The current hospital / A&E crisis

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.

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.”

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.

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.

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.

The magical Irish medical card.

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 !

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

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?!

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.

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”.

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.

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.

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