Beds crisis continues, flu or no flu

The first signs of normality began to return to the casualty department at Dublin's Mater Hospital on Thursday morning. Since the hospital suspended elective surgery earlier in the week, the number of patients waiting for admission had diminished and, by late this week, the flood of new patients presenting with respiratory and flu-like symptoms had dried up.

But while normality involved the return to the treatment of the run-of-the-mill casualties in the busy accident and emergency department, the rest of the hospital is still stretched dealing with the upsurge in viral illness.

"We are now in the second phase of this. How do you get all these extra patients out of hospital?" the Mater's Accident and Emergency consultant, Mr Peter O'Connor, says. Surgical and other specialist beds are currently occupied by flu and respiratory patients, and until they are discharged the restart of these specialities is severely curtailed.

But, just as a combination of events resulted in the health services straining to cope with the epidemic, a variety of factors are also contributing to hinder the handling of the second phase of the crisis.

The task of discharging patients is complicated by the fact that many are elderly. It is estimated that the elderly account for 80 per cent of patients in some hospitals. Doctors are slow to discharge elderly people who live alone and where it is not possible to find a place in a nursing home where they can convalesce.

Nursing homes have been affected by the nursing shortage, with beds closed as a result in some cases, according to Mr O'Connor. He appealed earlier this week for families to help ease the hospital crisis by taking their elderly relatives home, but he believes his call was largely ignored.

Double-income families have contributed to this problem. "These families may bring their elderly relative up from the country and then, suddenly when the relative gets sick, it is up to the health service to pick up the slack," he says.

Mr O'Connor cites the example of an 84-year-old woman who was due for discharge from a Dublin hospital this week. Her daughter, from an affluent suburb, who also has homes in France and New York, told the doctor she was going to the Continent on business and asked what the social services could provide for her mother.

"The days when you would not go home until you were ready are long since gone, and people have to be aware of this," Mr O'Connor says. "Medicine has lost the human touch and is more factory-like."

The proportion of elderly patients is increasing, with the population increasing and people living longer. The elderly are more likely to be ill and take longer to recuperate. They account for a major proportion of the so-called "bed-blockers", patients who no longer need their hospital bed but who cannot be discharged.

In an attempt to tackle the problem, the Department of Health provided an additional 225 places in convalescent and subacute hospitals this winter.

The now-annual winter beds crisis is getting worse each year, according to a Waterford consultant physician, Mr Garrett FitzGerald, with the increasing and ageing population, and the loss of 20 per cent of hospital beds in 1987. "To a certain extent it is like putting another 100,000 cars on the roads and then saying the roads are fine," he says.

Mr FitzGerald believes there is no Government plan to tackle the problem which, he claims, results in the situation of surgical and specialist beds being closed for six months each year, from December to May.

In addition to funding for additional acute hospital beds, he says, funding must be provided for community care and home nursing, and for convalescent homes and rehabilitation. These services would help prevent some elderly patients being admitted to hospital in the first place, as well as reducing the length of their hospitalisation.

Many of the elderly admitted to hospital in recent days were not suffering from flu. "For some, once the temperature drops below 1O, their hearts and lungs go into failure," Mr O'Connor says. "What these people really need is three weeks' rest, but we cannot give that to them. They need convalescent care, not acute hospital care."

A consultant respiratory physician at St James's Hospital in Dublin, Mr Luke Clancy, says he had ideological difficulties with such patients being admitted to some of the most expensive hospitals in the State when the treatment they required could be provided by the equivalent of a county hospital.

St James's is seeking approval for an alternative approach, which would involve an assessment unit treating people in their homes, to prevent them needing to be kept in hospital. If the proposal is approved, it is hoped to start the scheme on a trial basis later this year.

However, Mr Clancy believes there are other lessons which must be acted upon which could also help prevent a repetition of this week's crisis. There is a need for a more co-ordinated State-wide approach to surveillance of the flu virus, involving both clinical and laboratory surveillance.

A proper vaccination programme is also required, which must include a campaign to highlight the need for flu vaccination and its efficacy and safety. At-risk patients should also be encouraged to receive the vaccination to protect against bacterial pneumonia.

An anti-flu treatment is also available to ease the effects of flu, but this must be taken within 36 hours of the symptoms being diagnosed, Mr Clancy says. Reducing the time-period which a person suffers from the flu can reduce the number of people to whom they pass it, and cut the risk of it progressing to become more serious.

A greater emphasis must also be placed on preventive measures so that people will not have to be kept in hospital. More than 50 per cent of patients were admitted as a direct or indirect result of smoking-related illnesses, Mr Clancy says. "I do not want to victimise smokers, but if we are serious about reducing the burden on hospitals, we have to do something."