If it is January then it must be time for the annual surge in patients waiting on hospital trolleys. Although numerically not as severe as this time last year, the beginning of the yearly crisis was evident last week when 54 patients at Beaumont Hospital in Dublin were waiting for an in-patient bed. University Hospital Limerick, University Hospital Galway and Our Lady of Lourdes Hospital Drogheda also topped the daily league tables compiled by the Irish Nurses and Midwives Organisation (INMO) and the Health Service Executive (HSE).
The INMO failed in its bid to have Beaumont taken off prolonged ambulance call, although the hospital subsequently redirected people attending with minor injuries to a satellite rapid injury clinic. But this will not deflect the rising numbers of older people, many with established chronic illness, who become acutely unwell with respiratory and flu-like symptoms at this time every year.
And, in the absence thus far of the seasonal influenza outbreak, the number of patients with respiratory problems and infectious illness requiring urgent hospital treatment is likely to increase. A sustained cold snap could also add to emergency department (ED) pressures.
The renewed threat of industrial action by the INMO this week in seven of the State’s acute hospitals will not help. The union should consider not choosing hospitals with high trolley numbers for threatened industrial action this winter. The complexity of healthcare is reflected in the reality that a solution to the current ED impasse will have a knock-on effect of causing non-emergency waiting lists to lengthen. This is because overcrowded hospitals will be required to cancel or defer elective procedures to reduce the number of trolleys in emergency departments.
With a general election in the offing, it is perhaps not surprising that Taoiseach Enda Kenny and Minister for Health Leo Varadkar have declined to repeat a 2011 election pledge to bring an end to the hospital trolley crisis. The Government has invested more than €70 million in additional funding to address delayed discharges from hospitals of patients who have completed acute treatment; the resulting speedier access to the Fair Deal nursing home scheme is reflected in a reduction in length of stay figures. But much remains to be done, including a comprehensive multi-year investment in general practice and primary care to build infrastructure so that more patients receive quality care outside the hospital sector.
Meanwhile, overcrowded EDs continue to make it difficult for staff to fully examine and adequately treat patients, while adding to the risk of cross-infection. This represents a clear threat to patient safety, something acknowledged by Mr Varadkar. It is one of many reasons why hospital overcrowding must feature prominently in the forthcoming election campaign.