Lack of lasting improvements behind Beaumont trolley crisis

The crisis in Beaumont Hospital’s emergency department, where dozens of patients are treated nightly on trolleys and chairs, is symptomatic of the health service’s inability to make lasting improvements to services.

Beaumont has been on the watchlist for years now. As far back as 2007, James Reilly made hay about its problems when he was in opposition as Fine Gael's health spokesman.

In the Dáil, week in, week out, Reilly would hound then minister for health Mary Harney over the chaos in the emergency department, the fact that trolley numbers would frequently rise to more than 40 a night and the fact that up to 100 patients could not be discharged from the hospital beds they were occupying because there was no nursing home to send them to.

As it was then, so it is now.

As if nothing had changed, the related problems of trolley waits and delayed discharges continue to plague the hospital, and the numbers have hardly altered.

As minister, Reilly threw money at the problem nationally, drafting in highly paid consultants and setting up a special unit to deal with the problem.

Dream evaporated

Long before he was demoted last May, his dream had evaporated.

The consultants packed up, the unit was effectively disbanded and the figures were shooting upwards again.

Trolley numbers are a seasonal phenomenon, but the early figures for this winter have already set off alarm bells in the health service.

Traditionally, Christmas is a quiet time in hospitals - but no-one in the sector is looking forward to January and February, when pressure on emergency departments tends to peak.

The cause of the problem can be summed up as the wrong patients in the wrong beds at the wrong time.

Lack of facilities

One out of every six beds in Beaumont is occupied by patients, mostly elderly, who are fit to be discharged but cannot be because of a lack of nursing home facilities or because care cannot be provided at home.

It isn’t good for such patients to languish in a hospital unnecessarily and it isn’t good for the hospital either.

Such delayed discharges have been clogging up the system for years now, and still a solution hasn’t been found.

Numerous reports pointing to the need for investment in State-run nursing homes have been sat on, presumably because the €1 billion needed to renew existing buildings isn’t to hand.

Meanwhile, investment in privately-run homes has stalled as the economy tanked, and the Fair Deal scheme to fund older people’s nursing needs has been starved of funds.

Beaumont’s plea

Beaumont has pleaded it has an older population in its catchment area, and says many of its beds are ring-fenced for cancer and neurology patients. However, like the general ageing of the population, these are factors that can be planned for - provided such planning is actually happening at national and local level.

The alarm bells have been ringing for some time. Back in August, the chief executive, Liam Duffy, warned in a leaked letter about the safety risk in the emergency department.

A few months earlier, clinical director Shane O’Neill relinquished that role over his concerns about the clinical risks involved in admitting psychiatric patients through emergency.

Nurses’ pickets

Still, little seemed to happen until nurses’ pickets were placed at the hospital last Friday over their concerns for safety.

This was after their union had contacted the Health Information and Quality Authority, which said it had no resources to conduct an investigation.

Now a raft of extreme and necessarily short-term measures has been introduced, such as the cancellation of elective work and the hospital going off-call for a short period.

Once again, the sticking plaster is being applied when a more permanent fix is required.