EDITORIAL: Worst fears realised by ED chaos

IT wasn’t as if Minister for Health Simon Harris was not aware that there were huge risks of large-scale overcrowding again in Emergency Departments (EDs) in January, as it has been a peak time for it in recent years and the HSE had warned him about the strong possibility of this happening before he published his Winter Initiative in the autumn, but he pressed ahead regardless and looks rather naïve and foolish now given the events of the first week of January.

The highest number previously recorded of patients waiting on trollies for treatment or hospital beds in EDs throughout the country was 601 in January 2015 and this provoked such an outcry that the then government, with Dr Leo Varadkar in the health ministry hot seat, pledged that it would it would never ever happen again. In his over-optimistic Winter Initiative, the current minister set a target to have the number of people on trolleys reduced to 236 in a day by early December. 

As many sceptics – ourselves included – predicted at the time, this did not happen and then far worse was to follow at the start of this month when the numbers of trolleys on the 3rd hit a new record high of 612. This was due to a combination of factors, the main one being a severe outbreak of influenza which mainly affected older people, necessitating hospitalisation in many cases.

Minister Harris’ Winter Initiative failed to plan properly for a worst-case scenario, as has happened, and the numbers may not have peaked yet as we have had relatively good weather so far this winter with little or nothing in the way of extremes that could put further pressure on EDs. A good plan must always factor in the worst-case scenario and, according to documents obtained by a journalist under Freedom of Information requests, the Department of Health put pressure on the HSE in advance of publication of the Winter Initiative to play down warnings about the risks of overcrowding in January.

If this was, as Labour Party spokesman on health Alan Kelly intimated, in order to generate more positive reporting on the plan, then it backfired very badly. Simon Harris’ initial attempts to deflect the blame for the overcrowding fiasco away from himself did not do him any favours; as Minister for Health, the buck stops with him.

His talk about the ‘building blocks’ he is putting in place to provide a long-term solution to the problems of the health service is good in theory, but some interim solutions are urgently needed in order to relieve the suffering and indignities being endured by patients in our hospital EDs, which is through no fault of the hard-pressed and hard-working staff of these units, we hasten to add. 

Our ageing population is being blamed for some of the pressure being put on EDs, but we have known about this increasing demographic for years and, again, successive governments have failed to plan properly for it. Apart from the obvious necessity to increase the number of acute hospital beds – particularly outside of Dublin – and recruit the staff to run them, a lot more needs to be done at primary care level in the community to take the pressure off EDs.

The National Association of General Practitioners has welcomed the acknowledgement by HSE Director General, Tony O’Brien, that there needs to be a redesign of the health service with a decisive shift towards general practice and primary care. Ironically, funding has been taken out of general practice and, according to NAGP chief executive Chris Goodey, ‘the profession is in crisis as a result.’

In some parts of the country, there are waiting lists building up for appointments with GPs, because – according to figures from the Irish Medical Council – Ireland has just 63 GPs per 100,000 people, well below the international standard of 81 per 100,000 people. It is difficult also to find young doctors to work in the general practice area, so funding needs to be provided to make it more attractive for them.

This is part of a longer-term solution, so in the meantime, every available hospital bed must be made use of where people need to be admitted after being seen at EDs. There are beds in private facilities that could be brought into service and more people could be discharged from acute hospital beds for step-down care in nursing homes, given that a snapshot survey by Nursing Homes Ireland the day after the numbers of people on trolleys in EDs peaked showed that 176 nursing homes had immediate bed availability of 742; the NHI has 370 members, so the total figure could potentially be double this.

And, as Irish Nurses and Midwives Organisation general secretary Liam Doran maintains, in order to ensure timely discharge of patients from acute beds, people with the authority to do so must be available seven days a week instead of just Monday to Friday.