herald

Sunday 16 December 2018

HSE bosses still try to fool us with promises as our health service collapses around us

It's time to rewrite the Guinness Book of Irish Health Service Records. And file it under Horror.

Five years ago, when A&E trolley figures reached 495, Mary Harney declared a national emergency and gave us an action plan.

Some plan. Trolley figures this past week came close to the 600 mark. That's almost 600 very ill patients who couldn't get a bed.

If it was deemed an emergency in 2006, it's something worse now. One consultant referred to a perfect storm.



collapsing

Many reasons have been given for the spike in A&E trolley waits:

l There's a lot of respiratory illness.



  • There's more swine flu about.


  • More people are attending A&Es, having postponed visits over Christmas.


  • Patients are now attending for operations that didn't take place in December.


  • Many patients in hospital at this time of the year are usually sicker and remain there longer.

Yet this type of thing occurs in hospitals every January -- it's bread and butter stuff.

Why are things so bad now? There was far more swine flu this time last year and trolley figures weren't as high.

People who work at the coalface in A&E return to the same three key factors -- capacity, capacity, capacity.



closures

Our hospital system has now reached a tipping point where it cannot function at its most basic level and is collapsing under seasonal and other demands it should largely be able to absorb.

The crisis is not just an A&E or trolley issue. Every sick patient lying on a trolley is testament to health service capacity problems.

Our hospitals, hampered by bed closures and resource issues, cannot cope with the demands being thrown at them.

Statements urging people to use A&Es for emergencies only are irrelevant and insulting. People on trolleys are genuine emergencies awaiting a hospital bed that cannot be found for them.

People turning up with nasty rashes or the sniffles could certainly go to their GP instead, but they aren't preventing sicker trolley patients being admitted -- it's the lack of beds.

Certainly we need reform, and this week we have been promised a better future, when people will be kept out of hospitals and treated elsewhere, and there will be no more trolley waits.

Tell that to your mother or your granny on a trolley or chair right now. She probably won't get much comfort.

What the health authorities won't admit is that right now we have too few beds in hospitals and not enough alternative long-stay or community facilities.

And the number of beds had been savagely cut back even before the current funding "challenges" took hold.

The HSE's latest figures show that around 1,100 hospital beds are closed. However, the nurses' union , the INMO, estimates that the real figure is nearly 1,700.

In addition , there are around 540 'delayed discharge' patients currently awaiting, but not getting, nursing home or other alternative care. So the number of unavailable beds in the system at present could be over 2,000.

And things will get worse. The traditional 'escape route' from the public health system, private insurance, is getting increasingly expensive.

This week's massive VHI premium hikes are testament to that. Over 50,000 people have given up their health insurance over the past year or so and have thrown themselves at the mercy of the public system.

These numbers are set to grow, putting greater pressure on A&Es and beds.



Broken

And the bad news doesn't end there. A shortage of junior doctors is due to hit A&Es, adding to service pressures.

But the HSE has some 'good' news. Its 2011 service plan states that by the end of the year 100pc of patients attending A&Es will be admitted to hospital or discharged within six hours of registration.

However, the HSE has admitted this target is "aspirational". In other words the promise may not be worth the paper it's written on. And people wonder why our health service is broken.

Niall Hunter is editor of irishhealth.com

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