Lack of intestinal failure service costing lives

Avoidable deaths are occurring in Ireland due to the lack of a specialist service for people with intestinal failure, the Irish Society for Clinical Nutrition and Metabolism (IrSPEN) has warned.

It highlighted this issue at its 6^th biennial national conference on nutrition and health in Dublin’s Aviva Stadium on March 21.

Around 100 adults develop severe acute intestinal failure every year in Ireland and they require highly specialised care. However, despite a decade of campaigning, there is still no dedicated adult intestinal failure unit in the country.

According to IrSPEN president and consultant gastrointestinal surgeon, Prof John Reynolds, there is “no excuse” for this lack of action. He noted that over the last 10 years, there have been “promises from government ministers and meetings with HSE executives”, yet there is still no specialist service.

“The case for establishing a dedicated unit at St James’s Hospital has been accepted by policy makers and has the support of all the expert groups and professionals.

“A detailed proposal, was originally submitted to government and the health services in 2017, then re-submitted last year. It remains under consideration. We know that this service is literally a matter of life or death and it must be prioritised,” Prof Reynolds insisted.

He noted that the costed budget for such a unit is €6 million per annum.

“However, a significant portion of this cost would be offset by the service not being needed elsewhere in the health service. This proposal was supported by the then Minister for Health Simon Harris in 2017, but never followed through,” he said.

According to Dr Cara Dunne, a consultant gastroenterologist at St James’s Hospital, much of the medical expertise needed for a specialist unit is already in place at St James’s.

“What’s now needed is additional funding to develop this into a specialised unit that is dedicated to these patients. Research from the NHS in the UK has equated under-capacity within intestinal failure care with 150 avoidable deaths each year. This would equate to 12 avoidable deaths per year in Ireland,” she explained.

She also pointed out that currently, Northern Ireland has a 12-bed intestinal failure unit for a population of 1.6 million people.

“In contrast, there is no dedicated unit in this country for five million people,” Dr. Dunne said.

Also speaking at the conference, the president of the European Society for Clinical Nutrition and Metabolism (ESPEN), Prof Rocco Barazzoni, pointed out that Ireland is an outlier in Europe due to its lack of a specialised service to treat intestinal failure. 

“Intestinal failure patients face high morbidity and mortality risks and Ireland should be taking steps to provide a dedicated national centre,” he said.

Intestinal failure occurs when a patient’s intestine cannot digest food and absorb fluids. Patients must be fed artificially via liquid nutrition through a catheter or needle inserted into a central vein in the chest. This treatment is lifesaving but the risk of serious complications is high. If not managed extremely carefully, emergency hospital admissions, prolonged hospital stays and death can occur.