Over 510 patients on trolleys in hospitals across the country

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Mrs Eileen has been waiting for a hip replacement surgery for six months; she lay awake every night in pain, worrying that she might not have access to medical care on time.

This is the case of almost 542,000 outpatients waiting to be seen by a specialist for the first time in public hospitals according to a recent data published by the National Treatment Purchase Fund. Of those, more than 216,500 have been waiting for more than nine months, and almost 100,000 have still not had a first appointment after a year and a half.

The HSE in 2018 promised a plan for outpatients, that nobody would be waiting more than 15 months for surgery or an outpatient appointment.

The 2018 service plan that never materialised had set out to carve up its €14.5bn budget between various health services, while promising extra funding across a range of areas including home care, disability services, mental health care, hospital beds, diagnostics and scoliosis operations for children and adolescents.

More resources, more staff, more beds still no change

Figures from the Central Statistics Office (CSO), current health expenditure was €18.4 billion or 10.7% of GDP in 2011 and in 2016, expenditure was €20.3 billion, representing 7.4% of GDP.

The majority of health expenditure in 2016 (€14.6 billion or 72%) was financed by the government while the remainder was mainly funded by household out-of-pocket payments (13%) and health insurance (15%) according to the CSO.

The HSE on the other hand has experienced over the years its fair share of challenges in relation to the recruitment and retention of[ clinical staff, and the actions necessary to ensure compliance with statutory limitations on working time.

In spite of these challenges, the HSE spent over €114m on agency staff in 2018, according to figures released to Sinn Féin’s health spokesperson Louise O’Reilly.

Agency personnel are only used where there is a difficulty in recruiting and employing hospital staff, and where there is a short-term critical need, or to permit flexibility to allow for variations in activity, or to meet patient demand needs.

A lot of questions beg for answers; such as, it is obvious that agency staff hired to plug staffing gaps is significantly more expensive than direct employees why not hire staff members directly?

According to the press release by Irish Nurses and Midwives Organisation (INMO) last month over 10,000 admitted patient were forced to wait without hospital beds in January of 2019 alone, this figures represent a 55% increase 10 years ago and 30% increase 5years ago despite increased funding since 2011. Why has there not been a significant change in the trolley figures?

Unfortunately the HSE and the Department of Health declined any comments or interviews.

The Irish health crises also extents to the INMO and employers. The INMO was deadlocked at the Labour court in February of this year in negotiations for a new contract that was to accompany a higher pay scale – part of a proposed resolution to the nurses and midwives’ strike in February of this year.

During a phone interview, a spokesperson for the INMO said that government previous contract terms was would have put nurses and midwives in some of the most insecure jobs in Ireland, allowing unilateral changes to work locations and hours.

“The government’s proposals were completely unreasonable and we are glad to see the Labour court has recognised this” he said.

He added that “there is no longer any cause for agitation in the new contract and the INMO would recommend acceptance of the Labour court’s ruling to its members”

What government policies will work in resolving the current health care crises?

The IMO expressed their views in relation to the existing problems in the Irish health sector and proposed solutions.

According to a report by the IMO “Long-waiting times in Emergency Departments impacts on the quality of care, on patients’ outcomes and on mortality.”

“Prolonged length of stay in the Emergency Department leads to overcrowding, which in turn impacts negatively on the safe delivery of care.”

“Numerous international studies show that Emergency Department overcrowding is associated with increased mortality and poorer outcomes for patients, whether admitted or discharged following assessment in an overcrowded”.

IMO insists that Emergency Department overcrowding is associated with high levels of stress and burnout among healthcare professionals particularly medical professionals, which exacerbates existing difficulties in recruitment and retention.

IMO recommends that in order to improve patient outcomes, many countries have introduced ED performance targets of between 4 and 6 hours for patients to be admitted or discharged from the time of arrival at the ED.

The Emergency Medicine Programme (EMP) set a target that 95% of patients should be either admitted or discharged within 6 hours of arrival, a target that is supported by the IMO.

The target recognises that a small minority (5%) of patients with complex issues may require longer than 6 hours and sets a target that 100% of patients should be admitted or discharged within 9 hours. The EMP also sets a target that no more than 5% of patients should leave the Emergency Department before being seen.

In order to achieve the 6-hour target, IMO is proposing 6 solutions – increase in acute bed capacity, increase in access to long-term and rehabilitative care, increase of staffing levels, improved access to diagnostics, design of emergency departments to improve patient flow and to resource general practice and care in the community.

Trolley numbers represent the unacceptable wait that patients in Ireland experience when they require emergency admission to hospital. The system needs to respond to the plight of every individual patient and put in place the resources to ensure that 95% of patients attending an Emergency Department in Ireland will be admitted or discharged within 6 hours of their arrival.


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