The answer to the Hospital Trolleys Crisis: Lemsip!!!

iamwhoiam wrote: »

Its a €100 to attend A and E without a GP referral

Not with Medical Cards. 44% of people have one.

Snickers Man wrote: »

The 6:1 news on RTE yesterday (Monday 6th Jan 2020) led with the by now regular news item from Fergal Bowers, RTE's medical correspondent, that there were "record numbers (760) of patients on trolleys in our acute hospitals."

Usual over-wrought description of chaos: Ambulances backed up for hours waiting to unload patients into gridlocked A&E departments; non emergency surgery procedures cancelled; the usual litany of interviewees: spokesperson from the INMO, soundbite from De Minister, outraged patients/passersby outside hospitals tut tutting and saying how the "whole world's in a state of chassis".

And just in case you didn't get enough of Fun-time Fergie, there he was back in the RTE news office offering some insightful analysis of where it's all going wrong. Verbatim transcript:

Interviewer: "What is causing the problem to be at such a record levels this year?"

Fergal Bowers: "Well this is traditionally one of the busiest weeks of the year for the country's acute hospitals. It's the post Christmas/New Year surge which is predictable. People have been socialising, gathering in large gatherings and that aids the spread of influenza and colds. People may have put off attending a doctor over the festive season and are now turning up at hospitals. While the flu has peaked it it is going to continue to affect the hospital system over the coming weeks.
.......
We have an aging and growing population. The capacity of the system is not sufficient to cope with this surge that we are seeing."

Are you f***ing kidding me? People go to the A&E departments of acute hospitals because they have a few sniffles??? What the hell is wrong with saving themselves a lot of trouble (and the health service a lot of scarce resource) and just going down to the local pharmacy for some rudimentary over the counter medicine? Like a Lemsip??

Can staff at A&E not be empowered to tell people who are clearly ill but not dangerously so to go home, tuck up warm and have a hot whiskey with a nice squeeze of lemon inside? By being indulgently nice to someone who shows up with a shiver and a temperature we are being necessarily nasty to genuinely acute patients who may have suffered a car accident or a fall or an illness that necessitates hospital treatment.

Think of it this way: if your elderly mother HAD to go to hospital for an important procedure or because she had been diagnosed as seriously ill and had to wait for up to seven hours in the ambulance at the loading bay because some indulgent jerk ahead of her only needed a cough bottle, what would you think?

I know. Some of you are going to say I'm "Victim blaming" but I am only going by what RTE's esteemed Health Correspondent offered as his "analysis" of the problem. Colds and flu....in ACUTE hospitals??

GTF outta here. Literally.

I think this is a hugely disingenuous post, and shows a very naïve understanding of a complex problem. I will desist from commenting on the political motivation for your post.

First of all, thanks to your friends in FG, and previously FF, bed capacity has been significantly cut over the past decade or so. The crisis that is unfolding is not an A&E crisis - it is a bed supply crisis that becomes severe at peak periods of demand. The problem is not with the demands placed on the A&E department, but the fact that once a decision is made to admit a patient - on the basis that they are no clinically safe to be at home - there is insufficient bed capacity (and associated staffing) to expediently admit the patient.

Second, the argument that people turning up with the flu to an A&E departments is the problem is nonsensical. Certain groups with the flu need top be admitted - in that they need IV antibiotics and oxygen. These include the very old and very young, those with weak immune systems, and those who have respiratory conditions such as COPD, asthma, etc. People turning up to A&E outside these categories will likely never see a doctor because they are triaged. Very few people who truly have the flu, and don't need to be in the hospital, are going to sit on a hard plastic chair (if they are lucky) in an overcrowded room for 24hrs.

Third, you haven't mentioned the drunks, druggies, homeless and wanderers. I guarantee you if you attend a city ED right now, you will see these people hanging around. They need to come through due process - and some of them have complex medical needs; most others are looking for somewhere warm.

Fourth, we also have to ask ourselves why people are turning up to the A&E with flu like symptoms. It is because primary care also lacks capacity - GPs, public health nurses are the unsung heroes - but they are pressed to capacity as well. A predictable consequence of FG's election grabbing attempt to sway family voters by offering free GP care but without properly resourcing the same. Most people with flu don't need to even attend their GP - BUT, in other countries GPs can administer anti-virals that limit flu. The people who have to wait three weeks to see a GP end up attending A&E with more severe illnesses, including pneumonia. They need to be admitted.

So unless you can see that this is a supply issue, you really are being blind to the root causes of this problem. The root problem is government policy - not only on beds, but in their refusal to meet with consultants. It is also a fallacious believe that investments in primary care this year will immediately manifest in less attendances and admissions to A&E - the effect is cumulative, and will require bigger, sustained investments, negotiations with consultants, and smarter ways of working to resolve. It also requires behavioral changes on the demand side - I agree with you that the A&E department should be a place of last not first resort. We also need to do more about hygiene.

Structurally, we need to think about dedicated public centers for elective surgery. A smart start would be to acquire and nationalise some of the smaller private clinics, and test the model. Especially for orthopaedic, cardiac, and renal surgery - these could be become centers of excellence.

In summary, this is not an A&E crisis - it is a healthcare crisis that is manifesting itself in the lobby of the healthcare system.