The current hospital / A&E crisis

Cluedo Monopoly

Hospitals stretched to their limits, says INMO (rte.ie)

The President of the Irish Association for Emergency Medicine, Dr Fergal Hickey said the current pressure on emergency departments is "the latest in a series of worsening situations".

Speaking on RTÉ's Drivetime programme, Dr Hickey, who is also a former consultant at Sligo University Hospital said Ireland is entered the clinical winter of 2022/2023 with too few hospital beds and "the dogs on the street know that".

"Emergency departments have been under pressure for months on end and this is just the latest in a series of worsening situations," he said.

Dr Hickey added that Ireland has 2.8 acute hospital beds per thousand of the population, while the OECD average is 4.3.

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There was a doctor on the radio this morning saying we have the same number of acute beds as we did in 1981. Crazy stuff.

Gregor Samsa

https://www.boards.ie/discussion/comment/120063432#Comment_120063432

This is the main problem, Ireland spends a lot on healthcare, but employ too many useless paper pushers.

Here's the breakdown of roles employed in the HSE for November 2022. https://www.hse.ie/eng/staff/resources/our-workforce/workforce-reporting/health-service-personnel-census-november-2022.pdf

Total staff is 155,227

Total for Management & Administrative is 25,224. That's 16.3%

I'm not saying this isn't too high, but what do you think the correct number should be? And what do you base that on?

Cluedo Monopoly

Before people start blaming Covid, here is a press release from the INMO in November 2019.

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2019 has seen the highest number of patients on trolleys in any year since records began – despite it still being November.

“Winter has only just begun and the record is already broken. These statistics are the hallmark of a wildly bureaucratic health service, which is failing staff and patients alike.

“We take no pleasure in having to record these figures for a decade and a half. We know the problem, but we also know the solutions: extra beds in hospitals, safe staffing levels, and more step-down and community care outside of the hospital.

“No other developed country faces anything close to this trolley problem. It can be solved, but a strong political agenda to drive change is needed.

“The INMO has written to the health and safety authorities this week to try force a change from the employers. Hospitals should be a place of safety and care – not danger.”

babyducklings1

How do other countries manage their health care systems? Do we have more sick people? In winter probably yes due to our wet climate , respiratory illness, flu, plus an ageing population. etc etc. Year in year out, especially around this time it’s always the same story but worse than ever this year. And gps aren’t taking new patients either. Long waiting times for appointments. Maybe only a troika for healthcare could sort it at this stage. Just don’t get sick in this country .

Sunny Disposition

I think a lot of people in many parts of the country are very reluctant to go to hospital, because they know how bad the situation is.

I think it's a bit of a cop out to blame the public, but the fact is Ireland has quite little hospital capacity for our population, which has grown very significantly in the course of a generation.

In the Mid West three A&Es were closed and everything concentrated on UHL. There were campaigners at the time, including former TD Dr Michael Harty, who warned it was the wrong policy, and they've been proved right in what they said. The policy failed for the reasons they said it would.

It's pretty disgraceful, A&E services were struggling 20 years ago and things are actually getting worse rather than better.

Boggles

https://www.boards.ie/discussion/comment/120063638#Comment_120063638

INMO are partly blaming Covid, calling for a new mask mandate.

Are those people allowed to? 😕

spaceHopper

I’ve had to bring my children to the GP 3 times since November, I’d no problems getting an appointment for that day or early the next day depending on when I called. 

I had to being my 79 year old mother to the out of hours GP service in Drogheda. I’d no problem getting an appointment for that after noon. And it was a very efficient services when I got there. I've been to A&E with my mother and the staff did their best but but it's a Sh1t show due to under staffing

It is not problems of to many people attending A&E when they don't need to. You have 700+ people waiting on trollies to be admitted. These are people who have been seen and accessed by a DR who has admitted them, clearly they need to be there.  Not moving them up stream into the hospital is clogging up A&E and they still need to be looked after by the staff in A&E as well as them coping with new arrivals.

Cluedo Monopoly

https://www.boards.ie/discussion/comment/120063736#Comment_120063736

Obviously Covid is a factor but we had a trolley crisis every year before Covid even arrived. There is a lack of political will to fix this problem.

Digital Times

Its become very difficult to get a GP appointment, If you have recently moved to an area its nearly impossible.

I had to go to A&E in the regional public hospital before Christmas at about 11PM as I got some metal in my eye, there was one doctor in the A&E department screening all the patients. When I arrived there were 11 people ahead of me, at about 1 AM some of our traveling ethnic friends arrived after attending a wedding where there had been a fight. They kicked up a massive fuss and were pushed to the top of the que despite most people waiting protesting. I was finally seen at 6 AM where I was told I'd have to get a doctors or opticians referral to go straight to the eye department. I returned at 10AM with an opticians referral and was informed that I would have to go through the A&E process again so I went to the private hospital now that they were open. The private hospital had me processed and in a bed within 45 minutes and the metal removed from my eye same day.

I think one of the main issues is abuse of the medical card, I know its important to provide health care to those who cannot afford it but it needs to be reviewed. Treatments should be characterized and all serious ailments should be covered but there should be a limit on the amount cover provided for minor ailments and this might take a little pressure off the system. I found out that GPs have to provide out of hours cover for medical cards holders but not their paying patients, its crazy that those that have to pay get a diminished service.

Eldudeson

We were in A&E with my 2 year old last year for an issue. He was admitted pretty quick and got a room the same day. After the initial tests, the consultant said he wasn't in any immediate danger but he needed a MRI on his brain. He checked the outpatient schedule for MRIs for his age and it came back with an appointment in 2033. That's not a typo, it was an 11 year wait. There are only 2 machines in the country to do it for children his size so the private route wasn't an option. He needed to take up a bed for 10 days to get the scan when he would have better off at home. Also, the scan wasn't clear so the MRI was essential for him. Who knows what would have happened if we hadn't taken up that bed for so long but it probably meant that some other kids had to wait on trolleys outside because it wasn't available.

Cordell

https://www.boards.ie/discussion/comment/120063628#Comment_120063628

Given that expenditure per capita is quite high, well above OECD average, but the results aren't, it's not a question of funding, but efficiency.

I don't know how many are too many, but it's not just the numbers and salaries paid, it's the inefficiency and overhead that exacerbate the problem.

recode the site

https://www.boards.ie/discussion/comment/120063781#Comment_120063781

Absolutely, true that those who pay get a diminished service. Once when I developed a post operative wound infection which my surgeon initially treated, she requested a public health nurse to call & assess & dress the wound daily, which took about 3 weeks to heal. She was told this wasn’t possible as I wasn’t a medical card holder. It meant I had to get daily taxis to and from my GP’s nurse and pay requisite fee. Couldn’t drive as I was on opiate painkillers. This is a phenomenon little discussed in the media. A medical card is your ticket to more healthcare than is afforded to other mortals.

SuperBowserWorld

The magical Irish medical card.

recode the site

https://www.boards.ie/discussion/comment/120063850#Comment_120063850

This is the type of inefficiency we used to hear about, beds being blocked to access diagnostics, unbelievable it’s still happening. Private insurance won’t cover this sort of thing at all when one goes that route.

hello2020

The COVID crisis was a missed opportunity to invest in healthcare and build new hospitals in the country instead of paying free money to people there should have been new hospitals setup and doctors trained !

hello2020

https://www.boards.ie/discussion/comment/120063850#Comment_120063850

its better to take a flight to a foreign country like Turkey/Poland etc for medical treatment than wait for 11 years for a MRI !

mumo3

We the nation are the big problem with the hospitals!! I had to bring one of my children to A&E during covid for an injury and we were in treated and back out in less than 2 hours, because people where terrified to attend. Now I know that led to other issues with undiagnosed serious illness's.

Another time I had to take my child to Crumlin A&E and the place was rammed with sick kids who had the winter bug.... now all of those kids where being treated with dioralyte, some serious cases where put on drips and the waiting room was rammed with more kids with the same condition, I'm no doctor, but would it not make sense to bundle and treat those kids together? Any that didn't need a drip should have been sent home with a prescription of dioralyte instead of taking up room for 5-6 hours and triage could have easily know that it was the same condition 60% of the children where presenting with.

As a parent, I'm well aware of the fright you get when your kids are sick, especially with the media scare mongering you with STREP A deaths, but seriously, we were all reared on 7up and Calpol, didn't see the inside of a hospital unless you where really, really sick or might have broke yourself up!! People rushing their kids to hospital for stupid sh1t instead of just waiting it out. I've spend many a night syringing 7up into my kids mouths when they've caught bugs, I never rushed up thinking they need a drip because they've been throwing up for a couple of hours and aren't drinking.

To add insult to injury, Joe Duffy was discussing the same thing yesterday and one of the callers said, she was told there was actually no doctor available in A&E, as the doctor on duty had been sent home sick.... like WTAF

Floppybits

I know for me the last place I would want to go is A&E and then I would really need to in a bad way. I am sure a lot of people waiting in A&E are not there for the craic but genuinely believe they are seriously ill and think they can't afford to wait 3 or 4 days or what ever the case maybe to see a Dr, who may just to tell you to go to A&E anyway. Basically they are cutting out the middleman. There is also the fear that if you don't go and get something checked and treated as soon as possible that it could turn into something more serious. So yep I can understand people going to A&E to be seen.

If they want to attract more people to work in the hospitals then the HSE need to make the conditions better simple as that. I feel for the medical staff working there in those conditions with no sign of conditions improving or any will to improve those conditions in terms of staffing or an increase in beds and improving services outside the hospital. For me Dr's clinics should at least be open to 11pm and not shutting at 5pm but then that would take having to have more GP's available. So it is now a chicken and egg situation and I don't think the will is there from a political point or from a management point in the Department of Health or the HSE upper echelons.

Larbre34

https://www.boards.ie/discussion/comment/120063159#Comment_120063159

And so why does a triage function exist and why is it not being used to not only rank the seriousness of presentation, but also to turn away people who have absolutely no medical need to be at an ED, but could could go to a GP or CareDoc or PCC or even a Pharmacy?!

Cluedo Monopoly

https://www.boards.ie/discussion/comment/120064133#Comment_120064133

I talked to a pharmacist about the flat 7Up remedy for upset stomachs. She said it used to work but not anymore. 7Up replaced the sugar with sweeteners which can actually inflame stomachs even more. They change from sugar to sweetener as a result of the sugar taxes.

jmayo

It is like everything else in this fooking country, lack of planning.

We need more hospital beds so that when people need to be admitted to hospital from A&E there is a bed available.

And to free up some of those beds we need step down care for the likes of the elderly.

Added to that we need to also remove the numbers going to A&E in the first place by using primary care clinics.

Part of that is revolutionising the medical cards so that those on them can't just keep turning up with every little complaint.

AFAIK we have less hospital beds now than in early 80s.

Has our population dropped since then?

It is the same with prisons, schools, almost anything provided by the state.

It is always chasing the numbers rather than being planned properly.

After years of planning consultancy fooking about, we build for yesterday rather than tomorrow, with it eventually being build the day after tomorrow.

And all of that is before we even talk about the not fit for purpose HSE, the representative body controlled health service and the continous loss of good staff because they have had enough.

Deeec

https://www.boards.ie/discussion/comment/120062940#Comment_120062940

While I do broadly agree with your post it is now impossible to get a GP appointment and this is contributing to the problems in hospitals and A & E departments. The advice the receptionists in my GPs office are giving everyone they cant give an appointment to is to go to A & E - now its wrong advice but thats what they are saying. I seldom contact my GP unless kids, husband or myself are seriously sick ( partly due to the high cost being honest) - when I do contact them we do really really do need to see a doctor but cant get appointments anymore. I then have to resort to ringing VHI or doctor on call just to get a prescription - in fact since before covid none of my family have got to see a GP face to face. I disagree that people are choosing to go to A & E rather than see their GP - its just impossible to see a GP!

To fix the issues the problems need to be solved from Gp's right the way up. The whole health service from primary care right the way up is a mess. Despite being with the same GP practice since I was a child - Im still registered with the practice but there is literally no service if you are sick and need to see a GP urgently.

Also medical card holders are blocking up all services largely because they dont have to pay and will go use services even for minor ailments. Those of us who pay for everything think twice before going to bothering our GP or going to A & E.

recode the site

https://www.boards.ie/discussion/comment/120064211#Comment_120064211

I’ve said it on Twitter but I’ve seen some very poor quality triage at play. I don’t think some of them even would have the competence to turn people away. I attended a course given by senior paramedic instructors in DFB & they shared examples of the sometimes very poor triage that can occur. Not always so of course, but not all triage nurses are as competent as each other. A good one will, eg, suspect sepsis/meningitis may be developing, another will just box tick it as “flu”.

Beta Ray Bill

My €0.02

My cousin is a newly trained Doctor, she's working in the A&E in Limerick.

Her Father describes her work/job as completely unworkable, 16 hour shifts are the norm, and when she gets home she's absolutely f**ked. He himself said that he would not like to be treated by her close to the end of her shift.

She herself is planning to leave Ireland along with her sister who is also in the medical profession, as there are better conditions (not pay so much) abroad

The problem is a ridiculous one if I'm honest. My GF's daughters friend got 600+ points in his leaving cert and wanted to do medicine to become a doctor. He ended up in a draw and didn't get the place, he's going to resit his LC and try and get more points. This is madness to me, this person is very clever and cannot study what they want, not because they're not smart enough, but because there isn't enough places on the course. I personally think this is a disgrace. They (government and colleges) have known for years that these courses are over subscribed, why haven't they worked towards adding more places?

I genuinely feel the issue is not enough staff as opposed to beds, as once someone is treated they can send them on their way (most of the time).

We're in this crazy position where the people in charge have been asleep at the wheel or just don't care. Ireland has the highest GDP per Capita in Europe after Luxembourg (which doesn't really count as it's basically a city state), we should have a world class health system, but it's near the bottom rung as far as the EU is concerned.

mohawk

I will hold my hands up and admit I am not an expert on this issue.

From outside looking in there are numerous issues causing this trolley crisis.

Not enough beds. Our population has grown, is ageing and yet we have less hospital beds then we did in 1981 (according to radio headline earlier).

We don’t have enough GP’s and this problem is forecast to get worse as more GP’s retire. Being a GP needs to be attractive to get more doctors to choose that speciality.

I am sure those working in healthcare will have hundreds of examples of unnecessary bureaucracy adding to their workload. Years ago I had a medical card and got a prescription from the hospital after being discharged in order to get the prescription filled for free I had to bring it to the GP and get them to write it (It was a particularly expensive drug so I couldn’t afford it). This might sound trivial but those small time wasting things all add up when dealing with multiple patients.

Issues with step down care. Patients no longer sick enough for an acute hospital but no where else for them to go.

Poor management of resources is another big one (this is not fault of Doctors and nurses). Doctors want to do the best for their patients and are doing things like keeping patients admitted so the patient can access diagnostic tests in a timely manner. Doctors shouldn’t be in this position.

The health service is now in a constant fire fighting mode which is making it harder to fix the issues. Things like cancellation of operations might help short term, however this can cause a knock on effect further down the line. When patients can’t get a procedure in a timely manner it can cause a deterioration in their condition which could lead to additional A&E or GP visits to stabilise the condition or cause the procedure to become an emergency which can often mean a trickier surgery and long time in hospital post-op.

Working conditions I suspect is contributing hugely to the recruitment issues the HSE is having. I left college well over a decade ago and back then I knew a load of newly qualified nurses who decided to do a year in Australia or NZ. Majority never came back purely because the working conditions abroad were vastly superior and they felt like they could give better patient care because of this.

Sure there are people accessing healthcare unnecessarily, however they aren’t on the trolleys right now. The nearest A&E to me is consistently the most crowded in the country. Majority of people I know don’t want to go near the place.

Like I said I am no expert, but successive governments and the management of the HSE have done nothing to improve the health service over the decades. The longer they leave it to do something the harder the task it becomes. This is not an easy fix at all.

Jarhead_Tendler

https://www.boards.ie/discussion/comment/120063440#Comment_120063440

If the HSE was managed properly and the doctors like your wife treated better could these vacancies be filled from here or abroad? I don't envy anybody having to work under the conditions your wife does. There has to be a better way for both staff and patients. Does she see any way that things could or will improve? It must be very taxing for her and indeed you and your family both physically and emotionally

Sunny Disposition

Read in the Irish Times today that Ireland has less than three beds per 1,000 people, compared to an international average of five. So it's not surprising that things are so bad in winter.

thomas 123

https://www.boards.ie/discussion/2058278103/the-current-hospital-a-e-crisis

This is not true at all.

Who in their right mind would actually want to ever go into a hospital let alone the vast majority?

The real issue is the route to care set up. Find me a GP that will do a stitch now? I went one time to get a small deep cut looked at by my DR he sent me to A&E for a tetnus shot, I gave up after 12 hours. Like others have said, if the end result is not an antibiotic with an obvious cause the GP will send you to A&E otherwise.

The center of excellence model is broken, things like stitches, broken bones, flu, should be looked after in non acute hospitals like Ennis, Nenagh and St Johns in Limerick. Imagine the pressure taken off Limerick if those cases were handled there?

Next is staffing, its well documented(Midwest Hospital Campaign) Limerick A&E can have one doctor over night in A&E, therefore if there is an accident, or a serious case that case will grind the entire building to a halt for hours, that is unacceptable for any hospital let alone one covering a vast area like Clare, Limerick, Tipp, and North Cork + Kerry.

In relation to your last comment about getting a GP appointment, My last GP refused to give me an appointment for 2/3/4 days always. I reckon it was due to being busy with Covid Jabs but who knows. It did not matter how sick I told them I was.

maninasia

Impossible to see a GP in many places within a week or two now. Some wont even take phone calls. Many refusing new patients.

maninasia

Family member has serious medical issue a while back. GP clinic wouldnt see him. Wouldnt even take a phone call to write a prescription or do assessment. Was left in agonisung pain.

Primary care is breaking down and that is why they are forced to go to the A&E.

Think about it.

Almost NOBODY wants to be at A&E if they can help it!!!