Tuesday 20 August 2019

'People should take to the streets and voice their anger' - Fears frontline health staff are in for a chaotic winter

Investigation reveals patients languishing on trolleys in one of Ireland's busiest hospitals

Kathy Armstrong and Sasha Brady

"People should take to the streets and voice their anger" about the ongoing overcrowding hospital trolley crisis, experts have claimed amid fears our frontline staff are in for a chaotic winter.

As the Irish Nurses and Midwives Organisation revealed this week that over 82,000 people were on trolleys in emergency departments so far this year, Independent.ie secured these photos, which show patients languishing on trolleys in one of Ireland's busiest hospitals.

At least six patients were stuck waiting on trolleys in the bustling hospital corridors of an A&E department while nurses and doctors tended to their needs. One 82-year-old patient said that he couldn't remember how long he had been waiting but it was "at least five hours".

He was in A&E because he had suffered a fall that morning. The patient stressed that despite the wait the nurses and doctors who treated him "couldn't have been better".

In October there were 8,903 patients, admitted for care in Irish hospitals, for whom there was no in-patient bed.

The figure is a 96pc increase on the same period a decade ago and shows a 15pc increase on last year’s numbers.

Dr Brian Turner, lecturer with the School of Economics in University College of Cork, said pressures on resources and capacity are increasing.

Dr Turner said: "Ultimately, what is needed to deal with the trolley crisis is more capacity.  We currently have fewer beds in the public hospital system than we did in 1980 – the impending bed capacity review will allow us to better quantify how many, but in the absence of that, my best estimate is that the number is at least one sixth fewer. 

"This is despite an increase of around one third in our population since then, and an increase of around two thirds in our over-65 population, who are more likely to require hospitalisation. 

"Greater use of day case instead of inpatient treatment and a move to treat people at primary rather than secondary care level have offset this to some extent but not by enough to ensure that we have sufficient capacity."

Read more: 'Your heart hopes tomorrow will be better but your head knows it will be crazy' - an Irish nurse on burning out
Dr Jim Gray, emergency medicine consultant in Tallaght Hospital, said that the situation has drastically gotten worse over the past eleven years.

He told Independent.ie: "This was declared a national emergency back in 2006 by then Health Minister Mary Harney and that was when we had 50,000 on trolleys for the entire year, in the first ten months of this year there were 82,500 patients on trolleys.

"Looking to the end of the year we'll be looking at either very close to or above 100,000 patients languishing on trolleys.

"A trolley patient is someone who has had their emergency department care but because of a lack of capacity in the system, those who should be on beds in wards end up on trolleys, which are predominantly in the emergency department.

"Year after year we have had successive ministers, successive task forces and success winter initiatives but it's getting worse, not better."

He claimed that a shortage of beds, a lack of accountability among management and problems recruiting and retaining staff are to blame for the crisis.

Dr Gray said that he feels the public should take action to try and bring about change.

He explained: "It is getting worse - 100,000 people on trolleys is just one part of the picture, there's also 680,000 plus or more on waiting lists, that's 14pc of the population.

"So while 3pc of the population have been on a  trolley, another 15pc have been on some kind of a waiting list, that's close to 20pc of the population who have either been on a trolley or waiting list.

"It's a national scandal, how it's not a major voting issue is beyond me, people should take to the streets and voice their anger about this.

"The water crisis caused a lot of issues for the government and it's time that the trolley crisis and waiting lists did, politicians should remember that patients are also voters."

Read More: 'Your heart hopes tomorrow will be better but your head knows it will be crazy' - an Irish nurse on burning out

Liam Doran, General Secretary of the Irish Nurses and Midwives Organisation said that "care is compromised" by overcrowding and said it has taken its toll on frontline staff.

He said: "I don't think morale among staff has ever been lower, frontline health staff don't mind dealing with extraordinary situations as it's not a career you go into for comfort but to face overcrowding every day is soul destroying.

"You're not able to provide adequate care, your own professional reputation is being put at risk because you can't cope.

"Nurses have a choice, they have a choice to go to places like Britain, Australian, North America, where the hours are shorter, there's not as much overcrowding and the pay is better.

"They're exercising that choice by walking away from the Irish health system.

"Emergency services are needed so that the health system is fit for purpose and able to meet demand."

Damien McCallion, HSE National Director Emergency Management & National Ambulance Service, empathised that the situation is difficult for both patients and staff but said that there are some improvements.

He said: "It's true to say there are less hospital beds than there were previously, I would say it's close to 2,000 beds but we have lived through austerity and we are trying to claw back some of those acute beds.

"The recent Slainte all party report on health care said that we need to grow capacity but not just hospital beds but also social care - so services like home care beds and transitional beds so that people aren't delayed in hospitals when they shouldn't be - that's not good for them and it means a bed is available.

"In the last two years attendance at emergency departments are up 7pc (83,000 patients per year), admissions are up 8pc (around 500 per week).

"With additional capacity the system is actually being quite productive but it is a balancing act.

"Nobody is happy having anyone on a trolley, we are trying to make improvements, while increasing the overall capacity long term."

He also said that measures have been put in place as health chiefs prepare for winter.

He said: "At the end of last winter we looked at the lesson from the previous few months to see what worked and what didn't, those plans have been used in conjunction with other bodies to try to prepare for this winter from hospital to hospital.

"There's an investment annually by the government both for the winter and also in part of the service planning process.

"There's two strands to it - one is getting the hospitals to work closely with the ambulance service to prepare for winter and secondly there's investment that comes from government."

He also said that the HSE is working to try to attract and keep staff.

Mr McCallion said: "Staff in frontline services are under pressure, there's no denying that and as many supports as possible are put in to help staff.

"We have done a lot of work in terms of recruitment and we are opening beds in some of our key sites over the winter.

"There are parts of the country that are still hard to attract staff but the overall situation has improved.

"There has been a lot of progress in terms of trying to attract and retain process, although there are ongoing challenges."

Read More: Hospital beds lie idle as 684,000 are left to suffer on waiting list

A spokesman for the Department of Health also said that initiatives are underway to prepare for the busy winter period in hospitals.

He said: "We face challenges in our EDs, particularly as we enter the winter, but every day huge efforts are being made by staff across the country to meet these challenges.

"During the first 10 days of November there are 653 fewer patients on trolleys compared to same period last year. This represents a 21pc reduction for the same period last year.

"The figure has been less each of the days this month so far compared to last November. (This data is directly from the HSE TrolleyGAR 8am count, which is published each morning on the HSE website).

"The Minister meets the HSE regularly on the issue of winter preparedness and receives regular updates. He has been assured that each Hospital Group and their associated primary care services have put in place integrated winter plans.

"Tackling overcrowding in EDs is a key commitment of this Government and I am delighted that €40m in additional funding in 2017 has been made available as part of the 2018 Budget to address winter pressures and waiting lists over the rest of this year."

He said that some of the spending measures include €5m for home care packages and transitional care beds to help elderly people stay in their homes; extra investment in diagnostic services to alleviate A&E overcrowding and they have driven a public health campaign about the flu vaccine.

The spokesman added: "In the long term we need to increase capacity in the system.

"The Department of Health is undertaking a Health Service Capacity review in line with the Programme for a Partnership Government commitment, the findings of which are due to be published before the end of the year, and which will provide an evidence base for future capacity decisions."

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