Hospitals told to implement seven-day working with ‘immediate effect’ to ease overcrowding

Move aims at discharge of patients at weekends at same rate as during week with goal of freeing up beds

Health Service Executive top officials have told hospitals to outline their plans for seven-day working for staff, including senior doctors, immediately in a bid to ease the overcrowding crisis in emergency units.

In a letter to hospital group chief executives, community healthcare organisations and clinical directors, the HSE’s chief operations officer, Damien McCallion, and chief clinical officer Dr Colm Henry have told hospital managers “to implement 7/7 working in hospitals and community services over the next two weeks with immediate effect”.

The HSE says that the purpose of the move is to ensure that patients are discharged from hospitals over the weekend at the same rate as they are during the week. This would, health chiefs hope, avoid a build-up of patients in emergency units over weekends and in the early part of the week because beds are not being made available through discharges.

It is understood that the move will include consultants in all disciplines as well as diagnostic services being asked to take part in seven-day rosters.


Last week, almost 2,000 patients attending hospital emergency departments had to wait over 24 hours due to “unprecedented” overcrowding, according to the HSE.

A total of 1,887 patients had to wait more than 24 hours, out of total attendances of 27,000, officials said. Last year, 67,000 patients waited at least a day in their emergency department before being admitted.

Wait times

HSE interim chief executive officer Stephen Mulvany said every one of these cases was “of concern” and the objective was to get wait times “down to zero”.

An increased on-site presence by senior clinical decision-makers is planned for the rest of this month, Mr Mulvany said. Support staff are also being asked to make themselves available for the period.

The directive is a short-term response that is not sustainable in the longer term, given the structures in place in the health service, he said.

Protocols have been changed to allow non-emergency department doctors assess patients in the emergency department where there is a significant risk due to delays, he told a media briefing on Thursday.

The HSE is also investigating whether nursing homes that recently closed could be reopened in order to provide more opportunities for discharging patients.

Last week saw a record number of attendances at emergency departments by over-75s, Mr Mulvany said, as demand for services reached “unprecedented” levels. The number of over-75s admitted to a bed was also a record.

The HSE’s modelling of current trends is matching or exceeding its most pessimistic forecasts, he added.

‘Not good enough’

Describing the situation as “very concerning”, he said it was getting “urgent and sustained attention” at all levels. The average wait time for people attending emergency departments was 8.3 hours last week and for admitted patients, 13.8 hours, the briefing heard.

“We accept it’s not good enough, it’s not what we want,” Mr Mulvany said. “We ask patients to accept our apologies [and] seek to make them as comfortable as possible while they are waiting.”

Currently, the HSE has access to 145 private beds, about 10 per cent of its capacity, but talks are continuing with the sector to increase this number.

In the long term, the HSE boss said, greater investment in capacity was needed.

He said there were considerable variations in wait times in different hospitals that could not readily be explained by variations in demand against available capacity. This pointed to the need for significant systemic improvements in process, clinical pathways and integrated working.

Attendances at emergency department were up 15 per cent last week compared to the same period in 2019, while admissions were up 6 per cent.

Pat Leahy

Pat Leahy

Pat Leahy is Political Editor of The Irish Times

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times