Q&A: Why are hospital trolley numbers spiralling to record highs?

I hear the hospital trolleys are back big time. What’s going on?

Yes, there were 760 patients waiting to be admitted to hospital on Monday; that’s as high as the previous record set in January 2020. Tuesday is often the worst day for overcrowding so there could be a new record shortly.

That amounts to a lot of misery for sick patients. What is causing this?

The much-predicted “twindemic” of flu and Covid has come to pass, but in fact it is a “tripledemic” because of a continuing wave of respiratory syncytial virus (RSV) that has hit children’s hospitals particularly hard. Adding to the problem for now is the number of people who injured themselves by falling on ice in the recent cold snap.

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Is it going to get worse?

Probably. Flu is definitely trending upwards and it’s far too soon to know when the graph will start to point downwards again. RSV may have peaked – at record levels – but case numbers are still very high. Covid, which of the three is the least of hospitals’ problems at present, is on the way back. It isn’t clear how big this Covid wave will be, but at least most of the population have built up immunity through prior infection or vaccination.

We haven’t managed to stop the spread of Covid in hospitals, so as cases rise there are going to be more staff absences through illness, which will heap further pressure on the health service.

What can hospitals do about all this?

They all have surge plans that allow them to scale up facilities as needed. If things get really bad, patients can be provided with critical care outside the intensive cae units (ICU) – not ideal, but satisfactory in most situations.

University Hospital Limerick, which has the worst overcrowding, has already begun doing what most hospitals will do if they remain under pressure. On Monday, management ordered the cancellation of most elective surgery and scans. In solving one problem, they are creating another, as these patients will be added to already-massive waiting lists.

There is nothing new about these surges in winter. Surely they have other plans?

Yes, in October the Health Service Executive published a €170 million winter plan for the health service, which talked about recruiting 600 extra staff, improving ambulance services, greater access to diagnostics for GPs and adding more supports for older people in the home. The aim is to avoid admitting as many patients as possible where this is feasible, to treat them as quickly as possible and to discharge them as promptly as possible.

The plan wasn’t submitted to the HSE board before publication, which doesn’t exactly inspire confidence. Many of the additional staff, including 50 extra Emergency Departments (ED) consultants, won’t come on stream until well into the new year.

So what is going to happen now?

This week will be rough. Then the hospitals will empty as they always do over Christmas. The hope is that the festive season and the closure of schools will create a sort of firebreak to limit the spread of viruses, but with high levels of intergenerational mixing, things could go the other way. That is what happened in 2019/2020, when large numbers of young children were sick before Christmas, and large numbers of older people were sick after it. The prospects for new year are not great.

Is there anything else to be done?

Plenty. If you think you have flu-like symptoms, keep away from others. If you think you are at risk of a serious illness, think about getting the flu vaccine and your Covid booster.

Nasal flu vaccines are available free for children, but the uptake is low. Yet giving children the nasal flu vaccine can help protect their grandparents. It can also, according to the UK Health Security Agency, help protect against the bacterial infection strep A, which can be a complication of flu.

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