At least 15 of the 59 total CT scanners in the Emerald Isle have passed their life expectancy dates but remain in operation, with one at South Tipperary General Hospital still in use despite passing its end of life date seven years ago in 2013.
Dublin’s Mater Hospital also has a scanner that has been out of date since 2016 and 10 others that expired in 2017 but are still being utilized, reports the Irish Sun
"The HSE (Health Service Executive) is aware of the high-risk equipment that requires to be replaced and as consequence has increased the equipment replacement budget to €65m in 2020 to remove the identified unreliable and at risk medical equipment," Ireland's HSE, which heads its public healthcare, told HCB News. "The HSE intends to continue to provide a steady state investment of €65m to the National Equipment Replacement Programme (NERP) into the future to address the backlog of aging medical equipment that currently resides in our front line health services."
David Cullinane, a spokesperson for Irish political party Sinn Fein, says that old equipment which is no longer being manufactured runs the risk of creating longer waiting times and reducing capacity, should it break down. “Some equipment can be maintained beyond its end-of-life, but it does not take long for replacement parts to dry up,” he told the Irish Sun.
Scanners slow down as they age and are more prone to breakdowns that can delay scans and create longer waiting lists for patients or force providers to send them to other facilities. Figures from the HSE show that 15 scanners have passed their end of life date and that two more will run out later this year. The fact that they have passed their end of life date means they are no longer serviced by the manufacturers that designed them. Eight others are well within their own dates, and the remaining 34 have no end of date information available, according to the Irish Sun.
Medical equipment faults are reported by the hospital to either a contracted service or maintenance company, or the hospital clinical engineering department, which then records the reported fault and the details of the necessary repair completed to allow the equipment to be returned to clinical service.
Hospitals in Ireland review equipment replacement on an on-going operational basis, as well as on a strategic basis each year in accordance with a detailed set of criteria issued by HSE for prioritizing replacement needs. A multi-year rolling replacement program is in place to plan equipment replacements over a period of three years and is adjusted each subsequent year to better align it with the replacement priorities of the service, according to HSE.
Should a major failure of a high cost, critical piece of medical equipment occur outside of the annual approved equipment list, the hospital can provide a report of failure and the effects of the clinical services to secure emergency funding. The case will then be evaluated based on risk and availability of funding. In the event, the equipment does not perform within the required criteria, the issue is either fixed where possible, or the equipment is replaced.
"With regard to CT scanners and other radiology equipment in operation by the HSE, this equipment is maintained in accordance with the manufacturers instruction with preventative maintenance, scheduled as guided by the manufacturer," said HSE> "The quality of imaging produced by the scanning equipment including dose output is monitored by way of a Quality Assurance programme managed by each site's medical physics department."
The biggest concern among critics like Cullinane is that the breakdown of outdated equipment will lead to delays and longer waiting lists. The European Health Consumer Index 2018 ranked Ireland as the country with the worst hospital waiting lists
in Europe and as lowest for value of money invested in the service. It also scored relatively poorly for quick access to cancer therapy following diagnosis.
The country, however, recently nationalized its private healthcare systems
in March in response to the outbreak of the COVID-19 pandemic. This move, according to CervicalCheck whistleblower and cancer screening campaigner Vicky Phelan, helped speed up her place on the waiting list for a CT scan.
“I was due a CT scan and expected to have to wait for weeks to get an appointment,” she told the Irish Mirror earlier this month. “I was pleasantly surprised when I was able to have one done on the same day as my treatment and to get the report back within a few days. I normally have to wait for weeks, and sometimes months in the public system,” she told the Irish Mirror earlier this month
, adding “The COVID crisis has shown us that when public and private hospitals come together with the sole aim of meeting patients’ needs, marvelous things can happen.”
The HSE plans to buy six more CT scanners this year. Cullinane, along with others in his party like public expenditure spokeswoman Maired Farrell, attribute the use of outdated machinery to improper funding for public services and are calling on the government to organize a plan to quickly phase out these past-end-of-life systems.
“Only this week the minister for Public Expenditure and Reform told us that the army of well-paid advisors that the government has hired is ‘great value for money',” Farrell told the Irish Sun. “But apparently having CT scanners inside their life span is not.”
The HSE does not currently record local information about medical equipment replacement on a national database except for the four primary X-ray equipment providers. It claims that it is continually expanding the national database to record all critical medical equipment faults.