Rising TB burden strains Ireland’s care system
The TB care centre at St James’ Hospital in Dublin has announced that it cannot meet current or future demand as tuberculosis cases continue to rise. The warning comes as emergency reviews linked to suspected or confirmed TB cases doubled between 2023 and 2024, signaling a health service reaching full capacity in a niche but critical area of care.
Tuberculosis remains a complex public health challenge, requiring coordinated clinical expertise, rapid laboratory testing, and robust patient management. The centre, a key hub for diagnosing, treating, and monitoring TB patients in Ireland, has highlighted that existing resources—particularly laboratory support, staffing, and infrastructure—are not keeping pace with demand. Without urgent action, patients and public health outcomes risk being compromised.
What is driving the surge in demand?
Several factors appear to be contributing to the increased pressure on TB services. First, higher case detection rates may reflect improved screening and referral pathways, alongside genuine shifts in TB incidence. Second, the complexity of modern TB management—especially drug-resistant forms and latent TB infection—necessitates longer hospital stays, more frequent monitoring, and multi-disciplinary care teams. Third, the broader health system context, including bottlenecks in laboratory turnaround times and limited specialist personnel, exacerbates delays in diagnosis and treatment initiation.
Public health experts stress that TB is a disease that benefits from swift laboratory confirmation and timely initiation of therapy. Delays at any stage—from specimen collection to culture, drug susceptibility testing, and clinical decision-making—can lead to worse outcomes and increased transmission risk in the community.
Impacts on patients and care delivery
When care centres operate at or beyond capacity, several consequences can unfold. Patients may experience longer waits for diagnostic results, slower initiation of anti-tuberculosis therapy, and reduced access to specialist consultations. For those with drug-resistant TB, the stakes are even higher, requiring longer, more toxic regimens and specialized infection control measures. In addition, the strain on staff can contribute to burnout and hamper the consistency of patient care.
The centre’s leadership notes that immediate improvements are needed in laboratory supports. Faster, more reliable testing is essential to confirm TB diagnoses, determine drug susceptibility, and tailor effective treatment regimens. Enhanced laboratory capacity would shorten the time to diagnosis, enabling clinicians to make informed decisions and reduce periods of infectiousness.
What urgent actions are being called for?
Officials are urging several concrete steps to avert a growing healthcare gap. These include: expanding laboratory capacity and staffing to reduce turnaround times; increasing clinical staffing levels at the TB care centre to manage rising patient numbers; and investing in infrastructure upgrades to support longer, more complex care pathways. Strengthening infection control measures within hospital settings is also critical to protect vulnerable patients and prevent nosocomial transmission.
Adopting a coordinated, cross-departmental approach is essential. TB care intersects with primary care, social services, housing, and immigration health policies, particularly in a country with diverse epidemiological inputs. A holistic strategy would not only address the immediate capacity issue but also the social determinants that fuel TB risk—such as housing quality, nutrition, and access to consistent healthcare.
Looking ahead: policy, funding, and patient-centred care
Experts say that addressing capacity constraints requires sustained policy attention and dedicated funding. By investing in rapid diagnostics, expanding the TB workforce, and modernising hospital infrastructure, Ireland can improve patient outcomes and curb transmission. Moreover, frontline clinicians emphasise the importance of patient-centred care pathways that reduce stigma, support adherence, and coordinate services across touchpoints in the health system.
As TB management remains a public health priority, the situation at St James’ Hospital serves as a bellwether for Ireland’s ability to respond to evolving infectious disease challenges. Timely action now could prevent longer-term harm and reinforce the health service’s resilience in the face of rising demand.
