Tens of thousands of hospital appointments along with hundreds of theatre operations were cancelled at Cork University Hospital during 2020, as the hospital dealt with the Covid-19 crisis, and the “unavoidable” fallout from the pandemic.
Information obtained under the Freedom of Information Act revealed that just over 20,000 outpatient hospital appointments were cancelled at CUH last year, along with 146 day cases and 110 inpatient appointments.
Meanwhile, more than 1,500 orthopaedics trauma theatre appointments were also cancelled as well as more than 400 same day theatre appointments.
The cancellations have been described as “unavoidable” due to the Covid-19 pandemic, which saw elective surgeries postponed and appointments cancelled as hospital capacity and staff were required to combat the virus.
A spokesperson for CUH said that the hospital, in collaboration with the South/South West Hospital Group (S/SWHG), “has undertaken substantial work to address waiting lists and manage the effect of Covid-19 on overall activity as we continue to work with all our hospitals to improve patient access to services.
“The group has generated additional capacity through a variety of means such as insourcing (out of hours capacity), use of the private hospital arrangement and National Treatment Purchase Fund (NTPF) funding,” they said.
“However, due to the current surge in Covid-19 rates in the community and the additional pressure on acute services, all elective work has been suspended across the region, with the exception of emergency surgery and time-critical elective cancer surgeries.
“This situation is being monitored and reviewed on a weekly basis and the recommencement of non-urgent procedures will be dependent on Covid-19 transmission rates, acute capacity and national guidance,” they added.
Meanwhile, Dr Ina Kelly, incoming president of the Irish Medical Organisation (IMO) explained that tackling elective surgeries and outpatient appointments was forced to take a back seat as Ireland combatted Covid-19 but, with the vaccination programme and if case numbers fall further, she is hopeful routine work will not be blocked by Covid-19 to the same extent as last year.
Documents obtained by this newspaper show that the majority of those 20,000 outpatient cancellations came in March and April last year, at the very beginning of the pandemic when Ireland was entering into a severe lockdown.
Some 4,700 outpatient appointments were cancelled in March along with a further 3,800 in April. Outpatient cancellations remained above the 1,000 mark for each month from May to November.
April also saw a spike in cancellations in both day case and inpatient appointments.
However, the majority of orthopaedics trauma theatre cancellations came between July and December last year, as more than 1,100 appointments were cancelled in that timeframe.
While no reasons were provided for the outpatient, inpatient, day case or orthopaedic cancellations, CUH did provide reasons for the cancellation of more than 400 same-day theatre surgeries.
Almost 200 of these surgeries were cancelled due to a lack of hospital beds, mainly the shortage of intensive care beds which are required in some cases for post-op recovery.
A handful of these surgeries were cancelled by the hospital in March last year, as Ireland went into lockdown and elective services were curtailed.
More than 50 surgeries were cancelled due to theatre list overruns and due to the fact that some theatres were overbooked, according to the hospital documents.
Almost 40 surgeries were cancelled because the patient was ill or deemed “unfit” while two dozen were cancelled by the consultant or their team.
A handful of surgeries were cancelled by the patients along with several that were cancelled specifically due to Covid-19 cases.
Dozens of other surgeries were also cancelled after treatment was delayed, emergency cases were performed, treatment was no longer required or due to unspecified reasons.
As well as cancellations, CUH has also seen its waiting lists for outpatient and inpatient/day cases increase over the past year.
As of February this year, more than 32,000 people are on waiting lists for outpatient appointments at CUH, according to the latest figures from the National Treatment Purchase Fund (NTPF).
More than 13,000 of these have been waiting over a year.
In February 2020, there were around 25,000 waiting outpatient appointments at CUH.
Meanwhile, more than 1,400 people are awaiting inpatient/day case appointments with more than 350 waiting more than 12 months, according to the latest data - an increase on the same time last year.
Dr Kelly explained that hospital delays and cancellations were unavoidable over the past year and one of the “immeasurable consequences” of Covid-19 on the Irish healthcare system.
Speaking to The Echo, Dr Kelly stated that Covid-19 must be brought under control to allow hospitals, such as CUH, to perform elective surgeries and conduct appointments.
“The volume of delayed essential work in healthcare in Ireland is of course one of the adverse effects of the pandemic,” she said.
“It is unavoidable that the hospitals would have felt that.
“CUH has faced very significant challenges in relation to Covid-19 which they have dealt with very admirably,” she added. “But there are now unavoidable delays.
“A lot of work has been delayed because of the need for acute beds and ICU beds for patients with Covid-19.
“If you have reached capacity or are near capacity in terms of ICU beds, you can’t bring people in for elective surgery because you will need those ICU beds to be available to them.”
Dr Kelly explained that the knock-on effects of the Covid-19 peaks and waves have had “almost immeasurable consequences” throughout the healthcare system in Ireland.
“That’s why it’s so important to minimise the spread of Covid-19,” she said.
“No healthcare system is able to deal with significant waves of this infection. Every avoidable case is a potential block in terms of another part of the health service running as best as it can,” she added.
“Covid-19 is putting a lot of other services on slow or on hold.”
Dr Kelly emphasised the importance of the Irish public doing what they can to minimise the spread of Covid-19. Dr Kelly, who works in the midlands, explained that public health specialists are seeing entire communities where Covid-19 is not under control.
“Some people have maybe forgotten the importance of reducing their contacts,” she said.
“Some people are mixing with each other, not everybody of course but a lot of people are, and they may not realise the impact this has on the health service and how it might impact one of their own family members or friends.
“It is one of the most challenging outcomes of Covid-19 and it’s not easily solved.
“One way to tackle it is to gain absolute control of Covid-19.
“The vaccination programme will make a huge difference and will allow hospitals to work more quickly and efficiently.
“But we need to make sure that we do not allow for the spread and development of variants that may be resistant to the vaccine.
“That’s one of the biggest challenges in Ireland at the moment - to protect against mutations of Covid-19 that may put our vaccination programme in jeopardy.
“The vaccination programme is the strongest tool to get Covid-19 under control and we can’t risk that.”