Dr. Gabrielle Colleran:

I thank the committee for the invitation to join in its discussions. The IHCA represents 3,200 hospital consultants, approximately 95% of the total in Ireland.

As Ms Power has articulated so well, there can be no doubt that the Covid-19 pandemic has caused delayed diagnosis and suboptimal care for people with cancer. As some cancers develop slowly, the impact of the pandemic on cancer cases and deaths will not be clear for many years. There is a grave and realistic concern that these delays in diagnosis and treatment will lead to increased cancer mortality over the next decade or more.

Growing waiting lists, a low number of consultant posts on a per capitabasis and vacant posts will severely limit the wider health system's ability to catch up after Covid and the cyberattack. In excess of 11,600 more people were waiting for an inpatient day case gastrointestinal, GI, endoscopy at the end of April compared with before the pandemic, an increase of 51%. Colonoscopies are the gold standard of diagnosis for bowel cancers. Pre pandemic, urgent referrals were seen within one month, but now 60% of referrals are waiting longer than three months. This significantly increases the risk of delayed diagnosis of cancer in these patients.

Difficulties in getting timely access to consultant appointments, diagnostics and tests to monitor cancer treatment response, regression or progression and to treat patients with other conditions were a problem prior to Covid, but the situation has deteriorated sharply. Unfortunately, the HSE's cancer services were already missing targets for cancer referrals, assessments and admissions in 2019. What is new is the scale of the growing waiting list crisis and the backlog of care that has accumulated in all specialties.

The cyberattack on the HSE and its public hospitals has had a devastating impact on the health service's ability to treat and manage not only those suffering from cancer, but all patients. It has especially impacted on patients awaiting medical and surgical assessment and results of biopsies, scans and other investigative procedures.

As we recover from Covid and the cyberattack, hospital management must work with consultants to design solutions to address the large backlog and other service delivery constraints that have been known about for more than a decade. The filling of one in five vacant permanent consultant posts and the appointment of additional hospital consultants on terms to be agreed with the association is the key enabler that is required to tackle the unacceptable waiting lists and the backlog of an estimated 700,000 fewer hospital appointments last year due to the pandemic and the expected reduction of 200,000 this year. The fact that the National Treatment Purchase Fund, NTPF, could only outsource approximately 7,000 scopes for patients in 2020 highlights that it is not the magic bullet the Government believes it to be. Expansion of public hospital capacity, including additional consultants and physical capacity, represents the effective sustainable solution.

Regarding the shortage of consultants, the failure to fill the one in five permanent specialist consultant posts that are vacant in our public hospitals is undermining public hospital capacity to provide high-quality and timely patient care. In addition to filling the vacant posts, our public hospitals need to appoint more specialists, as we have the lowest number on a per capitabasis in the EU. In cancer services, for example, there will be a need over the next eight years for Ireland to increase the number of medical and radiation oncologists by 111% and 72%, respectively. Meeting this level of staffing will require the recruitment of 73 additional oncologists, that is, the creation of and recruitment for an average of ten additional cancer specialists per year between now and 2028. Overall, an increase of 1,653, or 53%, in the number of consultants working in acute hospital specialties is required by 2028 to address current shortfalls and meet increased patient demand. That is in addition to filling existing vacancies.

There are a record 883,000 people now on some form of NTPF waiting list due to hospital consultant vacancies and other capacity deficits. This is an increase of 45,000 so far in 2021. More than 21,000 patients are now waiting longer than one year for essential hospital treatment, representing a 70% increase. In addition, more than 200,000 people are waiting for diagnostic scans such as MRIs, CTs and ultrasounds, with a quarter of these waiting for longer than one year. They are not on any NTPF list, so public hospital waiting lists already exceed a million people waiting for hospital treatment. Coupled with the backlog of 900,000 fewer hospital appointments in 2020 and 2021, there is a high risk that these delays will cripple public hospitals and the health system. Failure to address these issues urgently will lead to impaired patient outcomes, a scenario that the Government has a duty to avoid.

Ireland has one of the lowest acute hospital bed capacities in the EU and the highest hospital bed occupancy rate in the developed world. Considering these and other factors, the IHCA recommends that a minimum of 6,000 additional public hospital beds must be funded in a revised national development plan, which is due in July, in order to reduce bed occupancy rates, operate with appropriate infection controls, including single occupancy rooms, and deliver more timely, safe care. This is in contrast with the increase of 2,600 acute beds included in the 2018 plan.

It is essential that we expand and develop additional protected elective-only surgery facilities across our hospitals rapidly. While plans are being advanced for the three elective hospitals in Cork, Dublin and Galway, it is known that it will take time before they are operationalised and it is not expected that this expansion will be sufficient. We believe that dedicated theatre and bed capacity to deliver elective scheduled care must be expanded across our acute hospital base, not just in three locations. The recently opened day surgery centre in Tallaght hospital and the additional theatre and related facilities in Croom are practical examples of what can be delivered to expand capacity.

A national electronic health record is a vital part of an efficient and effective health service. It needs to be properly planned, resourced and implemented without delay.

Ireland trains enough doctors every year, but they are leaving for or remaining in other English-speaking countries because they are not being treated in an equitable manner here and their working conditions are much better abroad. Our highly trained specialists will remain in Australia, New Zealand, Canada and the US or they will practise outside the public hospital system in Ireland unless the Government ends the 2012 inequity and ensures our public hospitals' capacity deficits are remedied. These are the basic essentials that are required to ensure that our public hospitals recruit and retain the talent we need. This is vital if the country wants an effective public hospital service, particularly as medical and surgical care are evolving at pace. We need an environment that supports hospital consultants who provide the essential care to treat patients successfully. We also need an environment where there is demonstrable equity of treatment for consultants who have taken up contracts since 2012 as was unambiguously committed to by the Minister, Deputy Stephen Donnelly, last October. The Government's failure to address the recruitment crisis and restore pay parity is driving our highly trained specialists abroad and exacerbates the extremely challenging task post Covid with the significant backlogs and waiting lists across all specialties, including cancer.

In conclusion, our ability to respond to the backlog of care that has built up involves many factors, with recruitment of consultants and physical capacity being the principal two. Without addressing these twin deficits, the structural mismatch between capacity and demand will continue to increase waiting times rather than decrease them. We are, like Tennyson, climbing the ever climbing wave. The solution is obvious: we simply must appoint additional consultants on terms to be agreed with the association. This action now will prevent the current crisis from continuing for the rest of the decade and beyond.