For many years now our public hospitals have struggled to offer a bed to patients who have been medically assessed as needing admission. The emergency department malaise has ebbed and flowed, with an annual winter peak.
This year, it’s different. Whereas before one could make an argument that once admitted to an acute hospital, the care you received would be of an acceptable standard, sadly this is no longer the case. That bubble has finally burst.
The canary in the national public hospital coal mine is University Hospital Limerick (UHL).
Unprecedented warning signs about UHL have been flashing for some time. Last June, the Health Information and Quality Authority (Hiqa) issued a damning assessment of patient care at the hospital’s emergency department: in a report following an inspection visit, the State’s health watchdog found that the “overcrowded and understaffed” department posed a significant risk to the provision of safe, patient-centred care.
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Later that summer, 14 hospital consultants at UHL wrote to the hospital chief executive to voice their “deep concern” about the safety of patients attending the hospital emergency department. Seventeen hospital registrars added their voices of alarm.
[ University Hospital Limerick declares ‘major internal incident’Opens in new window ]
But perhaps the most worrying warning came last November from local independent TD Richard O Donoghue who told the Dáil about an open letter, signed by some 70 UHL doctors, listing patient safety problems on the wards of the hospital. The letter highlights several “near misses” in the medical assessment unit (MAU) where doctors say patients almost died due to understaffing and a lack of medical cover. It says patients have to wait more than 10 hours for a bed in the unit without medical attention while other “lost” patients are sometimes left unseen by doctors for a number of days.
People are dying in Irish hospitals because of delays in our emergency departments
This scenario chimes with anecdotes emerging from other public hospitals around the country. There are multiple stories of patients not being seen by doctors for a number of days following admission to wards. In one instance, a patient had to inquire of nurses who their consultant was – the name plate over their bed remaining unfilled for the duration of their stay. It seems the very basics of good care and governance are now missing from more than just our hospital emergency departments.
Last January, doctors from emergency departments across the UK published an important paper in the Emergency Medical Journal. It showed that delays to hospital inpatient admission for patients in excess of five hours from their time of arrival at the emergency department are associated with an increase in mortality. For delays between five and 12 hours, they found a predictable dose – response effect. And for every 82 admitted patients whose time to inpatient bed transfer is delayed beyond six to eight hours from time of arrival at the hospital, there is one extra death.
This metric shows indisputably that, on an ongoing basis, people are dying in Irish hospitals because of delays in our emergency departments. Amid record-breaking waiting time numbers such as we have seen this week, these deaths are multiplied.
What needs to be done? Certainly it requires more than a label of “unacceptable”, as offered by Taoiseach Leo Varadkar, when on his way to attend yesterday’s Cabinet meeting. The Cabinet has four former or current health ministers in its ranks, including the current Taoiseach and Tánaiste. They must form the nucleus of an emergency cabinet health committee, meeting at least three times a week, to deal with this unprecedented threat to the nation’s health.
Their first move must be to declare a “public health emergency of national concern”. Modelled on the World Health Organisation’s international response to the Covid-19 pandemic, such a declaration emphasises the critical nature of the problem and provides a framework for the kind of extraordinary response that is now required.
To facilitate the emergency response we need to abandon all elective hospital work until the end of February ... we cannot run an elective health system with the level of acute and emergency need we are seeing at present
The threat to people’s health posed by present circumstances is every bit as serious as the threat of a pandemic. We need an immediate Covid-19 level of response with reallocation of hospital staff from specialities with an elective emphasis to perform emergency department triage in areas adjacent to current emergency facilities. A second wave of temporary MAUs is also needed, to further unblock the system and to avoid delays to planned treatments.
To facilitate the emergency response we need to abandon all elective hospital work until the end of February. Yes, people will miss planned elective treatments during this period, but we cannot run an elective health system with the level of acute and emergency need we are seeing at present.
In the medium term, we need to set up a system of “flying squad” intervention teams to be deployed to any hospital labelled by a Hiqa inspection as unsafe. UHL has already passed the threshold for such an intervention and must be the location for the first such intervention.
And looking further ahead there is now a need for a “Sláintecare II”, with a focus on completely reconfiguring hospital care. Clearly we need more beds. However to fully staff these beds, we need to make working in the health system as attractive as countries such as Australia do (and where much of our graduating medical and nursing workforce now goes).
[ Whatever happened to Sláintecare?Opens in new window ]
While the present “tripledemic” of infectious diseases has pushed the system over the edge, our public hospitals are now dangerous places for many other reasons. We ignore that at our continuing peril.
Dr Muiris Houston is a medical writer and health analyst