In response to the COVID-19 pandemic the HSE had to take measures to defer all non-urgent elective scheduled care activity, including outpatient clinics. This was to ensure patient safety and that all appropriate resources were made available for COVID-19 related activity and time-critical essential work. This decision was in line with the advice issued by the World Health Organisation, the measures set out in the Government’s Action Plan in Response to Covid-19 and the recommendation of NPHET.
In line with the expert advice, delivery of essential non-Covid care has continued to date, although at significantly lower volumes than previously. In particular, the delivery of cancer care, urgent surgery and trauma services are areas in which care continues to be delivered, often in alternative locations and using innovative methods of care delivery. Where possible, hospitals are working to provide services in a different way, which includes virtual clinics for some outpatient department appointments. Cancer services are continuing with prioritisation of time-sensitive treatment, and the ongoing review of the location of the delivery of cancer services.
The NPHET has now recommended that steps be taken to resume non-urgent scheduled care in the context of the safe care guidelines set out by its Expert Advisory Group. Guidance on patient pathways to mitigate the risks associated with the delivery of non-covid care, for patients and healthcare workers, and support safe delivery of care has been developed under the auspices of the Expert Advisory Subgroup of NPHET (EAG) and approved in principle by NPHET. This guidance includes, for example, guidance on screening, swabbing and use of PPE.
In collaboration with my Department’s communications team, research to understand why some people are avoiding interacting with health services has been initiated. Findings from a survey and focus groups commissioned by the Department indicate that fear of infection is one of the primary factors influencing peoples' reluctance in attending for acute services. This data has informed the development of an advertisement campaign reassuring the public that GP services and EDs are available and open for business, with changes made to accommodate patients safely in the context of Covid-19. The campaign commenced on Monday 11th May, through national and local radio and social media, supported by local spokespeople and will be revised or concluded in line with impact seen on the ground.
In terms of understanding the impact of COVID-19 on waiting lists, the HSE and my Department are actively working to build methodologies for gathering relevant data to try to facilitate not only a better understanding of the health system at this time, but to try to model growing service demands as the year progresses and as the health system continues to deal with the Covid-19 pandemic.
The Outpatient waiting list at the end of April shows an increase of 5,636 in comparison to the end of March. The figure for those waiting less than 3 months has fallen by 24,076 in the same period, a reflection of the decrease in referrals by GPs. Meanwhile, the number of patients awaiting an Inpatient or Day Case (IPDC) procedure increased by 8,595 at the end of April when compared to the end of March waiting list. During the same period the number on the ‘To Come In’ (TCI) list (those with an appointment for a procedure in the next six weeks) has reduced by 5,427. Accordingly, a large part of the increase in the IPDC waiting list relates to patients moving back to the Active waiting list from the TCI list. While the IPDC waiting list figure at the end of April is indicative of fewer patients being treated, it is of note that there were also fewer patients seen in Outpatient clinics in the same period and as a consequence fewer patients were referred for procedures.