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Child Item

The current hospital / A&E crisis

NIMAN

Appreciate that our hospitals are under resourced and under staffed, but why do I never hear any of the presenters, interviewers or columnists address the elephant in the room in this crisis?

The fact that the vast vast majority of people sitting clogging up A&Es around the country don't need to be there.

Heard a consultant on Morning Ireland say that typically 5% of people in A&E actually need to be there. That's a shocking stat and explains why we are in such a mess.

I know people are going to say they can't see a GP, but where we are, getting a GP appt isn't a big issue. Can people genuinely not get GP appts?

How much free time must you have to waste that you'd sit in a hospital for a few days, only to be sent home with some paracetamol.

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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.

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.

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.

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?!

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.

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

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 !

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 !

[Deleted User]

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.

SuperBowserWorld

The magical Irish medical card.

[Deleted User]

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.

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.

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.

[Deleted User]

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.

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.

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.

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? 😕

[Deleted User]

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.

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 .

Cluedo Monopoly

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

-------------------------------------------------------------------

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.”

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

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.

--------------

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.

Cluedo Monopoly

https://www.boards.ie/discussion/comment/120063497#Comment_120063497

You're right. It will only get worse unless work conditions improve. Nurses and doctors are leaving in droves.

Gregor Samsa

Over the years, I've been with both VHI and Laya, which both offer a Nurse Line service for medical queries. Any time I've ever phoned them, usually related to the kids when they were much younger, the ultimate advice was to go to A&E. We never actually did, because while the issues were concerning enough to seek advice, they definitely weren't serious enough to go to A&E for (which for us would be a 40 minute drive to Limerick and all it's overcrowding and issues). If they had been serious enough for A&E, we wouldn't have been wasting time phoning a nurse. But those services must be sending a hell of a lot of unnecessary traffic to A&E, because basically there's very little medical analysis you can do over the phone, and they have to cover themselves in case it is something serious, and so err on the side of caution.

Never been to A&E myself, but we've had to bring the kids twice. One fell out of a tree and cut her leg badly and needed stitches. If it had happened 30 minutes earlier, we could have brought her to the local Minor Injures Unit 5 minutes away, and she would have been sorted out within an hour. As it was, the unit was closed, so it necessitated the 40 minute drive and 9 hours in Limerick. The second time was another daughter who had been complaining of an intermittent sore stomach for a number of weeks. Brought her to the GP, who told us that it was probably nothing serious, but she should get a scan to rule anything physical out. He said that we'd be waiting months for a scan appointment, so to bring her to A&E to get it done there and then. Waste of recourses (and the scan was clear), but that's the game you're made play.

Dyr

https://www.boards.ie/discussion/comment/120063469#Comment_120063469

Allow even more to be pisssed into the black hole that is the HSE you mean.

Backstreet Moyes

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

Yes and people don't want the jobs because of the workload, which is only going to get worse.

Why would someone want to take a job here working themselves into an early grave.

When they can move somewhere else and have less of a workload.

We are training up healthcare staff and they are then immigrating once qualified.

We can't get gp's to cope with the demand and the current ones will eventually retire.

All while we keep telling everyone in the world to come on in.

We are heading towards a bigger population and less staff to manage then we currently have.

I would hate to see what things will be like in 10 years.

I would like to see what plan we have for this to work, the only thing I have heard is to advise people to wear masks.

[Deleted User]

https://www.boards.ie/discussion/comment/120063404#Comment_120063404

Can’t dispute that we pay enough in taxes, and Government spend in healthcare is enormous, perhaps we need the German model, where 7.3% of everyone’s income is deducted for health insurance. That will give a huge boost to the health pot and allow more to be spent.

Dyr

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

We all have private car insurance, we all have private house insurance, theres no reason that public health insurance won't work the same way. And, yes given that this is Ireland, the insurers will try to create a cartel and the government and regulators will be in on it but its still better than a system run by TDs and unions.

healthcare is a mess because its run by the government. Unless you change that you wont fix it.

[Deleted User]

https://www.boards.ie/discussion/comment/120063396#Comment_120063396

The jobs are advertised, personnel do not want them, how does that equate to “not hiring enough”?

I agree with you, more staff are needed, but you can’t stop staff leaving, and you can’t make people take jobs they don’t want.

Cordell

https://www.boards.ie/discussion/comment/120063346#Comment_120063346

When everyone have private insurance no one really have private insurance.

I can bet that both of us know someone who's working for the HSE but not as doctors and nurses. This is the main problem, Ireland spends a lot on healthcare, but employ too many useless paper pushers.

And of course the population increase, mostly through immigration, is a big factor no matter how hard some are trying to deny it.