Hospital Capacity Pressures Continue

– Dr Michael Boyle, Rotunda Hospital

As Covid-19 backlog persists, preterm and newborn babies could become latest casualties of Ireland’s acute hospital capacity pressures, it has been claimed.

According to the recent Health Information and Quality Authority’s (HIQA) “Overview Report on the National Standards for Safer Better Maternity Services” published in February 2020, approximately 10% of newborns are admitted to neonatal units every year, the majority of which are struggling to deliver the required levels of care.

The report showed that four neonatal units did not have adequate isolation facilities, and that neonatal cots were being placed too close together, increasing the risk of crossinfection between infants in these units.

However, the Irish Hospital Consultants Association says that these isolation facilities are now critical for managing care for infants and parents in a Covid-19 environment in line with international guidelines.

Infants of Covid-19-infected or Covid-19-suspected mothers should initially be isolated if they require admission to a neonatal unit. However, without adequate investment to create the additional space, consultants warn that the risk of transmission of infection will remain dangerously high.

Capacity issues in Ireland’s neonatal services are further compounded by severe consultant shortages.

HIQA found that none of the specialist maternity hospitals (the National Maternity Hospital (Holles Street), Rotunda Hospital, Coombe Woman & Infants University Hospital, and Cork University Maternity Hospital) had achieved the recommended levels of staffing, meaning that the nation’s specialist facilities are falling below the required levels. Difficulties and delays in recruitment is a key issue that Department of Health confirms is impacting the implementation of Maternity Policy in Ireland.

The medical staffing requirements are also at odds with HSE figures, which suggest that only 37 of the approved 41 permanent consultant neonatology posts in public hospitals are filled on a permanent basis.

A recent HSE report on medical specialist staffing further confirms the gravity of the current and projected consultant recruitment and retention crisis: Ireland has the lowest number of consultant paediatricians on a population basis (5.4 per 100,000) compared Hospital Capacity Pressures Continue Increased breast cancer risk in obesity linked to fat cell chemicals with England, Scotland, Australia, and New Zealand.

The report also projects a 78% increase in the demand for consultant paediatricians and neonatologists by 2028, meaning an extra 199 consultants will need to be added to the current headcount of 255 in less than eight years.

Speaking in a video interview released by the IHCA as part of its #CareCantWait campaign, consultant neonatologist Dr Michael Boyle of the Rotunda Hospital said, “Having a baby is one of the most momentous experiences of anybody’s life, and if you add a huge stressor like giving birth at 25 weeks into that, it’s full of uncertainty and worry.

“There are significant challenges as I would see it from my perspective such as access to intensive care beds. We would occasionally find that we are unable to accept a referral from another hospital because we don’t have the space or the staff to care for them and that is an awful position to be in. “We are firefighting, we’re dealing with the issues as they present on the day. It’s a challenge to improve a service when you can’t focus on the longer-term elements that you’d like to develop.”

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