Fear of needing to access healthcare in Ireland is growing. Patients and their relatives are worried. Increasingly General Practitioners are finding getting appropriate services for their patients is challenging, Hospital Doctors are concerned about their ability to provide safe and timely care to patients. Waiting lists are long, Emergency Departments overcrowded, and Hospital occupancy runs at in excess of 97% nationally.
The IMO’s conference Getting Healthcare in Ireland brought together prominent Irish medical professionals from across the health service to talk about both the successes and challenges in providing high quality care to the patients who need it and what could be done better with a properly resourced health service.
Conference Speakers and Presentations
Session 1 - Improving Healthcare in Ireland
Dr Peadar Gilligan IMO President 2018/2019
Dr Peadar Gilligan, President of the Irish Medical Organisation (IMO) opened the conference highlighting the increasing difficulty that patients are having accessing hospital care across Ireland. According to the Euro Consumer Health Index, Ireland ranks 21st overall, and last out of 36 countries for ease of access to healthcare. He explained that despite the fact that in 2007, the Acute Bed Capacity Review estimated that 12, 778 hospital beds were needed, 13% of existing beds were removed from the system between 2006 and 2015. Dr Gilligan also highlighted the findings of this year’s Health Capacity Review, which show that the health system in Ireland is operating beyond full capacity and that across hospital, GP and community care the whole system is under pressure. He highlighted how the conference aims to show what doctors are achieving in such a pressurised system and what they could do even better if resources allowed.
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Dr Peadar Gilligan is President of the IMO and a Consultant in Emergency Medicine at Beaumont Hospital, Dublin. Dr Peadar Gilligan qualified from University College Dublin in 1992 with an honours degree. He undertook general medical training in Beaumont Hospital and Letterkenny General Hospital. He is a specialist in Emergency Medicine and subspecialist in Paediatric Emergency Medicine. He holds membership of the Royal College of Physicians in both the United Kingdom and Ireland in adult and Paediatric medicine. He is a Fellow of the College of Emergency Medicine and holds Diplomas in Child Health and Immediate Medical Care.
He was awarded Gold Medals in Paediatrics from University College Dublin and in Immediate Medical Care from the BASICs Group of the Royal College of Surgeons in Edinburgh. He holds a Master’s degree in Medical Education from Sheffield University. He is a Consultant in Emergency Medicine at Beaumont Hospital and Chairperson of the Resuscitation Advisory Group in Beaumont Hospital.
Deputy Roisín Shortall, TD, Chair of the Oireachtas Committee on the Future of Healthcare
Roisin Shortall, TD and chair of the Oireachtas Cross-party Committee on the Future of Healthcare spoke of the process that brought about the Sláintecare Report from the Dáil motion which led to the to the creation of the cross-party committee to the consultation process and the publication of the Sláintecare Report in May 2017. Deputy Shortall spoke of the priorities addressed in the Report: the population health profile; entitlement and access; integrated care; funding; and implementation. Since May 2017, Sláintecare has been debated in the Dáil, an implementation plan has been published and the executive director of the Sláintecare office has been appointed, but as yet no budget has been allocated. Deputy Shortall’s vision is that one day every household in Ireland will receive a letter, as all UK households received when the NHS was created, entitling them to all medical, dental and nursing care
R-Shortall-Slaintecare-Slides.pptx
Róisín Shortall has been a TD for Dublin North-West since 1992. She is the co-leader of the Social Democrats. Róisín previously served as Junior Minister with Responsibility for Primary Care. She was the chair of the Committee on the Future of Healthcare which was tasked with developing a cross-party consensus on a ten year strategy for delivering a universal single tier health service for Ireland. This was published on 30th May 2017 as the Sláintecare report.
Session 2 - Getting Care
Dr. Gerard Bury (Trinity College Dublin, 1981) MD, FRCPI, MRCGP, MICGP
Professor Gerard Bury, Professor of General Practice and Director of the Centre of Emergency Medical Science at UCD, highlighted the role and dedication of professionals providing pre-hospital emergency care. Professor Bury spoke of the training provided to emergency care professionals in our ambulance and fire brigade services as well as training provided to GPs and the defence forces. Professor Bury also highlighted how there are more deaths from drug overdose than there are from road traffic accidents and that there was an urgent need to provide Naloxone under the GMS to help reverse the effects of Opioid drug overdose.
Professor Gerard Bury, MD, FRCPI, MRCGP, MICGP is Professor of General Practice and Director of the Centre for Emergency Medical Science, at the School of Medicine, UCD as well as GP with a practice in inner city Dublin. Professor Bury’s Previous posts include President, Medical Council 1996-2004, Vice-Chair of the Pre-Hospital Emergency Care Council, 2000-2008, Vice-Dean for Education, School of Medicine, 2003-2006 and Director of Medical Education, Health Service Executive, 2009-2012. His Research interests include Pre-hospital emergency care; Cardiac arrest in the community; Substance misuse; Medical education; Professionalism; Drug overdose prevention & care.
Dr Padraig McGarry, Vice President of the IMO
Dr Padraig McGarry, Chair of the IMO GP Committee and Vice-President of the IMO, spoke of how General Practice should be the jewel in the crown of the health system but instead is the Cinderella of the health service –starved of resources. Dr McGarry spoke of how continuity of care and the holistic approach in general practice has been shown to be the ideal approach for delivering services in the community at a cost which is both affordable and efficient. He discussed the essential elements that are required to develop a modern day contract for general practice which are included under the memorandum of understanding between the Department of Health, the HSE and the IMO. However, Dr McGarry expressed his disappointment that discussions on a new GP contract had stopped dead as soon as the issue of resources arose.
Access-to-General-Practice-Care-pdf.pdf
Dr Padraig McGarry is IMO Vice President and Chair of the IMO GP Committee and is in General Practice in Longford. Dr McGarry qualified in medicine from the Royal College of Surgeons in Ireland (RCSI) in 1982. Dr McGarry worked in Jervis St Hospital , Temple St Hospital , St Luke`s Hospital , Kilkenny and Regional Hospital , Mullingar.
Dr John Hillery, President of the College of Psychiatrists of Ireland
Dr John Hillery, President of the College of Psychiatrists, described the difference between mental health and mental illness strategies. While mental health is important and should be promoted, serious mental illness requires effective treatment. Dr Hillery highlighted the issues of recruitment and retention of all mental health professionals and in particular voiced his concerns in relation to the filling of specialist posts by nonspecialist temporary and locum staff. Dr Hillery also stressed that by 2023, Ireland would need 800 consultant psychiatrists and he spoke of the importance of valuing all our health professionals be they doctors or allied health professionals.
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Dr. John Hillery was a Consultant Psychiatrist in the services for people with intellectual disability run by Stewarts Care, Dublin and St. John of God Kildare Services as well as the HSE Mental Health Services at Tallaght. He resigned in February this year. He is a former President of the Medical Council and the International Association of Medical Regulatory Authorities. Dr Hillery was also a member of the Council of the Pharmaceutical Society of Ireland and of the Independent Monitoring Group of A Vision for Change (the national policy on Mental Health). He is currently the President of the College of Psychiatrists of Ireland having formerly been the Director of Communications and Public Education.
Dr Raymond Carson, Consultant Rehabilitation Medicine, Mater Misercordia University Hospital
Dr Raymond Carson, Consultant in Rehabilitation Medicine and Dr Jacinta McElligott, National Clinical Programme Lead in Rehabilitation, spoke of access to rehabilitation as a basic human right supported by the United Nations Convention on the Rights of Persons with Disabilities. They spoke of how demand for rehabilitation is increasing as the number of referrals increased by 50% in one year. Ireland has less than half the number of recommended rehabilitation beds and only one quarter of the recommended number of specialists in rehabilitation medicine. Dr Carson and Dr McElligott described the model of care for specialist rehabilitation services and welcomed the significant capital development of a 120 bed unit at the National Rehabilitation Hospital.
Carson-and-McElligott-Access-to-Rehabilitation-IMO-Final-14th-Aug-pdf.pdf
Consultant in Rehabilitation Medicine at Mater Misericordiae University Hospital, Cappagh National Orthopaedic Hospital & National Rehabilitation Hospital, Dublin
Adjunct Clinical Lecturer at University College Dublin Medical School
Dr Raymond Carson is a consultant in rehabilitation medicine at the Mater Misericordiae University Hospital where he provides an acute rehabilitation consultation service for patients of all ages. He has a special interest in neurological rehabilitation including acquired brain injury, stroke & spasticity management. He leads an in-patient rehabilitation service at Cappagh Hospital and also works at the National Rehabilitation Hospital where he is setting up a transitional clinic for adolescents with acquired brain injury.
Dr Jacinta McElligott, Consultant Rehabilitation Medicine / National Clinical Programme Lead Rehabilitation
Dr McElligott is a Consultant in Rehabilitation Medicine and the HSE Clinical Programme Lead for Rehabilitation Medicine with a Consultant appointment to National Rehabilitation Hospital, Tallaght Hospital and Peamount Healthcare. She graduated from the Royal College of Surgeons in Ireland and did her training in Rehabilitation at Montefiore Medical Centre in New York. Dr McElligott was an Associate Professor in Rehabilitation Medicine at East Carolina University in Greenville North Carolina before returning to Ireland. She is a Senior Clinical Lecturer at Trinity College Dublin. Dr McElligott’s current research interests includes, Traumatic Brain Injury, Epidemiology and Rehabilitation in Ireland, Brain Computer Interface in persons with Disorder of Consciousness, and investigating the impact of neurological music therapy for sensorimotor techniques.
Session 3 - Access to Acute Hospital Care
Dr Fergal Hickey, Consultant in Emergency Medicine, Sligo University Hospital
Dr Fergal Hickey, Consultant in Emergency Medicine, Sligo University Hospital, exploded some of the myths about the causes of ED overcrowding. He said it’s not just an ‘A&E’ or an ED problem, there’s overcrowding across the health system. Dr Hickey said it is not just a ‘Winter’ problem either, hospitals are overcrowded all year round. He said it is not caused by ‘Inappropriate attenders’ nor by ‘Drunks’ and it’s not confined to Adult Emergency Departments, Paediatric Emergency departments are equally affected. Dr Hickey emphasized that ED overcrowding is a capacity issue which has negative implications on patient outcomes and the retention of ED staff. He also identified the myths around the solutions. While investment in primary care and chronic disease management is to be supported it will not immediately resolve overcrowding. He said there is little scope to improve patient flow and creating alternative routes into the hospital simply increases demand when the number of beds remains the same. Dr Hickey feared that unless capacity issues were immediately addressed, the number of patients waiting on a trolley will reach 1,000 this coming winter.
Access-to-and-from-EDs-in-Ireland-Fergal-Hickey-150918-13.00-pdf.pdf
Dr. Fergal Hickey FRCS, FRCSEd, DA(UK), FRCEM, FIFEM
A native of Kildare, I qualified as a doctor in University College, Dublin in 1985. I had a general training in General Surgery, Orthopaedic Surgery, Accident & Emergency Medicine, General Medicine, Anaesthesia / Critical Care and Paediatrics in Ireland and the UK before taking up a Registrar and later a Senior Registrar post in Accident & Emergency (now Emergency) Medicine at Leicester Royal Infirmary. I took up my Consultant post in Emergency Medicine in Sligo in 1995 where I have been since then. I am a former President of and long-time spokesman for the Irish Association for Emergency Medicine and an outspoken critic of the harm caused by Emergency Department crowding with admitted in-patients and the decades of failure in tackling this public health issue. I am passionate about medical education and the role EM can and should play in a properly functioning health care system and regularly feature on the national media commenting on these issues. My clinical interests are in Resuscitation Medicine in all its forms and injury, particularly soft tissue injury.
Dr Carol Blackburn, OLCHC
Dr Carol Blackburn, Consultant in Paediatric Emergency Medicine, OLCHC and National Clinical Lead in Paediatric Emergency Medicine described the range of undifferentiated acute paediatric presentations to Paediatric EDs across Ireland. Dr Blackburn described the different routes of access to paediatric emergency care and how no child is turned away despite hourly occupancy rates of 148%. Dr Blackburn described some of the challenges to paediatric emergency care including infrastructure, staffing issues and service limitations including adolescent care, child mental health emergencies and that currently there is no national plan for paediatric major trauma. As yet no single site has the full spectrum of specialty services although this will be addressed in the new children’s hospital. Dr Blackburn described how paediatric emergency care could be improved for example with PEM specialists in adult EM departments seeing >16,000 children per year, more consultants, that observation units could potentially optimise ED capacity, access to general paediatric outpatient departments and the development of key services where gaps exist would also be helpful.
Accessing-paediatric-Emergency-Care-final-pdf.pdf
Dr Blackburn graduated from University College Cork in 2000. Following completion of her specialist training in Paediatrics in 2010, Dr Blackburn undertook a clinical fellowship in Paediatric Emergency Medicine at the Royal Children’s Hospital, Melbourne (RCH). Since 2012, Dr Blackburn has worked as a consultant in Paediatric emergency medicine in Our Lady’s Children hospital, Crumlin.
Dr Blackburn is current clinical lead for paediatric emergency medicine. Interests include paediatric procedural sedation, instructing APLS and clinical guideline development.
Dr Una Geary, St James’s Hospital
Dr Una Geary, Director of Quality and Safety Improvement, St James’s Hospital, Dublin described the dimensions of quality in healthcare and results from the national patient experience survey which shows that the majority of patients report a good or very good experience of hospital care in Ireland. Dr Geary highlighted the emphasis on governance within the Sláintecare Report and how the focus must always remain on the patient. Quoting Mary Dixon Woods, Dr Geary described the “priority thickets” or dense patches of overlapping or disjointed goals created by a proliferation of externally set priorities, agencies and actors and how there is a need to prune back less useful quantitative targets and measures. Dr Geary suggested greater focus should be placed in on tackling big problems and helping services to adapt to change. She also highlighted how systems, conditions and constraints were often to blame for patient safety incidents and how there was a need to move away from fear and blame and promote trust and balanced accountability.
Access-to-high-quality-hospital-care_slides-to-share.pdf
Dr Una Geary has been Director of Quality and Safety Improvement in St James’s Hospital, Dublin, since 2014. She trained in Emergency Medicine in Dublin, Australia, the USA and UK and worked as a Consultant in Emergency Medicine in Liverpool, UK and at St James’s Hospital. She is a former Clinical Lead of the HSE National Emergency Medicine Programme. Her current work is focussed on supporting front-line hospital teams in providing care that is safer, more effective and person-centred, while promoting systems learning and continuous service improvement.
Dr Michael Power, Beaumont Hospital
Dr Michael Power, National Clinical Lead Critical care programme and Consultant in Anaesthesia and Intensive Care described the critical care pathway and how the survival rate of patients with traumatic brain injury is two-fold greater if patients are transferred to specialist neurosurgical centers rather than managed in a non-specialist neuro centre regardless of their need for neuro-surgery. Dr Power however highlighted results from an audit of patients referred to a national specialty neuro-centre which showed that where capacity is available patients are receiving effective and timely care but that increasingly overcrowding of the ICU is acting as a barrier to accessing care.
Dr Michael Power FJFICMI, FFARCSI, FACP is National Clinical Lead, Critical Care Programme, National Clinical Programmes, HSE. He qualified MB University College Dublin and completed internal medicine residency training at Medical College of Wisconsin, Milwaukee, USA and Board-certification American Board of Internal Medicine. He completed anaesthesia specialist training in Dublin and is Fellow of the Faculty of Anaesthetists of Royal College of Surgeons in Ireland (FFARCSI). He is Fellow of the Joint Faculty of Intensive Care Medicine of Ireland (FJFICMI) and Consultant in Anaesthesia and Intensive Care, Beaumont Hospital, Dublin. Dr Power is Past President, Intensive Care Society of Ireland, 2006-08. The Critical Care Programme has published the Adult Critical Care Model of Care available on Critical Care Programme HSE website. The Model of Care is a ‘hub-and-spoke’ acute hospital system provision framework whereby critically ill patients can access timely effective specialty critical care as needed.
Session 4 - Care for At-Risk Groups
Dr Ray Walley, GP North Inner City Dublin
Dr Ray Walley, GP North Inner City Dublin described the healthcare services provided at Balseskin Reception Centre for asylum seekers. The HSE refugee clinic provides a comprehensive health screening assessment to asylum seekers, refugees and victims of human trafficking which is voluntary, confidential and has an uptake of over 80%. Dr Walley described the range of physical, psychological and socio-political factors that can impact on the health of migrants. Dr Walley also described how asylum seekers access system in Ireland and the changing profile of asylum seekers accessing the system.
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Dr Raymond Walley is a full-time General Practitioner based in North Inner City Dublin and is GP at the National HSE Reception Centre for Refugees / Asylum seekers Balseskin. Dr Walley is also a GP Trainer on the HSE DML (UCD) Training Scheme and also a Director of Medisec Ireland Limited.
Dr Walley graduated in medicine at UCD in 1987. Having received GP training on the NHS East Sussex Vocational Training Scheme in UK, Dr Walley worked as a fund holding General Practitioner in a multi-partner purpose built Primary Care Centre in East Sussex before returning to Dublin. Dr Walley was a founding member of Brightdoc, Brighton GP out of hours service in 1996 and Development Co-ordinator and founding Chairperson DDOC North Dublin COOP out of hours service 2004 - 2006
Dr Walley is both a former Chairman of the GP Committee and former President of the IMO. He continues to be a member of the IMO Council, GP committee and International Affairs Committees and is head of delegation to CPME (the Standing Committee of European Doctors).
Dr Austin O’Carroll, GP and Founder of Safetynet
Dr Austin O’Carroll, GP and Founder of Safetynet described the numerous reasons why health services for homeless people should be prioritised. Dr O’Carroll described how homeless people are likely to delay seeking treatment, unlikely to finish treatment or to adhere to prescribed medication and that they avoid psychiatric services. Dr O’Carroll also highlighted some of the particular barriers faced by homeless people including distance to services, form filling for a medical card, difficulties in attending for appointments or waiting in queues, difficulties complying with rules and general stigma and discrimination. Dr O’Carroll described some of the difficulties that doctors can have communicating with homeless people and people with drug addiction and how some of those difficulties can be overcome.
Dr-Austin-O-Carroll-2018-pdf.pdf
Dr Austin O Carroll founded Safetynet in 2007 and was Medical Director of Safetynet from 2007-2017.The focus of his career has been improving access for communities affected by marginalization or deprivation to quality primary healthcare. He initiated several projects with Safetynet including the Mobile Health Unit Service for Rough Sleepers. He founded with Dr Ming Rawat the North Dublin City GP Training programme which is the first programme internationally that trains GP’s to work in communities affected by deprivation or marginalization. He is founding member with Dr Kieran Harkin of GMQ services which provides 12 clinics for homeless people in hostels/drop-in centres. He ran the Mountjoy Street Family Practice since 1997 which also provides 6 clinics to homeless people since 2005. He co-founded the Partnership for Health Equity between the HSE Social Inclusion, NDCGP, ICGP and University of Limerick. He is presently establishing for Safetynet, Curam Healthnet, a new social enterprise that creates new GP practices in areas of deprivation. The first practice is in Summerhill, Dublin 1.
He completed a Doctorate in ethnographic research into the health service usage behaviours of homeless people and being involved in several research projects addressing access to primary care. He was a co-founding member of Northdoc. He received the Fiona Bradley Award; the Time & Tide Award for his work with migrants; the Healthcare professional of the Year Award 2015 and was awarded an Honorary membership of the RCPI. Throughout, he has worked closely with Dr Fiona O Reilly on their mutual passion to rectify health inequities.
Statement by the Irish Medical Organisation (IMO)
IMO Conference hears warning that numbers on trolleys could reach over 1,000 this winter
Sunday 16th September 2018. Dr. Fergal Hickey of Sligo Universtiy Hospital has warned that the numbers on trolleys this winter could reach over 1,000 for the first time ever.
Dr. Hickey was speaking at a special conference on Healthcare organised by the Irish Medical Organisation (IMO). The conference, which took place in Croke Park on Saturday, was attended by over 100 Doctors and Medical Professionals. The conference title was Getting Healthcare in Ireland.
The event was told by the IMO President Dr. Peadar Gilligan that when cuts are made, they are felt. He said; “There is a direct correlation between stripping out of resources and problems in the health service, but the health service is not a black hole nor is it Angola and the depiction of the health service in this way is unhelpful as it suggests a hopeless scenario. The reality is that a key success of the health services in Ireland is that every day we give hope to people and we deliver on that hope.”
Social Democrats co-leader Roisín Shortall, who chaired the Oireachtas Committee on the Future of Healthcare, told the conference that it was her hope to see the Sláintecare plan implemented; “It is my goal that Sláintecare is not yet another report left to gather dust. We have the plan, now we just need the political will to do it.”
Experts in immediate, general, psychiatric and, rehabilitative care all presented to attendees, outlining the successes and work that they face.
The conference was told that the rehabilitation sector ranks last in both doctors and beds per capita among European countries and the lack of specialists in this area compared to other countries is compromising the delivery of care in this important speciality.
Dr. Raymond Carson of the Mater Hospital told the conference that the “historically neglected” area is seeing demand increase but that there can be a “seamless pathway to care in the home”.
Dr. Padraig McGarry said that “well-trained GPs are leaving Ireland due to conditions, access to diagnostics and reality of burden on practices.”
During a discussion on access to acute hospital care, Dr. Fergal Hickey of Sligo University Hospital warned that the numbers on trolleys could reach over 1,000 this winter; “This is a problem with capacity and system failures that are felt in EDs…..much like people in property say it’s ‘location, location, location’, this is capacity, capacity, capacity.”
Dr. Peadar Gilligan – from the floor - said that until we increase the number of beds in line with the capacity review report, we will continue to have a problem with hospital overcrowding, manifesting in our Emergency Departments.
In the final session, the challenges in delivering access to care to at-risk groups were outlined. GP and founder of Safetynet, Dr. Austin O’Carroll gave an inspiration presentation in which he spoke of the challenges of providing healthcare to the homeless and most vulnerable in the community. He pointed out that Ireland’s record providing healthcare to homeless people is “one of the top five in the world”.