Now is the time to fix our healthcare system

Frontline innovation shows that the Irish health service can change for the better

Ireland started this pandemic with the longest waiting lists in Europe and the lowest number of specialist consultants in post. But Covid-19 is not to blame for these problems. In fact, the pandemic has shone a light both on the deficits in the system and on the speed and ease at which they can be overcome when consultants are given the space to implement changes.

In 2020 hospitals across Ireland were able to revolutionise the ways they care for patients.  We were able to set up new respiratory assessment units, enhance NCHD and consultant numbers, change emergency department admission pathways, and move stable patients to off-site facilities, allowing for improved patient flow. Consultants also provided in-person consultant care in local nursing homes to help with Covid and infection control, and outsourced outpatient scans and phlebotomy for vulnerable patients to decrease waiting times.

Within Children’s Health Ireland innovative use of the City West facility as a “pop-up” food challenge clinic led to 474 children being seen at this collaborative, interdisciplinary clinic, some of whom had been waiting since 2017. These successes highlight the potential when the frontline is empowered and resourced.

Of course, there have been challenges that individual or even groups of hospitals cannot easily overcome, regardless of Covid. As a country, we remain short on beds and short on specialist consultants. Many of our hospitals need refurbishment and infrastructural upgrades. We still do not have a unified electronic record system. These issues require concerted national action orchestrated by the Government in collaboration with medical staff.

While these issues cannot be solved overnight, the pandemic has shown us that where there is a will to fix and solve, there is a way to make it happen. Consultants, medical staff, and hospital management boards across the country, despite the immense pressure of the last year, have been able to effect change for patients and staff, resulting in better health outcomes and more efficient care delivery.

The question now is: Are we going to amplify this small-scale pandemic-era culture of innovation and make it work on a country-wide scale? Is Ireland’s health service to return to its pre-pandemic inefficiencies and chronic resourcing issues, or will we all move forward constructively and build a fair health service fit for a growing 21st Century population?

That any of this innovation occurred at all is a testament to the skill, character, and endurance of Ireland’s consultants. Even before the pandemic, most senior doctors shouldered a very challenging workload, and low numbers in posts and tight call rosters continue to lead to burnout. 

In fact, recently published work by Prof Anne Doherty shows levels of burnout in Irish consultants at 77 per cent. This is not sustainable. As we start to think about moving on from the pandemic and dealing with a backlog of care, Government decision-makers need to decide whether they want to help meaningfully deliver for Irish patients in the long-term or simply to control Irish consultants. 

Every leadership course I have ever attended has talked about the importance of the “view from the balcony”, of stepping back and taking in the broad panorama. Decision-makers are often stuck at this level. There is value in this, of course, but there is also value in listening to those on the ground, at the frontline, where the action happens.

It is the frontline staff who deliver care, and as we have seen with Covid-19, when obstacles are removed, they can and do innovate and deliver. It is important that consultants in Ireland can speak up and act when there are deficits in care; in fact, the Medical Council mandates that we do this.  This means we should be vocal in our advocacy and, where problems exist, we should call them out. Our silence would not benefit our patients. There are some things consultants can change, but there are many other things they cannot.

That is why it is important that we are truly listened to by decision-makers and given the opportunity to shape the service we deliver and experience every day, not have it dictated to us. Orders from the top are rarely effective and often work only as imagined, not in reality.  Prior to Covid-19, many thought the agility and innovation seen in response to the pandemic in our health service was an impossible feat. Now is our chance to fix our system so that we have capacity to meet the needs of our growing population.

Patients are waiting too long to be seen, and some of them will have worse outcomes as a result of the delays in access. In the words of Prof John Crown, care delayed is care denied. We don’t need to re-invent the wheel, just to copy what works in countries like Australia and New Zealand that recruit and retain well. Doctors want to work in a system that works for patients.

We must move forward bravely together, embed the changes that have worked for patients and finally work together as a team to deliver the accessible public health system that the people need and deserve.