The new year has begun with depressing and all too familiar scenes of extreme overcrowding in hospital emergency departments. On Tuesday, a new record of 931 patients waiting for admission was set and, with flu still raging, the 1,000 mark for trolleys could be exceeded next week.
The consequences for patients having to wait long periods to be admitted to hospital can be dire. Many will have worse outcomes and some will die, international research has shown. The current overcrowding is – and everyone accepts this – completely unacceptable.
Minister for Health Stephen Donnelly has blamed the problem on a “perfect storm” of flu, Covid-19 and other respiratory viruses, and has pointed out health services in other countries are also feeling the pressure. This is true but apart from the UK, whose health service is undergoing a distressing meltdown, the rest of Europe seems to be managing more calmly than Ireland.
More hospital beds has been put forward as the answer by the Minister and by staff in the health service. Yet the Government seems to be on track to meet its own commitments in this respect. In 2018, a capacity review recommended the creation of about 2,500 extra beds by 2031. By last November, one-third of the way into the period, 1,000 had been added. Either these estimates will have to be revisited, particularly to take account of Covid, or other solutions will need to be found.
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In any case, providing extra hospital beds is expensive and staffing them takes too long. As Donnelly has noted, faster ways of building health infrastructure will have to be found.
None of this will address the immediate crisis. With flu cases still rising, the HSE expects the situation to get worse before it gets better. It has appealed to people to “consider all options” before going to a hospital, but this may discourage people who need medical care from attending.
The Minister pleaded with hospital consultants this week to come in at night and at weekends, outside their normally rostered hours, to speed up discharges. Predictably, medical organisations took umbrage, with the Irish Hospital Consultants Association pointing out that its members are on call 24/7 and often work over recommended levels. Senior staff remain in short supply, it pointed out, though this is partly due to the failure of the Department of Health and medical organisation to agree a new consultant contract.
The health budget has increased by almost ¤6 billion a year since 2019, with extra money left in place even though the Covid threat has receded. No other health system in Europe has received this kind of boost. Yet, in spite of some praiseworthy innovations, we are left with a system that is dysfunctional, lacks flexibility and is resistant to change. If this continues, we are doomed to repeat these winter crises for years to come.