Building for the future

During the Covid-19 pandemic, much focus has been on the new. To control the spread of the virus, social distancing measures were implemented. There was also the reorganisation of health services and the agreement with private hospitals to ensure capacity in the event of a surge. Virtual clinics became the norm rather than the exception. And this year, the vaccination programme got up and running. This was a massive and unprecedented undertaking, which, as of 13 August, had seen 80 per cent of the adult population being fully vaccinated against the disease.

Even with significant additional funding released over the last year, these new measures have made it more difficult to rectify the existing problems within the health service. The effect of the pandemic on chronic capacity deficiencies has been highlighted repeatedly by medical and patient representative bodies. Waiting lists have continued to grow. Recruitment difficulties persist.
HIQA’s recent overview report of its monitoring of healthcare services in 2020 has drawn further attention to these issues.

“While Ireland’s hospital system has had some success in managing the additional burden of Covid-19, the pandemic has further exposed many of the long-standing and well-recognised issues within our healthcare system,” according to the report.

In the report, a strong emphasis is placed on infrastructural deficiencies. At the start of the Covid-19
pandemic, a small number of services that HIQA subsequently inspected were renovated and upgraded.
“However, in many instances, the infrastructure of hospitals

inspected through this programme was found to be poor,” the report states. “HIQA continued to identify deficiencies in hospital infrastructure, which had the potential to negatively impact on infection prevention and control measures. HIQA noted that improvements were required in nearly all services inspected except for one.”
“Very significant” infrastructural deficiencies were identified in 12 hospitals. The Authority noted how the underlying fabric and ageing infrastructure of some services continue to present ongoing challenges to their maintenance and services’ ability to adhere to best practice standards.

While the majority of hospitals inspected were substantially or fully compliant with most of the national standards assessed, others were not, despite supplementary investment. This was of particular concern to HIQA in the context of the Covid-19 pandemic. Furthermore, HIQA escalated concerns in relation to risks identified in five out of the 10 inspections conducted in public acute hospitals. Infrastructural deficiencies and maintenance issues have been commonly found in the Authority’s various infection prevention and control inspection programmes over many years.
“Public acute hospitals need to be better supported through the existing Hospital Group structures and the HSE at national level to better address long-standing infrastructural deficiencies,” the report recommends.

Responding to Covid-19 has required a huge degree of innovation and forward thinking. But it also necessitates responding comprehensively to problems that have been chronicled for a very long time.