Thursday 27 October 2016

Priscilla Lynch: Trolley crisis will get worse without dramatic action

We are barely over the summer when already tales about emergency department (ED) overcrowding and patients being left on trolleys are emerging.

Yesterday almost 400 patients across the country were on hospital trolleys waiting for a bed.

In one of the worst cases, an elderly cancer patient was forced to stay on an ED trolley waiting for a hospital bed for five days.

The man was just one of 40 people in need of a bed in the severely overcrowded ED unit in Our Lady of Lourdes Hospital, Drogheda, while other hospitals, in the Dublin region, are also experiencing significant trolley issues.

While unacceptable at any time of year, it is very worrying to see such cases at this time, which is traditionally a quieter period in our EDs.


Usually these stories only emerge during the worst weather of the winter months, when more people, particularly the elderly, are ill due to respiratory infections and flu.

However, in a disturbing trend, ED waiting figures have remained stubbornly high this summer and in fact have been on the rise, year on year, for 14 months in a row.

The Irish Nurses and Midwives Organisation (INMO) reports that in August there were 6,518 patients on trolleys, a 40pc increase when compared to August 2014.

Beaumont and Tallaght hospitals were among the five hospitals suffering the greatest levels of overcrowding during August, despite previously being targeted by the HSE with extra help to ‘resolve’ their issues.

Healthcare staff have rightly warned that the ED crisis will only get much worse in the coming months unless dramatic steps are taken now.

Last year, a record 600 patients were on trolleys at the peak of the crisis, but that figure could be surpassed this year, given the figures so far.

Nurses in Drogheda – and other affected hospitals – have said they are at breaking point and will not continue to tolerate the incessant overcrowding and unsafe conditions for patients, with strike action now a very real possibility.

Is it any wonder the HSE finds it hard to recruit hospital staff given such conditions?

Is it a surprise that elderly patients are fearful of having to attend EDs when sick?

Lying on a trolley, in a crowded corridor, with no darkness or privacy to allow sleep, is not conducive to a good health outcome for our most vulnerable patients. Our hospital patients, and staff, deserve better.

Excessive ED waits and vulnerable patients languishing on trolleys are issues that successive Ministers for Health have been unable to solve.

Why is this? We’ve had plenty of much hyped initiatives that we were told would solve the crisis for good.

These include 10-point plans, special delivery units, task forces, extra funds for Fair Deal scheme, and new facilities like minor injury units, admission lounges, etc, but still the problem persists – and it appears to be getting worse this year.

Our ED problems are obviously complex but are largely down to delayed discharges (where patients are fit to leave hospital but have nowhere suitable to go), acute bed closures and staffing shortages.

The Minister for Health Leo Varadkar took prompt action when he took on the job last year, setting up an ED task force and securing extra funds for nursing home places.


But like his many predecessors, he has learnt that throwing money at short term, quick fixes doesn’t make the problem go away.

It just eases bottlenecks – and negative headlines – for a few months.

Long-term, sustainable solutions are needed to resolve our ED problems.

Just throwing money at them has obviously not worked and it is clear some extra funds, beds and staff are urgently needed. The HSE’s recent request for an increase of €1.9bn in its health budget next year and an extra 5,000 staff was quickly shot down.

However, the Government might do well to remember that it has an election coming up. Stories of elderly patients on trolleys for days will not win votes.

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