Eilish O'Regan: 'Worst October for trolleys will set alarm bells off as winter's hardship has yet to hit'
The true scale of risk, suffering, distress or even discomfort endured by the 9,055 hospital emergency patients who were forced to wait for a bed in October is not captured in trolley figures.
It was the worst October for overcrowding on record, according to the Irish Nurses and Midwives Organisation.
The hardest hit were University Hospital Limerick, which had 1,045 patients on trolleys, followed by University Hospital Galway, Cork University Hospital and Letterkenny Hospital.
However, it has highlighted how smaller hospitals such as South Tipperary General were also under intensified pressure - and the full impact of winter is yet to strike.
Ten years ago the numbers on trolleys in October stood at 5,041, and they have climbed every year.
At that stage the bigger hospitals in Dublin were the most congested. But hospitals outside the capital have since then seen their A&Es increasingly thronged.
So what of the annual "winter initiative", the action plan which the HSE should be ready to roll out to ease the ordeal of some of our sickest patients?
The HSE insisted yesterday that winter planning is "well under way". It said it continues to work with the Department of Health, hospitals and community groups to finalise plans to ensure "robust preparedness" for winter.
It mentioned the €10m in extra funding for 2018 and a similar investment in 2019 to provide additional beds.
However, the timescale for the opening of these beds remains vague.
The HSE said that 78 additional beds are due to open later this season.
These include an additional 30-bed ward in Our Lady of Lourdes Drogheda, a 40-bed modular ward block in South Tipperary General Hospital, and four high-dependency beds in both the Mater Hospital and Cork University Hospital.
It will be early this month before it finalises the winter plan, although we were told in the midst of last winter's mayhem that planning would start in summer.
The same pledges are made every year.
However, if the trends highlighted in the October trolley figures are seen as an early alert, it may be already losing the battle.
The October level of overcrowding is shocking in itself, even without the strains which the flu, respiratory illness and the winter vomiting bug will bring.
The last few weeks should have been a quiet time, allowing hospitals to catch up on carrying out surgery on waiting-list patients.
But too many hospitals struggled with little reserves of beds for patients who had to lie on trolleys or even chairs.
Attendances at A&E departments are continuing to increase and topped 1.4 million last year.
The number of over-75s who need emergency care and have to be transferred to a ward is also increasing.
Despite the now well-worn promise to end the problem of bed-blocking, it was back to high levels again yesterday.
The HSE reported that 593 delayed discharges - patients who no longer needed acute hospital care - were occupying beds.
"This significantly restricts the hospitals' ability to admit new patients from emergency departments for treatment and care," it said.
The fact so many patients are not being discharged highlights the lack of community services, including homecare packages and other supports as well as transitional beds.
The hope is that the flu season here will be mild and will mirror that of the recent Australian winter.
It saw the number of flu cases and admissions to hospital lower than the previous winter. But flu is unpredictable and the advice is to continue to prepare for the worst.