Endoscopy services are implementing various initiatives in the face of growing waiting lists. David Lynch reports
ndoscopy services were particularly impacted by the public health restrictions introduced following the onset of Covid-19, contributing to growing patient waiting lists.
According to a briefing paper discussed by the HSE planning and performance committee in January, there were 39 public endoscopy sites serving adults and children across Ireland.
The paper stated that the demand for gastrointestinal (GI) endoscopy typically increased by 4 per cent annually. This was driven by direct GP referrals, inter-hospital transfers, emergency procedures, and inpatient treatments for both public and private patients.
It outlined a “range of strategies underway” led by the National Clinical Programme in Endoscopy and HSE Acute Operations. These included improving the quality of the information on referrals, “with the use of a specialist referral form on Healthlink ultimately supporting improved decision-making in terms of patient triage/treatment plans.”
The document, which was obtained by the Medical Independent (MI) under Freedom of Information law, also noted the rising use of faecal immunochemical tests (FIT) home kits and capsule endoscopy.
FIT
In January 2023, MI reported that the HSE had introduced FIT testing as an additional triage tool for newly referred (non-urgent) patients. This was part of a broader initiative that also included the expansion of capsule endoscopy services across hospitals, supported by the HSE’s endoscopy programme.
As reported in MI last month, a total of 7,076 patients received FIT home kits instead of undergoing a GI scope in the first seven months of 2024, according to data provided to this newspaper by the HSE.
FIT home kits, a non-invasive alternative to colonoscopy, have been offered to newly referred patients since the beginning of 2023. Funding for colon capsule endoscopy (CCE), another non-invasive diagnostic option, is also now in place at nine sites in Ireland, up from four in 2021.
A HSE spokesperson told MI that in 2022, 1,317 patients had a capsule endoscopy instead of a traditional GI scope. In 2023, that number increased to 2,155. To support this initiative, the HSE has recruited nine additional capsule endoscopy nurses.
Tallaght University Hospital has offered both CCE and small bowel capsule endoscopy for some time. The HSE’s spokesperson also noted that the Executive has funded nine new CCE services, with seven operational at Beaumont Hospital, Dublin; Connolly Hospital, Blanchardstown; St James’s Hospital, Dublin; and St Vincent’s University Hospital, Dublin. This is in addition to Galway University Hospital, Letterkenny University Hospital, Co Donegal, and the Mercy University Hospital, Cork. The remaining two funded services are being set up at Cork University Hospital and the Mater Misericordiae University Hospital in Dublin.
“These new services will also have the ability to perform small bowel capsule studies,” said the HSE spokesperson.
Pandemic
The IHCA has noted that the GI endoscopy waiting list has had 2,329 additional patients added since the beginning of 2020, reflecting the impact of the pandemic. An Association spokesperson told MI in late July that this represented an increase of approximately 10 per cent from the 22,707 recorded at the end of February/beginning of March 2020.
“The waiting list for GI scopes peaked at 36,820 in February 2021 during the height of the third wave of Covid… but is now back at its highest level in over a year.”
The IHCA’s spokesperson added that the “hospital overcrowding crisis” continues to have an impact on waiting lists. They said management in a number of hospitals use endoscopy units to “accommodate inpatients at times of increased demand, resulting in widespread cancellations or the inability to book procedures”.
“These scopes can be essential for the early detection and prevention of stomach cancer, bowel cancer, and oesophageal cancer,” the Association’s spokesperson said. “If delayed, it can result in much later presentations of cancer and poorer patient outcomes. Protecting these endoscopy rooms for GI patients is essential in order to maintain patient access and ensure timely care.”
In the medium- to long-term, the IHCA argued that the Government must commit the “required capital funding” to build surgical hubs and elective hospitals, along with the “essential additional hospital beds already announced by the Minister for Health, in order to cut waiting lists”.
These additional hospital facilities are required across the health service and not just in the six surgical hubs and four elective hospitals identified, according to the Association.
A HSE spokesperson acknowledged the “significant” impact of Covid-19 in 2020, 2021, and early 2022 in terms of curtailment of routine elective work, particularly during periods of surge.
“Endoscopy unit closures/reductions in service, staff redeployment and leave because of Covid-19 infection/close contact, all impact on the ability of GI endoscopy services to meet national waiting time targets,” the Executive’s spokesperson told MI.
“Over the course of the past two years, there have been improvements in all GI scope KPIs [key performance indicators]. This is the result of a significant and sustained focus on GI endoscopy.”
24/7
Early last year, the RCSI published the Surgery for Ireland report, which proposed a new networked approach for emergency surgical care.
One of its key recommendations was that emergency surgery centres should have availability of interventional radiology services and endoscopy on a 24/7 basis.
At the launch of the report, the current RCSI President (then Vice-President) Prof Deborah McNamara said access to high-quality emergency surgical care “is lifesaving and must be available to everyone”. She noted that greater life expectancy means that emergency surgery patients are more complex and have greater co-morbidity. “At the same time, advances in surgery, interventional radiology, and endoscopy mean that more treatment options than ever before are now available to surgeons and their patients.”
“The majority of emergency operations can be delivered safely in most hospitals, but the current system, with onerous on-call rotas and low volumes of high-risk cases in many hospitals, makes it difficult for the more complex emergency patients to receive the care they need.”
Asked about the report’s recommendation for endoscopy services to be available 24/7, the HSE’s spokesperson stated there are already 24-hour emergency endoscopy services in the model 4 hospitals and some model 3 hospitals.
The spokesperson added it was “envisaged that a more formal arrangement” will be established in each of the six health regions, “with a hub-and-spoke emergency endoscopy service model, much like the recommendation in the RCSI report”.
They said the “exact configuration” will depend on the respective health regions’ hospitals and services.
Waiting list
The Government’s €437 million 2024 Waiting List Action Plan aims to reduce waiting lists for outpatient appointments, inpatient and day case treatment by 6 per cent or around 39,300 by the end of the year, compared with the number waiting at the start of 2024.
The IHCA’s spokesperson noted the reduction target for GI scopes “is significantly less, at just 0.5 per cent or an expected 133 fewer patients waiting by the end of the year”.
However, the spokesperson said a “real positive has been the insourcing of NTPF [National Treatment Purchase Fund] work in terms of helping consultants deal with waiting lists, with many consultants doing extra weekend lists to deal with the growing demand for endoscopy”.
“Despite this increased activity and validation, the waiting list is only expected to marginally reduce due to a projected 4.5 per cent increase in referrals for GI scopes this year compared with 2023. This may be related to our ageing population who have much more complicated medical needs.”
As of the end of June 2024, the inpatient/day case GI endoscopy waiting list stood at 25,036. “This is an increase of 1,417 patients awaiting a scope compared with the start of the year – a 6 per cent increase in the first half of 2024 alone,” stated the IHCA spokesperson.
The Association further noted that the HSE anticipates a requirement for around 50 additional consultant gastroenterologists by 2028, representing an approximate 50 per cent increase from current levels. This projection is in response to the growing population and rising incidence of gastroenterological diseases.
Leave a Reply
You must be logged in to post a comment.