The recent crisis in hospital Emergency Departments, with a record 601 people on trolleys across the country, shows how fragile our rundown health service is. The crisis was not without warning. In 2006, former minister for health Mary Harney said it was a ‘national emergency’ when there were 495 patients on trolleys. In 2011, after trolley numbers peaked at 569, former health minister James Reilly said ‘never again’.
In December, staff at Beaumount Hospital were outside the gates protesting at the unsafe conditions in the hospital and the hospital’s Clinical Director resigned. Trolley numbers for December were one-and-a-half times what they were the previous December.
In early January the HSE official responsible for trolley waiting times, Dr Tony O’Connell, resigned after only 9 months in the job. Health Minister Leo Varadkar warned there might be a major crisis in January, set up an ‘emergency taskforce’ and then went on holidays.
€100 million recommended by the department of health in 2014 to avoid a trolley crisis was refused in the budget and watered down to €25 million, which was completely inadequate.
The health budget increased for the first time in 5 years but only by a miserly 0.7%.
With rising levels of demand and even low inflation this is effectively a cut.
The bank bailouts have meant austerity budgets targeting healthcare, first by Fianna Fáil and then by the current Fine Gael Labour government. Over 6% has been cut from the total health budget since 2008, while other EU countries increased their health spending.
Health staff numbers have been slashed by more than 10% from over 110,000 health workers in 2008 compared to about 100,000 in 2014.
At first the government blamed the trolley crisis on winter weather and patients staying too long in hospital and advised people to avoid going to hospital ‘unless it was necessary’, but the weather was not severe at the time and the government themselves were responsible for refusing to fund nursing home beds for patients in hospital ready to go home.
Cause of the Crisis
The real reason for the crisis is well known.
As the Irish Times reported: “The main reasons for hospital overcrowding are lack of beds and shortage of staff.”
Almost 30 years of neglect have meant the health service has never recovered from the savage cuts in hospital beds started by the Fine Gael-Labour coalition government in 1987 by Labour’s Health Minister Barry Desmond.
There were 18,000 beds in the 1980s compared to 13,000 now and many of these beds are not available due to closed wards.
Discharging patients to ‘step down’ beds was suggested by the HSE as a solution to overcrowding.
Professor Des O’Neill, an expert in care of elderly patients, warned of the dangers of discharging patients to ‘step down’ beds when what they need is a ‘step up’ to a rehabilitation unit.
These units should have properly trained staff such as nursing, physiotherapy, occupational, Speech and Language and other therapists for patients with serious conditions such as heart attacks and strokes.
Prof O’Neill further warned that: “The private sector has not distinguished itself to date in this type of service, and it is likely that public and voluntary services are the appropriate setting for any new initiatives.”