The lack of capacity in Cork hospitals could see the health system in the region face major difficulty this winter, according to a Cork GP.
Dr Ronan Boland said major surgeries have already been cancelled due to capacity constraints and the Covid-19 pandemic, and with coronavirus cases increasing in Cork, he warned that further knock-on effects may be felt in the coming months.
The Cork GP explained that hospitals in Cork have been operating at or close to capacity for months now, and that any spike in Covid-19 cases could have a serious impact on a system that was struggling for capacity even before the global pandemic.
Cork has seen its Covid-19 cases rise from three or four per day to more than 40 per day on several occasions in recent weeks.
As the number of cases rises, the likelihood of more people seeking hospital treatment also increases, Dr Boland explained.
He warned that the hospital system in Cork could struggle to cope with any such increase in demand.
“While the level of hospitalisations at this stage of the Covid-19 pandemic has thankfully been small up to now, the HSE has been producing daily data in relation to the existing capacity in terms of general beds and ICU (intensive care) beds at hospitals,” explained Dr Boland.
“If you look at our two acute hospitals, MUH and CUH, both of them have been working at or close to capacity pretty much continuously since June/July."
He said there have times where there have been zero, one or two beds available across the entire city.
“That was at traditionally a quiet time of the year and it would be concerning even if there was no pandemic going on.
“As we head into the winter months when demand for beds is usually greater, if you have a significant pandemic on top of it, it is a particular worry.
“It’s also particularly worrying because we’ve already had so much elective surgeries and treatments deferred because of the pandemic.
“So it’s not just our capacity to deal with Covid cases, it’s the displacement of the ongoing need for care that exists that is a big worry.
“It’s a particular worry in Cork because the capacity just seems to have been that much tighter.
“It’s also been brought into sharp focus in recent weeks as there has been a sharp increase in Covid cases in Cork.”
Dr Boland explained that the “worst case scenario” in the coming weeks would see patients fall ill from Covid-19 and require hospitalisation, including a percentage in need of intensive care.
“If you don’t have intensive care beds to treat them, you don’t have the beds,” he said.
“Even short of that, if ICU beds are occupied by patients who are ill with Covid, it has a knock-on effect on other areas of healthcare.
“Major surgeries, such as those for cancer for example, can’t be carried out unless there’s an ICU bed available for them after the surgery,” he added.
“It ends up having all sorts of knock-on effects in terms of those surgeries, which can impact everyone from young to old, because those surgeries can’t go ahead due to the lack of capacity.
“In a system that’s operating far too close to capacity at the best of times, there’s a concern about the ability to deal with the Covid pandemic in the first instance but also the displacement factor in terms of the normal workload that can’t be catered for now.
“We’ve gone from three to five cases a day in Cork three or four weeks ago to 40 to 60 cases a day in a very short space of time.
“If those numbers keep rising at anything like that rate and that 40 to 60 rises to 100, 200 or 300, then we’re going to see a significant knock-on effect in terms of hospital occupancy and capacity constraints.”
Dr Boland said that displacement has already been keenly felt in Cork with major surgeries cancelled as a result of the pandemic, and subsequent lack of capacity.
“Cancer surgeries and others have already been delayed.
“I don’t think there’d be a doctor in Cork who has not seen major surgeries for patients being postponed in recent months because it’s been all hands on deck as a result of the pandemic,” he explained.
“Will that affect long-term outcomes for some patients? It’s hard to be certain but it’s likely to be the case.
“If someone has cancer and they need surgery, the sooner the surgery is carried out the better.
“We may not know for weeks, months or years even whether delays affected the long-term outcome, and we may never be certain in fact.
“That’s before we even talk about the hugely stressful impact that postponement of elective treatments can have on a patient and their families.”
Despite the knock-on effects capacity constraints have had on the entire hospital system, Dr Boland explained hospitals in Cork have actually coped well in the current circumstances but that is down to the fact that Ireland did not experience the horror that unfolded in the likes of Italy or the USA.
“I think the system has coped well given the constraints,” he said.
“But we’ve dodged a bullet because we were faced with a very frightening prospect in March and April because, compared to our EU neighbours, we have low numbers of ICU beds, low numbers of acute beds and we have very real capacity constraints.
“We were faced with a potential nightmare scenario of what happened in Northern Italy, where they have far, far greater capacity in a sophisticated hospital system that is far better than ours in terms of its capacity to cope with this type of situation - yet, they were overwhelmed,” he added.
“Any doctor working at the coalface was really worried that we were going to face a similar situation, so we did dodge a bullet.
“But what I think Covid has done is thrown into sharp focus the lack of capacity in our healthcare system.
“This is not something that happened overnight, it’s something that happened over the past 10 or 20 years.
“We have a population that is getting older and we don’t have enough acute beds to deal with the workload that is there.
“The trolley crisis that is constantly being referred to in the media is a symptom of that rather than a problem on its own.
“The reason we have a trolley crisis is because in any given week or month, there aren’t enough beds upstairs to admit patients that are in the Emergency Department.
“That’s the primary reason the trolley crisis exists, it’s a capacity issue in terms of not having enough hospital beds.
“Obviously, if you add Covid to that, that crisis has the potential to get much, much worse.”
Dr Boland highlighted the need for extra capacity to be signed off on now so the same conversation is not being had in five or ten years time.
“I’ve seen some commentators asking why the capacity hasn’t been built in recent months,” he said.
“Some people were saying they thought we were locking the country down to increase capacity.
“But you can’t build hospital capacity in six months, it takes 10 years to do that,” he added.
“Take the National Children’s Hospital for example and I know there were specific issues there but it shows that, to go from the political decision to build a hospital to actually opening its doors, there’s a process of several years.
“Capacity gets built over years and it gets eroded over years and we have seen our hospital capacity eroded, notwithstanding the fact the population of this country has grown over the past two decades.
“Decisions need to be made now to increase that capacity - not for tomorrow because it won’t be here by then - but so we have it going forward five, ten years into the future, because we’re clearly going to need it.”