Why are hospitals so overcrowded and is there anything that can be done?

Trolley numbers could break the 1,000 mark, possibly next week, depending on flu trends

So I hear the hospitals are crowded. What’s going on?

They certainly are. On Tuesday, there were 931 patients who had been admitted but for whom no bed could be found. That’s one patient on a trolley for every 10 in a hospital bed across the State.

Sounds familiar. Doesn’t this happen every year, at this time of the year?

Yes, but 2023 so far has been worse than other years. The previous overcrowding record was 760 patients on trolleys, according to the count carried out daily by the Irish Nurses and Midwives Organisation, but even the 838 patients waiting for a bed on Wednesday, while lower than the day before, is the second-highest figure recorded.

I wouldn’t like to have to visit at emergency department just now…

Indeed, the overcrowding has resulted in lengthy waits for patients; one man related how he had spent four days on a trolley. Minister for Health Stephen Donnelly, Taoiseach Leo Varadkar – everyone agrees it is unacceptable. The inevitable outcome will be worse outcomes, even death, for some patients.

What’s going on? I thought they were pouring money into health since the Covid pandemic?

Donnelly has blamed it on a “perfect storm” whipped up by three waves of infection – flu, Covid and RSV (respiratory syncytial virus) – all surging at more or less the same time. This is certainly the worst flu season since 2019 and cases are still rising. RSV, which mostly affects young children, seems to have peaked, but Covid has come back strongly for another wave.


Donnelly says he has funded almost 1,000 hospital beds since the pandemic but it doesn’t seem to be enough.

Everyone gets a bug in the winter. Where’s the surprise?

To be fair, Donnelly has been predicting a bad winter for months now. The HSE was given €170 million to come up with a plan for the winter, and it is spending this money on extra temporary staff and back-up beds in the private health sector. But the infection numbers are up around the most pessimistic projections they made in advance.

We do hear something like this every January. Is there anything that can be done?

In the short term, it’s a case of all hands on deck to get through the crisis period, until the flu peak has passed. Most hospitals have cancelled non-urgent work, recruited extra temporary staff and redeployed existing staff into emergency departments (EDs).

In the longer term, big changes are needed. Even in summer now, there can be up to 500 patients on trolleys. Ask most health staff and they will tell you more beds are needed – 5,000 and more. But that will take years, if it can ever be achieved.

Any other suggestions?

Some hospitals do better than others in keeping trolley numbers down. Often this is achieved by taking a tough line with people turning up at an “emergency” department with non-serious conditions, or by discharging well patients as soon as is feasible. Some of the pressure on EDs is driven by people not having anywhere else to obtain care; some might not even have a GP. Ironically, perhaps, it will be necessary to build up services in the community in order to have hospitals run more smoothly.

How long is this going to continue?

No one knows for sure. The number of trolleys could break the 1,000 mark, possibly next week, depending on flu trends. My guess is that people socialised less once Christmas started and this will contribute to a partial “fire-break” slowing the spread of infection. That might lead to some improvement, though the return of school could make things worse. And then there’s the weather… As I said, no one knows for sure.