Cork consultant: When and how do hospital waiting lists end?

One in ten Irish people are now waiting to see a consultant. The ball is in your court, Minister Harris — so says Dr Sinead Harney, Consultant Rheumatologist at CUH
Cork consultant: When and how do hospital waiting lists end?

One in ten Irish people are now waiting to see a consultant. The ball is in your court, Minister Harris — so says Dr Sinead Harney, Consultant Rheumatologist at CUH

HOW long are you prepared to wait? You might spend half an hour standing at a bus stop or 15 minutes on hold before getting fed up and hailing a taxi or calling back later. In the grand scheme of things, these delays, annoying and inconvenient as they are at the time, are trivial, especially when we have other options.

However, if we fall ill, or experience worrying new symptoms, nothing is more important than timely access to a specialist doctor who can diagnose and treat us.

Care is one of the few things that simply can’t wait, especially for those with no alternative to the public health service.

In Ireland, the official Government policy is counter-intuitive: if you’re waiting to see a consultant in a public hospital, join the queue.

In July, the number of people in line increased to over 565,000 — that’s more than a tenth of the population. The waiting list has grown by 200,000 since 2014, and 7,000 more are added to it every month.

This crisis isn’t contained to a single hospital: it is epidemic across Ireland’s public hospitals and across every speciality from cancer care, to cardiology to rheumatology.

The key issue is capacity. Ireland has the lowest number of medical specialists in the EU per 1,000 population, with half or less than the EU average in many specialties.

There are 500 permanent consultant posts either completely empty or only temporarily filled by expensive agency or “locum” doctors. These vacancies attract few and sometimes zero applications.

Some public hospitals are so desperate to fill consultant posts that they have resorted to employing doctors who are not recognised as specialists by the Medical Council. While these doctors are medical doctors they are not qualified to work as specialists, they lack the specialist expertise needed to perform the role expected of them.

Entire newspaper columns could be filled listing out the specialties and hospitals where patients are forced to wait more than a year to see a consultant. For example, 13,000 are waiting more than a year to see a urologist, and 14,000 a dermatologist.

Nearly 50,000 children are waiting for a consultation with a paediatrician in the three Dublin hospitals that make up Children’s Health Ireland.

In the South/South West Hospital Group which encompasses hospitals in Cork, Waterford, Tipperary and Kerry there are over 115,000 patients waiting to see a hospital consultant and of these 40,000 plus have been waiting more than a year for an appointment.

In my area of rheumatology, at Cork University Hospital, there are currently 1,677 patients waiting for an appointment, with a wait time of up to 33 months for a routine appointment and up to a nine month wait for an urgent appointment. As patients wait, their joints can be irreparably damaged, and their condition deteriorates further. The issue at CUH and across the Hospital Group is a capacity one, with an insufficient number of consultants available to see patients in a timely manner.

The National Critical Care Programme, whose remit is to help the most vulnerable, dangerously ill patients in Ireland, has less than half the ICU consultants it needs.

The inevitable by-products of this shortage are especially apparent during the winter months, when ICUs are stretched to breaking point. Consultants are frequently forced to ration out intensive care services to select patients based on the severity of their symptoms. This is a disgrace in a country with Ireland’s wealth and high tax rates.

Quite understandably, faced with such a hopeless system, many of Ireland’s consultants and junior doctors choose to emigrate. Irish Medical Council data shows that 700 specialists left the Irish health service for other countries in 2016 and 2017. There is no evidence to suggest that this brain drain has decreased since.

Consultants, and doctors on the path to consultant positions, do not want to work in a health service that discriminates against them and does not — and cannot — guarantee patient care and safety.

The Government’s response to this chaos is to simply shrug, pat consultants on the back, and wish them the very best of luck. Such a dangerously laissez-faire attitude might work in a country without a public health service, but in Ireland, our Government has pledged to create “a modern, responsive service that offers the right care, in the right place, at the right time”. This is a noble, necessary goal, but it is unattainable without change.

We have no reason to believe that waiting lists will simply magic themselves shorter (especially not as our population ages), or that consultants will opt to choose less attractive working conditions over safer, fairer alternatives abroad.

We must demand answers to a very straightforward question: when and how does this end? Spending billions building new hospitals or setting up Sláintecare will achieve little, if anything, if there are no specialist doctors to do the work.

There was a moment of hope earlier this month when Minister Harris committed to opening talks with hospital consultant representative bodies in September, but within a matter of weeks, September had become “the near future”. This is not the first time he has demonstrated such indecisiveness: Minister Harris made the exact same pledges in March and April, and in October last year, with no productive output.

For the one in ten Irish people waiting to see a specialist, many of whom may be severely unwell, this issue can no longer wait. For everyone’s sake, Minister Harris must set (and keep) a date to meet our consultants—only then can there be progress.

Dr. Sinead Harney is a Consultant Rheumatologist at Cork University Hospital.

Public and patients can support the campaign for change by following #CARECANTWAIT

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