Trolley numbers being massaged by hospitals, committee hears

Hospital trolley numbers are being massaged by hiding patients waiting for admission out of the emergency department, an Oireachtas committee has been told.

The real number of patients waiting for admission could be twice as high as the HSE’s official count, according to a senior emergency department consultant.

On some days, there can be over 1,000 patients waiting for admission - or 10 per cent of all beds in the country, according to Dr Mick Molloy of the Irish Medical Organisation.

The HSE has issued directives to hospitals not to count certain patients who have been through ED and are waiting for a bed, he told the Oireachtas health committee, including those placed in daycare or day surgery beds, or in the acute medical assessment unit.

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This was displacing other patients and activities and yet the people involved were not reflected in the HSE’s daily TrolleyGar count of patients waiting for admission, he said.

Dr Molloy said the health service had a huge capacity issue that needed to be addressed by quick "modular builds" of facilities. "China could build a hospital in 10 days at the start of the pandemic - why can't we do something similar?"

Irish Nurses and Midwives general secretary Phil Ní Sheaghdha said that on some days hospitals had “two wards’ worth of patients” from whom there was no allocation nurses.

Trolleys were being moved from ED into other areas so they don’t form part of the HSE’s count, a practice she described as “scandalous and not acceptable”.

On Wednesday, according to TrolleyGar, there are 392 patients waiting for admission, more than twice the number on the same day last year and similar to two years ago. The INMO says there are 515 patients waiting for admission, according to its TrolleyWatch count, which includes patients in ED and on wards.

‘Persistent failure’

A number of health union representatives address the committee on the persistent overcrowding issue in hospitals.

Overcrowding and long waiting lists are the “direct results of a persistent failure, by successive governments, to invest bed capacity, infrastructure and medical workforce to meet the needs of a growing and ageing population,” Dr Molloy said.

Twenty years ago, a need for an additional 5,000 hospital beds was identified yet despite a one million increase in population, there has been “little positive growth” in capacity.

Dr Molloy called for “urgent and simultaneous investment is needed in a range of measures, including 5,000 additional beds, a near-doubling of critical care beds and more investment in diagnostic, radiology and lab departments.

“There is unfortunately no quick fix to hospital overcrowding. However, without concerted investment across our health system we will likely be discussing hospital overcrowding crisis for many years to come.”

Legislation should be implemented to underpin staffing levels in hospitals and other parts of the health service, according to the INMO.

Bed occupancy should be reduced to 85 per cent and the Government should commit to the multi-annual funding of Sláintecare, the union said.

‘Cry for help’

Issuing a “cry for help” for the health service, Ms Ní Sheaghdha likened nurses calling out for action to whistleblowers. “When the frontline is screaming for assistance, someone must listen and take action.”

She said 12 hospitals have so far been funded to implement safe staffing on surgical and medical wards but the rest of the State’s 50 hospitals do not have it.

The INMO also called for a strengthening to health and safety legislation to protect staff. Over 7,600 assaults on healthcare workers were reported last year, half of them on nurses, Ms Ní Sheaghdha told TDs.

This included more than 5,800 physical assaults, 41 sexual assaults and almost 1,700 other assaults.

In one case, a nurse who suffered a career-ending assault had to work on for four hours after it because no-one else was available to take over.

Siptu sector organiser John McCamley said overcrowding was returning to pre-pandemic levels. The national average for turnaround times at an emergency department now stands at 54 minutes but on occasions there have been delays of seven to 14 hours.

A number of committee members called for an independent review of University Hospital Limerick, which has the worst overcrowding figures in the State. Midwest TDs also questioned why senior management in Limerick had moved to offices 2km from UHL, rather than being based in the hospital.

Sinn Féin's health spokesman David Cullinane said failings in management need to be addressed in situations where resources are allocated and delays continue to occur.

Calling for zero tolerance in relation to hospital waiting lists, he said it was not fair to either patients or staff when these occurred.