EDITORIAL: Self-inflicted ED crisis sad indictment

APOLOGIES by Minister for Health Simon Harris do little or nothing to mitigate the suffering of patients forced to wait for hours – and sometimes days – on trolleys in or near hospital emergency departments (EDs) in our acute hospitals for treatment, and for possible admission, due to the shortage of hospital beds that continues year after year. The setting in the past week of another unwanted new record for the highest number of patients on hospital trolleys is another sad indictment of the government and the HSE’s inability to get to grips with the situation in EDs, especially as it is entirely predictable because the number of people presenting with flu symptoms is always higher at this time of year.

The first week of January in recent years has seen shameful new records being set for people waiting on trolleys at EDs – from 601 in 2015 and, after a brief improvement the following year, it hit 612 in 2017 and, now, 677 as we entered this year. This is an escalating crisis that nobody in the Department of Health or the HSE seems to be able to get to grips with, so is it time to get outside expertise to fix the problems that cause it annually?

Even when the situation is not as urgent as it tends to be in the depths of winter, there can be 300 to 350 people on hospital trolleys countrywide a lot of days. Last July, Fianna Fáil’s spokesman on health, Billy Kelleher, warned that worse was to come unless the Minister Simon Harris began to deal with the root causes of the escalating trolley crisis. He said that the Minister has been talking up his efforts to deal with the crisis, but as Mr Kelleher pointed out, the situation has got worse since Mr Harris took office, reaching the latest record number last week.

The Minister opining last week that ‘no effort or resource is being spared to improve this situation’ smacked of too little too late, especially when what happened was so predictable. The measures being taken by the HSE now to alleviate the current crisis, including having consultants available for longer hours to effect patient discharges and increasing access to home and transitional care, are ones that should be in place at all times – and not just during emergencies like this – otherwise, the overcrowding problems at EDs will never be solved.

The Minister restated his long-term priorities also, including ‘the bed capacity review, the slaintecare implementation plan, the home care scheme, nurse recruitment and investment in primary care, plus working with GPs on a sustainable future.’ We’ve heard all this before, but have seen very little progress, which is why things are still as bad as they are.

The most important element of this should be investment in primary care, but former Minister for Health, Dr James Reilly’s call for a ‘seismic shift to primary care’ on radio last week was not appreciated by the National Association of General Practitioners (NAGP), who accused him of ‘political grandstanding,’ especially given his own failure to get to grips with the perpetual shortcomings of the public healthcare system during his time in office. 

The NAGP said it is ‘deeply upset over the inhumanity of having vulnerable adults and children waiting for long periods in emergency departments’ and was not at all appreciative of Dr Reilly’s intervention, given that during his time as Minister, they maintain, he set primary care back by at least a decade, with GPs ‘forced to endure savage cuts, which continue to affect the delivery of care to patients.’ His successors as Minister for Health, Leo Varadkar and Simon Harris, also failed to improve matters, in spite of the millions upon millions that have been pumped into the health sector. 

The bed capacity review, which is due to be considered by the government, recognises the reality that at least an additional 2,500 hospital beds will be needed by 2030, which will cost €2.5bn to put in place and €766m annually to run them.

It seems sometimes as if money spent on healthcare is just being devoured in a bottomless pit, begging the question: it is being spent in a properly-targeted manner that leads to tangible progress and results? Some independent oversight would help here, while political point scoring on the matter is utterly distasteful given the gravity of the current situation.