost increases including new healthcare developments.

Acute hospital demand and bed capacity

The demands on our public hospital and mental health services are growing each year fuelled by our population growth, set to soon hit 5 million people, and by our aging population, with the number of people over age 65 increasing 44% since 2008. These demographics are now placing huge strains on public hospital services with the number of inpatient and day cases exceeding 1.5 million in 2018, 273,000 (22%) higher than a decade ago.

Despite these demographic pressures, the number of hospital beds across our public hospitals has not been increased to match demand, but instead has been reduced, compared with 2008 levels. Ireland has one of the lowest numbers of acute hospital beds across the EU at 2.77 per 1,000, 31% below the EU average of 4.02.

Unsurprisingly, Ireland has the highest bed occupancy rates in the developed world at 94%, well above the recommended occupancy rate of 85% and 23% higher than the EU average of 77%.

Consultant recruitment crisis

With one in five of all consultant posts (500 posts) now vacant or filled on a temporary basis, the impact is being felt right across our hospital and mental health services:

  • The number of additional patients waiting to see a hospital consultant is growing, on average, by 7,000 patients per month since the start of 2019;
  • 200,000 more patients are now waiting to see a hospital consultant than was the case in 2014;
  • The number of life-enhancing elective surgeries in public hospitals have more than halved (54%) from 197,817 in 2012 down to 91,815 in 2018;
  • The cost to the State in resolving adverse outcome claims under the Clinical Indemnity Scheme has ballooned to €246 million from €62 million in 2013.

Capital investment

The government today published its Health Service Executive’s Capital Plan and while welcome, a full analysis shows that it will deliver less than promised under the National Development Plan, particularly on beds. The NDP promised 260 new hospital beds each year for the period 2019 to 2021, totalling 780 beds. Today’s plan provides only for 480 beds, or 100 less beds over each of the three years.

IHCA recommendations

The IHCA’s Pre-Budget Submission contains a number of key measures which it urges the Government to introduce as part of Budget 2020. These include:

  1. Funding our acute hospitals adequately to maintain existing services and, meet unmet and increasing demand, thereby addressing the rationing of care, record waiting lists and the unacceptable number of patients being treated on trolleys;
  2. Front-loading delivery of the additional 2,600 acute beds promised under the National Development Plan rather than waiting until 2027, as currently planned;
  3. Capital expenditure for acute hospitals must be increased to address the physical infrastructure and equipment deficits resulting from a decade of capital cuts and underinvestment. Future overruns with the National Children’s Hospital development must also be funded separately to avoid the cancellation or delay in putting in place other essential capital projects.
  4. Restoring pay parity for all consultants appointed since October 2012, to retain and attract consultants back to our health service; and
  5. In addition, filling all consultant posts in public hospitals on a permanent basis rather than relying on costly agency or locum consultants.

Commenting on the Submission, IHCA President Dr Donal O’Hanlon noted:

Despite the economic bounce-back in recent years and strength of Exchequer revenues this has not translated into adequate investment in our public hospitals for a better health service.  Instead, access to timely care is worsening as the numbers waiting grow.

“Our public hospital and mental health services are now at breaking point due to the shortage of consultants and the lack of beds and other facilities. The quality and safety of patient care is deteriorating further due to persistent underinvestment.

“There are simple and effective measures that can be implemented immediately, such as those outlined in today’s Submission that can improve waiting times, get patients off trolleys and treated quicker.

“We cannot expect patients to continue to wait for the ‘promised land’ of Sláintecare. The IHCA urges Government, in Budget 2020, to prioritise the implementation of measures to address consultant shortages and increased bed capacity.”

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