Dr Muiris Houston: Five ways to deal with the trolley crisis

Apart from the obvious discomfort and stress for those waiting to move from a trolley to a proper hospital bed, the risk to patient safety is much greater in cramped conditions.

Doctors and nurses cannot readily access patients on trolleys, cross-infection is more likely and harried health professionals, through no fault of their own, are more likely to make mistakes.

Unsurprisingly, there are no easy solutions in a poorly managed system that is in such an advanced stage of sclerosis.

While the ultimate resolution of the problem is likely to emerge from a multi-pronged approach involving the entire health service, here are some initiatives that may help:

1. A temporary, sticking plaster solution is to cancel all elective hospital admissions until the winter surge from emergency departments subsides.

Involving at least two weeks suspension of elective work, the move is likely to be marginally effective given that many units are already curbing elective work.

2. Recruit more nurses and doctors for front-line roles in an attempt to speed up the triage process in emergency departments. However, this will not benefit really sick patients for whom hospital admission is an essential element of treatment. Recruitment realities also mean that getting “boots on the ground” will take a minimum of three months.

In the longer term, recruit additional staff so scans and operating theatres routinely open 18 hours a day, thereby shortening the length of hospital stay.

3. Develop a “surge response” system for use in times of extreme pressure on beds. This means having additional staff specifically contracted in advance in a stand-by role.

Mothballed wards would need be ready to re-open within hours of the surge response being activated. It requires the HSE to honestly budget, in advance, for this surge capacity. A solution for next winter, not this one.

4. In some of our major hospitals, over one-third of beds are occupied by patients whose active phase of in-patient treatment is complete.

Having a high percentage of beds effectively out of commission is one of the major drivers of the current crisis. Spending money on more step-down facilities and long-term care options is the only solution.

This will require Minister for Health Leo Varadkar overcoming Minister for Public Expenditure and Public Reform Brendan Howlin's opposition at the Cabinet table.

Realpolitik suggests it is unlikely to happen in the short term.

5. Make a commitment to re-orientate the care of people with chronic illness from hospitals to the community.

Revamp the out of date GP contract to incentivise chronic care. Invest in primary care staff and infrastructure so the initial management of acute deterioration in people with chronic illness occurs in the community.

Most of the solutions are already laid out in the 2001 Primary Care strategy. It will take three to five years of political commitment matched by adequate funding to make it happen. But it can be done and would make a real difference in the longer term.

The ultimate solution may appear to be to increase the number of hospital beds across the system. But with day-care procedures and surgery becoming the norm, the global trend is to develop short-stay facilities.

Unfortunately, while the risk to patients currently lying on trolleys is at its highest, there is no quick-fix solution available.