Hospital crisis requires true leadership and prompt action
Analysis from Irish Independent on ED crisis from 7 January 2015
So where is Leo Varadkar when he is most needed? As the numbers of very sick people on trolleys hit a record high and hospitals went into full meltdown in the first week in January, Mr Varadkar was uncharacteristically nowhere to be seen or heard.
Just two weeks after Varadkar convened an Emergency Department Taskforce, the numbers of people waiting on hospital trolleys hit over 600. And to make matters even worse, Tony O’Connell the recently appointed HSE National Director of hospitals and newly appointed chair of the taskforce, resigned on the same day that trolley numbers reached their highest yet.
It would be really interesting to hear from Tony O’Connell what happened the great white hope for Irish hospital reform between the 22 December when was announced as the taskforce chairman and 5 January when he resigned?
Despite the pre-Christmas announcement of a new taskforce, the membership of the task force is not yet confirmed, there are no minutes of its first meeting, it is now without a chairman and its convenor, Mr Varadkar, is absent from the debate, so far.
In his absence, a HSE hospital chief, the HSE’s Deputy National Director of Hospitals, Angela Fitzgerald, was rolled out on national airwaves to defend the indefensible.
Cathal Mac Coille’s ‘Morning Ireland’ interview was an exemplary case of a great interviewer and poor interviewee who did not answer straight questions. Inexplicably, Ms Fitzgerald would not reveal how much the HSE sought from the Department of Public Expenditure to address hospital overcrowding last October, even though a figure of €100 million had already been published in a national newspaper that same day.
And despite acknowledgement from both nurses and emergency medicine doctors earlier on the same show that hospital overcrowding was putting patients’ health and lives at risk, she refused to answer a question, eight times, on whether Irish hospitals were safe places to be.
While there are many grey areas in medicine and healthcare, the evidence on hospital overcrowding, long waits in Emergency Departments and patient outcomes are black and white.
There are unanimous findings from Australia, Canada and England which prove that over-crowding and longer waiting times in Emergency Departments increase the need for hospital admission and poorer health outcomes, as well as the greater likelihood of preventable deaths. In other words, they are not safe places for patients to be.
In totally classic HSE newspeak, Ms Fitzgerald introduced the term “urgent emergencies”. The vast majority of people do their best to avoid going to hospital unless it is an emergency. By their nature, all emergencies are urgent. No one is deemed in need of hospital admission who is not in need of a hospital bed, they are simply discharged. Instead of holding up her hands and admitting the hardship that is facing every single one of the 601 people on trolleys yesterday in Emergency Departments, hospital wards and corridors around the country, Ms Fitzgerald said that they had anticipated this crisis last September and got extra money to address it. Quite clearly the numbers alone prove the HSE have failed to prevent this crisis.
Problems in Emergency Departments are symptomatic of dysfunction across the health system, problems which have been evident since the 1990s. The 2001 health strategy committed to ‘a substantial programme of improvements in accident and emergency departments’ (as they were then known). Included in this was more specialists in emergency medicine, increased use of nurse practitioners, acute medical assessment and minor injury units.
There was also a commitment to 2,800 more acute hospital beds and 5,600 community nursing and step-down beds, including Micheal Martin’s promise to build 17 50-bed community nursing units and a primary care strategy to address the crisis. Even though these commitments were made when the State was sloshing around in its own economic bubble, there are now fewer acute hospital beds and public community nursing home places than there was then.
Next in office, Mary Harney promised to address the crisis with a 10-point plan in 2004. In 2005, then HSE chief Brendan Drumm said it would take two years to solve. In 2006, Mary Harney declared the crisis in A&E “a national emergency” and established an Emergency Department Taskforce that produced a report detailing a range of measures required to address the problem, for which there was undisputed support.
But the trolleys never went away, the shelves of reports on what to do were ignored and just as James Reilly took up the post as health minister in 2011, he promised that “never again will we see 569 trolleys in Emergency Departments”. Reilly was wrong and for the first time numbers hit over 600 this week.
Solving the Emergency Department crisis means investing in primary care and community services to prevent people ending up in hospital in the first place or to get them out of hospital when they are ready for discharge. It requires the greater involvement and resourcing of GPs and nurses to manage and assist patients to manage their own care, especially those with chronic diseases.
It necessitates access to essential tests and diagnosis outside of hospital. It means better management of people through and out of hospital, even over the Christmas period, so that hospital beds are continuously freed up.
All this entails better management and planning of staffing, of more step-down facilities, homecare packages and nursing home places. It means investment in hospital and community infrastructure including electronic patient records, incentivising hospitals to free up beds and rewarding community services to keep people well and at home.
The current situation in Irish hospitals was absolutely inevitable. Years of cuts combined with a failure to solve this intractable problem means the health system is starting the new year in the worst possible way. Addressing some of this crisis requires additional resources, but most of all it requires leadership, high quality, sustained management and actions.
Silence from the health minister and the HSE boss, combined with the resignation of the newly appointed hospital chief and taskforce chairman are a very poor omen for 2015.