Editorial: Health service chaos?

ONE hopes that all the gloomy predictions that have been made in recent weeks about the ability of our health service to cope this winter don’t come to pass. However, it is difficult to be optimistic about the service’s ability to meet demands in hospital emergency departments in particular.

Last March, an unwelcome new record for people waiting on trolleys in emergency departments was set when the figure reached 714; already this month the figure has hovered around the 600 mark on a few occasions. Way back when Mary Harney was Minister for Health, when the figure reached 495, it was regarded as a national emergency. However, since then and several health ministers later, things have continued to get progressively worse and there have been warnings from within the medical profession that the number could hit the 1,000 mark this winter, which would be an absolute disaster and a damning indictment of the HSE and the Department of Health. 

The health budget has continued to increase year-on-year, with a record €17bn allocated for next year, but the services have not improved commensurately. Dr Peadar Gilligan, president of the Irish Medical Organisation (IMO) – who works as an A&E consultant in Beaumont Hospital in Dublin –  pulled no punches when he said that what the authorities will be spinning in January when the trolley count mounts as a ‘flu crisis’ or a ‘winter crisis,’ is no such thing: ‘It is a failure of policy,’ he declared. 

Dr Gillligan predicted that under-funded hospital emergency services, combined with a lack of beds and experienced doctors, will put hospitals under intolerable pressure this winter. This will result in further misery for seriously-ill and elderly patients stuck on trolleys in emergency departments due to a severe shortage of hospital beds to which people in need of treatment can be admitted. 

In recent years, there seems to be a greater incidence of older people left on trolleys while awaiting assessment and treatment at emergency departments, which makes the ordeal even worse for the patients and their relatives. This is just not acceptable.

Minister for Health Simon Harris opined that more hospital beds are coming on stream – with 2,600 promised over the next 10 years – but while it is patently clear that the roll-out of these needs to be front-loaded, this is not happening. Mr Harris has said €10m is being made available in 2019 to increase acute bed capacity this winter. 

It seems that some of the 79 such beds coming are due to be in place by the end of this year, but the majority of them are not expected to be ready until early 2019 – and probably not until after the peak demand that usually hits in January. 

In a broader context, currently, there are 500 unfilled consultant posts while 1,000 extra GPs are needed, along with a crucial cohort of nursing staff to enable new beds to come into service. A determined and sustained recruitment drive is needed to fill all these vacancies.

More nursing home beds and home care packages also need to be provided in order to free up acute hospital beds. 

The imminent National Service Plan announcement for 2019 will reveal how the Department of Health and HSE have agreed how to allocate the massive health budget. It would be nice to think that we could look forward to getting value for money, but that will – sadly – probably remain an ongoing pipe dream.

In the meantime, former Health Minister and current Taoiseach Leo Varadkar has not helped morale among health service frontline staff by trying to discourage them from taking leave during the busy Christmas period with his remarks also being endorsed by the current incumbent. Add to that the threat of industrial action by members of the Irish Nurses & Midwives Organisation, and psychiatric nurses, over wages and staffing levels, as well as a pre-existing work-to-rule threat over pay by hospital consultants who are members of the Irish Medical Organisation.

It is difficult to envisage how another winter of discontent in the health sector can be avoided.