Consultants concern over elderly access to specialists

Professor Declan Lyons, consultant in medicine for the elderly
“A BAD deal for Limerick people” is how a senior consultant has described changes at University Hospital Limerick which he says deny elderly patients automatic access on admission to a specialist in medicine for the elderly.

“A BAD deal for Limerick people” is how a senior consultant has described changes at University Hospital Limerick which he says deny elderly patients automatic access on admission to a specialist in medicine for the elderly.

Prof Declan Lyons - and consultant colleagues Dr Margaret O’Connor and Dr Catherine Peters - say the changes introduced by management against the better advice of doctors this week could result in longer hospital stays, higher readmission rates and more expensive care for the elderly.

In a statement, the HSE suggested the only change introduced this week has been increasing activity at the new acute medical assessment unit in Dooradoyle, an initiative that follows “extensive consultation and planning with all doctors and nurses who are involved in the delivery of care to medical patients, many of whom are over 75 years of age, who present to the hospital as an emergency”.

But Prof Lyons, who supports and was involved in setting up the medical assessment unit, says the HSE response doesn’t address the concerns raised by his colleagues on who the over-75s will see upon admission. Elderly patients were a vulnerable and growing cohort with complex needs, he said.

As co-lead with Dr Con Cronin in the acute medicine programme, Prof Lyons was all too well aware that the “acute medical assessment unit is a great idea if we can get it to work”.

“It will be a real advantage to the hospital and a much better environment in which to assess patients. But hospitals up and down the country who are putting in these units are aspiring, every one of them, to put in specialist rotas for elderly medicine because it is such a huge issue,” he said.

This, Prof Lyons added, was something Limerick already had in place and was reaping the benefits of - until this week. The rota had until now allowed elderly patients get immediate access to specialist care and was “the envy of the Dublin hospitals”, said Prof Lyons.

According to a statement from the three consultants:

“The model of elderly medicine that has been operational at the hospital for the past 15 years has been painstakingly built up to deliver high clinical standards, with activity data for elderly patients demonstrably the best in the country. The approach has been to rapidly diagnose and treat the causes of ‘age-associated diseases’ from the time of admission under the care of a specialist consultant-led team. The new changes deny automatic access to this service without any particular rationale being advanced for the change.”

“The provision of a quality service for older patients is delivered by a specialist rota that allows immediate rather than delayed access to the relevant specialty care.”

Professor Lyons said the system was now being dismantled by management, a move he said was considered as “mad” by Prof Bernard Walsh, president of the Irish Gerontological Society.

Responding to the concerns raised by the consultants this week, the HSE said the changes introduced concerned bringing more patients through the medical assessment unit as opposed to the emergency department.

Ongoing reorganisation of acute hospitals in the region by the HSE involves the establishment of medical assessment units at University Hospital Limerick, St John’s, Ennis and Nenagh as a way of alleviating emergency department overcrowding and of ensuring patients better access the most appropriate expertise and level of care.

“These revised arrangements ensure that patients who require acute care will receive this in a timely manner with access to the appropriate specialist team as required, ie medicine for the elderly, cardiac, respiratory etc. and if requiring admission can be cared for in any of our medical beds in our hospitals. These changes are designed to ensure that medical patients of all age groups will be treated faster, safer and more appropriately with access to all subspecialty requirements,” a spokesperson said.

But Prof Lyons described the HSE response as “off -the-point” and “irrelevant”.

“Everything they say about the medical assessment unit is grand but it has nothing to do with what we have gone public on, which is the lack of access to elderly specialisation from the point of admission,” Prof Lyons said.

He added that it was an irony that all three of the consultants recently appointed as general physicians for the medical assessment unit were geriatricians by specialty - all of them trained in Limerick.

“What we have had is on the one hand an expansion of consultant geriatrician expertise but on the other a contraction in access to it. Try working that one out,” said Prof Lyons.