The Emergency Department Taskforce Action Plan was published yesterday by Minister for Health Leo Varadkar and Minister of State Kathleen Lynch. This report, the fourth such initiative over the past nine years, contains a range of actions, together with specific funding for an expanded Fair Deal scheme, aimed at alleviating the chronic problem. We now move to the critical implementation phase of the plan.
The Irish Nurses’ and Midwives’ Organisation began its daily trolley watch count in 2004. At 9am each morning, the INMO contacts every acute hospital to establish the number of patients who have been admitted but, because there is no bed, are being cared for on trolleys in areas across the hospital. The INMO publishes these figures daily at inmo.ie
In 2007 the then Minister for Health, Mary Harney TD, stated it was a national emergency when over 570 people found themselves on a trolley, with no bed available. There were some efforts made to reduce overcrowding. All have failed, been short-term and have not generated the service-wide response required.
Since 2009, the overcrowding situation was exacerbated as a direct result of the overt policy, of successive governments, to downsize our health service, reduce staffing levels, close beds and curtail other services in the face of the crisis. This has left our health service poorly staffed, uneven and unable to meet, with dignity, privacy and quality-assured care, the demands being placed upon it. Recent Health Service Executive internal reports have confirmed the health service was doing less, with less, and the quality and quantity of services available were not adequate or satisfactory.
In the latter half of 2014, the INMO’s Trolley/Ward Watch figures confirmed the number admitted for care, but being maintained on a trolley, was increasing, on a month-by-month basis. In 2014, 77,091 admitted patients were on trolleys as compared to 50,402 in 2007. This deterioration came about from a number of factors including the closure of over 2,000 beds, the lack of funding for the Fair Deal nursing home scheme, which has left over 800 people in acute hospital beds when they had been clinically discharged, and a contraction of community and homecare services. This was all against a backdrop of demographic pressures and increased demand in our emergency departments and health services in general.
Solutions not implemented
The Ministerestablished the Emergency Department Taskforce in late 2014. It is charged with bringing forward an action plan capable of tackling this crisis. However – and this is critical – there is nothing new with regard to what causes emergency department overcrowding. Each action now identified and required to reduce overcrowding has been clearly identified numerous times over the past 10 years but not addressed.
Overcrowding, whether in the emergency department or inpatient wards, cannot be solved without Government and health service management recognising that our health service is too small and we must increase capacity. The new Fair Deal initiative is positive but we must also expand our public health system.
The first thing Government must do is allocate additional resources to the health service, so that it can open closed beds, (both acute and continuing care), and restore community-based nursing and home-help services. This will not be a waste of taxpayers’ money, as our health service is productive and efficient but is simply too difficult to access. Second, we must expand the bed capacity in the acute hospitals facing the highest levels of overcrowding. We must also open publicly funded long-term care beds in specific areas, ie North County Dublin and Louth/Meath and this is provided for in the new action plan.
The third step must be to recruit additional nursing and other frontline staff, to allow these expanded services be safely staffed. The fourth step, and this is also covered in the report, is we must improve hospital practices leading to cross-consultant discharge, delegated discharge and expanded roles by nurses, including the ordering of diagnostics. We must also see consultants from core specialities (ie medicine/surgery) present, on a rostered basis, during the extended working day. The fifth step, and pivotal in the longer term, is real, sustained, investment in primary care leading to the provision of services on a 7/7 basis.
None of these steps is new or radical, but they are required. Overcrowding will not be solved until we expand our health system. However, is there a willingness by Government to accept this? And, if necessary, maintain progressive and fair taxation to fund a larger health service?
Dignity of care
Patients and health service staff want these changes, and the Government must allow allocating additional resources immediately. Our public health service is efficient once you access it, and is staffed by excellent people, but it must be fit for purpose. All patients deserve care with dignity and we will fail them for as long as overcrowding continues. It must end.
Implementing, with additional resources, the taskforce report is a critical and long overdue initial step. Liam Doran is general secretary of the Irish Nurses’ and Midwives’ Organisation, and joint chair of the Emergency Department Taskforce