THE GOVERNMENT NEEDS to find alternative options to transfer patients who require emergency medical or surgical treatment abroad, the health service watchdog has said.
‘Priority 1′ transfers involve transporting patients by air from Ireland to another country within eight hours of them requiring emergency medical or surgical treatment, without which the patient’s life or health is significantly endangered.
Since 2012 all Priority 1 transfers, with one exception, have been completed by the Air Corps or the Irish Coast Guard (IRCG). To date, the majority of these patients have been children who required heart or liver transplant surgery in the UK.
As of 6 November – due to staff capacity constraints with the Air Corps and regulatory requirements on the IRCG – these organisations have not been available to provide Priority 1 transfers between the hours of 7pm and 7.30am.
In a report published today, Hiqa said the government needs to address the issue.
Reassuring families of paediatric transplant patients
The HSE welcomed the publication of the report and a spokesperson told TheJournal.ie the executive “has implemented an interim solution for the provision of night-time Priority 1 air ambulance transfers”.
The HSE said it is working with the Department of Health “to assess all of the options outlined in the HTA (health technology assessment) with a view to ensuring the provision of a regular and sustainable Priority 1 transfer service for Irish patients”.
The spokesperson added that the executive “would like to reassure families of paediatric cardiac and liver transplant patients of our commitment to them and to ensuring safe and timely transfer”.
The health technology assessment focused on options for the treatment and transfer of paediatric heart and liver transplant patients. In the immediate-term, Hiqa said the optimal option is to engage a private provider to deliver a dedicated night-time service.
Short and long-term options
In the short-term (that is, to be implemented within the next six months), the optimal solution may be to negotiate changes to the existing IRCG contract to allow for 12-hour rosters at one or more bases, thereby enabling the IRCG to undertake night-time Priority 1 transfers.
“The cost of this option should be compared to the cost associated with the ongoing use of a commercial provider or of having a dedicated IRCG crew on standby at the Dublin base,” Hiqa said.
The watchdog said the Department of Health could also look into the use of an air ambulance service supported by philanthropy and examine whether the IRCG can fly patients to the UK under a 24-hour shift following changes to the regulatory framework.
The organisation said the preferred long-term alternatives are those provided by the IRCG or the Air Corps, noting that the next contract to provide coast guard services – due to run from 2022 – could provide for an additional aircraft and aircrew to provide air ambulance services.
The Air Corps options include the provision of an air ambulance service on an ‘as available’ basis or through a model similar to that used by the Garda Air Support Unit, where aircraft would be provided by the HSE and dedicated aircrew would be provided by the Air Corps. Hiqa said these options “leverage existing State resources and are contingent on restoration of sufficient air crew capacity”.
Health Minister Simon Harris told reporters today that his priority is providing “absolute certainty” for parents.
I was really concerned that there was a lack of certainty. We have had a very good relationship with the Air Corps and the Coast Guard but, for a variety of reasons, they weren’t always able to provide 24-hour cover. So I have taken the step, in line with what Hiqa have recommended to me, to provide a private air ambulance service that will provide absolute certainty for parents.
Harris said he was concerned to see some media reports talking about fears for parents.
“Let me assure parents, that service is in place now and it is in place for a 24-hour basis for the protection and welfare for their children.”
“We can’t continue in this patchwork way,” he said, stating that the question needs to be asked about how Ireland provides this service on a sustainable basis. The minister said he would be working with other departments to find that answer in the coming weeks.
‘Deep concern’
Dr Máirín Ryan, Hiqa’s Director of Health Technology Assessment and Deputy Chief Executive, said Priority 1 transfers “should be considered as part of the wider patient transport services”.
“The long-term development of an integrated aeromedical service for Ireland could provide a more sustainable approach and allow for more efficient use of resources than can be achieved by a service designed only for Priority 1 transfers.
“We realise the deep concern that the families of children awaiting heart and liver transplants must feel about how their loved ones can travel to the UK for a transplant, and we believe that the advice we have provided to the [Health] Minister and the HSE offers the best possible solutions in both the immediate future and in the longer term,” Ryan stated.
With reporting by Christina Finn
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