The current hospital / A&E crisis

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 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.

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

Not at this moment in time. You are wrong. That would be a patients' perspective at a normal busy time and if you don't mind me saying, would be fairly limited.

II have worked through this for the last 40 years and thankfully no longer have to. But this is much worse than any other year currently.

I know normally that what you say may be applicable.

But now the heat is on there will be extra scrutiny on who is coming in, whether they can be postponed safely with a referral for procedures at a later date or to be done on the NTPF in a private facility. There will be consultant led teams clearing bed blockers( as you refer to above) on the wards, discharging and sending to step down care anybody that can be.

You won't get people in for elective procedures or day cases. All will be cancelled Thise beds will be used as A&E overflow.

Thats how this situation works whenever there is a crisis. The problem is the double whammy of high Covid cases and Flu cases also requiring admission for oxygen and IV antibiotics and monitoring.

ICU is not overwhelmed.. yet.

Problem is not only lack of beds in acute hospitals but lack of step down hospitals (all those down graded and closed by successive governments) and lack of community nurses and community care (again poor policy decisions and no commitment by government to Sláintecare which could have alleviated this pressure on hospital led care)

The lack of nursing and medical staff due to attrition after Covid along with high costs of housing in cities, and emigration is another issue.

Not much point making more beds if there are no staff to run them.

We in nursing have been calling these issues out for many years and successive governments have tinkered around the edges but not taken the Healthcare system in hand and progressed a complete and ongoing reform . Slaintecare for all its failingswould have been a big improvement and was agreed as the way to go but is dying for lack of attention by one taoiseach after another.

You watch Leo pass the buck and Donnelly " overseeing" emergency measures that are already ongoing, vis a vis UHL. They will try to take the credit for what is already being done but as usual none of the blame, and once this crisis is over it'll be shoved behind the door until the next crisis, with nothing of any note or import done in the meantime.

Bit cynical I know, but all the positivity and hope gets knocked out of you when you have faced this year after year, all your working life.

Ireland needs a hugely expanded privatized primary care service.

At least with that the middle class can actually get to see a doctor for them and their kids. You pay money and you get a service. Its not cheap but at least it works.

The current situation is a huge disaster. Even if you are paying for prviate insurance, willing to pay the high GP fees you still can't see a GP within any reasonable time frame. Its causing so much pain and worry to patients as well as stressing the hospitals to hell.

Fail. Fail.Fail.

Start again with vastly expanded private clinic chains. Get private investment in to open more clinics and hire more doctors. They dont need to be surgeons just reasonably competent and AVAILABLE to see you. TIMELY treatment is a very important health metric. Clinics can then compete to offer better services.

GP system is absolute ****, a relic from the dinosaur age that charges high fees but can't keep up with the demands on it (increased population, aging population ) nor are they willing to work weekends and evenings much either.

I only recently learned about them. There is no mention of such things at the GP and pharmacy and the only place I learned about their existence was the A&E.

They or you should have kicked up more of fuss, you pay your PRIS and are entitled to the treatment under the public systems, a medical card has nothing to do with it.

Interesting

Lovely, so much of the country is nowhere near one!

That would explain why I haven't heard of them.

Exactly, they should be everywhere. We have one in our town. Amongst the family, we've had to use it 4 or 5 times (cuts that required stitches, a broken foot, broken rib) and it was great. Never spent more than 90 minutes in there, and that was including x-rays. They're only open during the day, though, and there's limits to what they'll treat. But still, they would take a huge load of A&Es if used properly and were more common.

The Triage teams in E.D.s should be empowered to turn away cases that can be perfectly well dealt with at minor injury clinics or private centres or primary care centres.

I know thats not how the system is supposed to work, but minor breaks, sprains and bruising simply cannot be at the E.D. in this period. The very old and very young and those with serious respiratory illness must be prioritised.

Obviously complex orthopaedic injuries should still come to the E.D., but not little Johnny's broken wrist or collar bone.

The prevailing 'compo culture' is partly to blame. Up to the 1990's or so, GP's would treat a large range of ailments and injuries but now they refer almost everything on to cover their backsides in case they may have missed something bigger. It's years since I've heard of a GP doing suturing, when once it was commonplace.

But who’s fault is that?

Cant blame a GP for covering their arses in a country where there is a payout every day for something ridiculous.

Its all about covering ones arse.

Ireland is finished.