Health service crisis being driven by internal legacy problems

The crisis in the health service is looking less like one caused by Covid-19 and increasingly one whose roots lie in age-old internal problems that have not been addressed.

Depressingly, there appears to be no willingness to tackle hospital overcrowding and long waiting lists, and many of the people who might be expected to tackle these challenges are now heading for the out-door.

First, coronavirus. The high, sharp peak in cases driven by Omicron and then the BA.2 subvariant has passed. Case positivity has been falling for almost two weeks, the number of recorded cases for about a week. Doctors are reporting fewer Covid-related queries and fewer people are being tested.

Over the weekend, 19,489 positive PCR and antigen tests were reported, less than half the 39,561 reported the previous weekend.

Covid-19: More than 19,500 cases reported over the weekend

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Ireland likely experiencing several hundred thousand Covid-19 cases per week, says Donnelly

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There are many more infections than are tracked through PCR and antigen testing but it is likely this multiple is declining as the force of infection falls.

There were 1,433 patients with the virus in hospital on Monday, 200 down from late March’s peak. After falling last week, this number edged up on Monday, but the post-weekend rise was much smaller than the previous week, so a further decline during this week seems likely.

Intensive Care Unit (ICU) numbers have been edging up; there were 59 patients with the disease in ICU on Monday, up from 54 a week earlier. This increase is likely to continue this week due to the time lag involved from time of infection.

However, about 50 per cent of coronavirus patients in hospital, and 70 per cent of those with the virus in ICU, are there because of other conditions rather than because of Covid-19. And less than half of those who are in hospital or ICU because of the disease are vaccinated fully and boosted.

Experienced emergency department doctors and nurses have described the conditions in the last few weeks as the worst they have ever seen. It is hard to think of anything that would rival the horrors of the first months of the pandemic but at that stage hospitals were cleared of almost all non-Covid patients.

Assuming Ireland follows the example of Denmark, cases will now decline sharply, and so will hospital numbers. The immediate crisis will pass, and the system will bumble on until the next surge, which is considered probable rather than possible.

Overcrowding is a crisis afflicting some, not all, hospitals. On Monday, there were no patients in Connolly Hospital Blanchardstown, three in Beaumont Hospital and four the State's largest hospital, St James's. In contrast, University Hospital Limerick (UHL) had 72 patients waiting for admission and Cork University Hospital (CUH), 49.

It is hardly coincidence that UHL and CUH were two of the nine hospitals whose performance was examined in a 2020 review of unplanned care, which has only just seen the light. The review, obtained by the Irish Patients’ Association in the face of clear efforts by the Health Service Executive to bury it, reaches conclusions that are entirely predictable and unsurprising.

None of the nine hospitals were found to be providing safe and effective care or operating round the clock. The widespread practice of placing patients in corridors is deplored in the report and questions are raised about the way hospitals are being managed.

What about Sláintecare?

The HSE decided not to publish the report because it was “no longer relevant”, saying a lot had changed since it was completed. Yet patients are still being placed on trolleys – 430 of them on Monday – many in corridors, and most of the worst-performing hospitals three years ago are still performing badly today.

Not that the treatment of patients with scheduled care needs is faring any better than emergency departments. With waiting lists heading up towards the one million mark, and Sláintecare reforms becalmed, the situation is worse than ever.

A four-year Sláintecare plan to eliminate waiting lists has been shredded and those behind it have left. In place are a series of smaller waiting-list initiatives, but the latest of these was put on ice within weeks of being published due to the most recent surge in coronavirus cases.

Is it any wonder there is a stampede towards the door, led by State chief medical officer Tony Holohan, who is heading to an "open-ended" professorship in Trinity College, and HSE chief operating officer Anne O'Connor, soon to leave for the private sector and a job at VHI. Many more staff, at all levels, will leave soon and who could blame them when the system seems so incapable of reforming itself?