Trolley crisis ‘the price being paid’ for focus on waiting lists

Measures introduced by Minister for Health Leo Varadkar

to bring down inpatient and outpatient waiting lists are having an adverse effect on the number of patients on trolleys, an emergency doctors’ group has said.

There were 359 patients waiting for a hospital bed yesterday, despite it being the height of the summer holiday season. Trolley numbers were substantially up on the same day in 2014 (227 patients) and 2013 (242).

The problem is concentrated in a handful of hospitals with chronic admissions problems; there were 47 patients waiting yesterday for a bed in Our Lady of Lourdes Hospital in Drogheda, 37 in Beaumont Hospital in Dublin, 36 in University Hospital Limerick and 35 in University Hospital Galway.

The Irish Association of Emergency Medicine said one reason for the rising numbers is that unscheduled care provided by emergency departments is being “squeezed” by the focus on improving performance in scheduled care.

"It's the price being paid for the massive focus on scheduled care and the achievement of the Minister's targets," says spokesman Dr Fergal Hickey.

Varadkar’s promise

Mr Varadkar claims to have substantially fulfilled a promise that by the start of July no patient would have to wait more than 18 months for inpatient, day case or outpatient treatment. By the end of the year, he aims to ensure nobody is waiting more than 15 months for an appointment or treatment.

The targets are being achieved through the outsourcing of 20,000 appointments to the private sector, and the Minister is following the precedent set by previous ministers of threatening to fine hospitals that do not meet the targets.

The Irish Nurses and Midwives Organisation said this week it would seek an immediate meeting with Mr Varadkar on the overcrowding crisis in emergency departments after figures showed trolley numbers in July were up 21 per cent on the same month last year.

Occupying beds

Trolley numbers are continuing to rise despite a fall in the number of delayed discharges, which had been blamed for the problem. The number of patients occupying beds when they were fit to be discharged fell to 550 this week, the lowest level since 2007 and down from a peak of 850 earlier this year.

This is the result of a €70 million funding package that has seen the provision of an extra 200 community beds and the opening of the former Mount Carmel Hospital in south Dublin as a private facility.

A spokesman for Mr Varadkar said the focus now was on developing specific solutions for individual cases.

Mr Hickey said consultant leave was a factor behind the continuing high trolley numbers, as locum replacements tended to be slower to discharge patients. Capacity problems were a feature in some areas; including a shortage of hospital beds in Galway and Limerick and a shortage of nursing home places in north Dublin and the northeast.

He warned the problem would get worse if the Health Information and Quality Authority proceeds with plans to close nursing home beds unless the Government funds renovations of older facilities with substandard accommodation.