The A&E unit at Dublin's Mater hospital is too small and is "not fit" to deal with the numbers of patients attending, according to an unpublished report commissioned by the Health Service Executive.
The report which follows an inspection of the unit by a firm of UK healthcare consultants, says the department "is severely compromised in delivering modern and responsive emergency care services because of the size and construction of the department".
And Tribal Secta consultants noted that while a new unit was to be built, this would be some years away and they felt steps should be taken in the interim to expand the treatment space in the department. This "may require Portakabin space", the report said.
Three portable cabins were offered to the hospital by the businessman Ben Dunne a year ago to ease pressure on its A&E unit but the offer was declined.
Furthermore, the report says the hospital's A&E is not equipped to deal with patients staying within the department for long lengths of time. Despite this, it says "given some of the challenges for bed availability within the Mater, as with other hospitals within the review, once a decision to admit has been made, it is not uncommon for a patient to undergo all their treatment on a chair or trolley within the department and be discharged from the department directly having never reached a ward bed".
The report on the Mater is one of 10 carried out by Tribal Secta late last year for the HSE. Details of six of these reports - which relate to Cork University Hospital, Galway's University College Hospital, Wexford General Hospital, Our Lady of Lourdes Hospital Drogheda, Beaumont hospital and Letterkenny General Hospital - have been published in recent weeks by The Irish Times, which obtained copies of them under the Freedom of Information Act.
Now the contents of the final four Tribal Secta reports which dealt with the situation at the Mater, Tallaght hospital, St James's and St Vincent's hospitals, have also been released to The Irish Times under the Freedom of Information Act and details of them are published here today.
The report on Tallaght hospital says patients can be on trolleys for seven days. Again at this hospital Tribal Secta says "many patients may actually never get into a bed" which is "wholly inappropriate for patients, family and staff". This hospital has also insufficient numbers of A&E consultants, they add.
In Tallaght, as in the Mater, St Vincent's and St James's, there were particular problems in trying to find facilities to discharge elderly patients to once they had finished their treatment.
It was also noted that ambulances were bringing patients into A&E at Tallaght "irrespective of their acuity and sometimes with minor conditions".
Meanwhile, Tribal Secta, while not asked to look at the issue of bed capacity in hospitals, has recommended a fresh review of bed capacity in an overall report on the hospitals published yesterday by the HSE. It is now being carried out by the HSE. Tribal Secta also noted that cuts in the 1980s have played "a significant part in the manifestation of waits" in emergency departments.
Yesterday the Minister for Health, Mary Harney, said if the public system could not supply diagnostics out of hours ,then "we will have to go to the private sector". Also yesterday, in response to a report that hospitals had been asked to install "hall beds" near overcrowded A&E departments, the HSE said it "would not support a policy which involves accommodating patients in hallways".