Respiratory services "buckling under pressure"

Delayed diagnoses and care now major issues
  • Deborah Condon

Patients with respiratory problems have missed out on essential diagnoses, important interventions and other routine care due to the impact of the COVID-19 pandemic, a new survey has revealed.

The Irish Thoracic Society carried out a survey of respiratory consultants to assess the impact of the pandemic on respiratory health services in Ireland. An overwhelming 95% of respondents said that the respiratory care of non-COVID patients has been negatively impacted this year.

Some 90% said that ongoing care had been delayed, 73% said diagnoses had been delayed, while 59% said acute treatment had been delayed.

Some 88% said that waiting lists for routine care had increased, with 27% warning that their lists had increased by over 50%.

Meanwhile, 79% of respiratory consultants also pointed out that they saw fewer non-COVID patients with lung problems between March and October of this year, compared to the same period in 2019. Some 27% of these said that they saw at least 50% fewer non-COVID patients this year compared to last year.

Furthermore, 95% said that they had carried out fewer procedures, such as lung function tests and sleep studies, between March and October of this year compared with the same period in 2019.

They emphasised that many diagnostic services are operating at significantly reduced capacity compared to pre-COVID.

Some 72% said they were not confident that the capacity and resources in their services could respond appropriately to the needs of their patients. This was due to issues such as staffing, bed capacity and access to diagnostics.

According to the president of the Irish Thoracic Society, Dr Aidan O'Brien, respiratory services were "already overburdened and under significant strain" prior to the pandemic.

"Now add to this the hugely increased workload of managing patients with COVID-19 in the acute phase, plus the need for ongoing care of those patients dealing with the long-term effects of the virus. Together, these issues are combining to have a severe impact on patient care.

"The results of our survey illustrate a large and growing backlog in patients who have missed out on essential diagnoses, interventions and routine care due to the impact of COVID-19," he explained.

Dr O'Brien said that this has already had a major impact on the health and quality of life of many patients.

"Of particular concern are people with lung cancer who may have experienced a delayed diagnosis and, as a consequence, delayed initiation of vital therapy," he noted.

He welcomed additional resources announced by the HSE as part of its 2020 Winter Plan, which includes the establishment of specialist ambulatory care hubs for chronic diseases. These are community-based hubs which will initially focus on respiratory health, heart health and diabetes. They will be staffed by healthcare professionals specialising in each of these specialties.

Dr O'Brien said that these plans need to be implemented without delay, however he also expressed concern that they are "not enough".

"Unless we take urgent action, respiratory hospital services will continue to buckle under the pressure of trying to catch up with the backlog of patients with non-COVID lung problems and the increasing volume of new patients presenting with post-COVID syndrome.

"This workload arises against a backdrop of staff shortages resulting from COVID-19 illness or quarantine requirements, and reduced access to diagnostic procedures due to longer turnaround times," he noted.

While he welcomed the positive developments in relation to a COVID vaccine, he insisted that it will "still take considerable time for this to be rolled out and for sufficient uptake to be achieved that would allow the health system to return to some form of normality".

"For these reasons, the Irish Thoracic Society is calling for dedicated respiratory units to be developed in hospitals, in tandem with expanded respiratory services.

"We need to see investment in upgrading and adapting existing diagnostic facilities with additional equipment and increased space to take account of infection control protocols, while also beginning to try to meet demand in a timely manner," he added.

Dr O'Brien made his comments ahead of the Irish Thoracic Society's annual conference of respiratory healthcare professionals, which runs from December 3-4.

The survey was conducted in November among consultant respiratory physicians working in hospitals in the Republic and Northern Ireland. A total of 60 consultants responded to the survey, which equates to over half of the total number of respiratory consultants on the island of Ireland.

For more information on the Irish Thoracic Society, click here.


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