SECOND OPINION:The Irish Nurses and Midwives Organisation is acting as the patients' advocate in seeking to resolve this issue, writes SHEILA DICKSON
IN RESPONSE to an opinion piece in Healthplus(August 17th, 2010) by Dr Peadar Gilligan, consultant in emergency medicine, I will not accept that "the INMO's threat of industrial action if extra patients are placed in wards is jeopardising patient care".
This organisation acts as the patients’ advocate and will continue to resist any move by those in the health system advocating this “simple solution”, as it only assists in covering up the real capacity problem that exists in the Irish health service to a point where it will have catastrophic consequences for many more patients and families.
While Dr Gilligan acknowledges that hospital bed closures have compounded the lack of capacity that plagues the Irish acute hospital system, the problem of AE department overcrowding did not begin when the INMO refused to allow any additional patients on hospital wards.
When hospitals are operating at in excess of 90 per cent capacity (Irish hospitals with AE overcrowding are generally operating at 100 per cent capacity), admitted patients are transferred to available beds, which are not necessarily the appropriate beds. Patients with heart problems should be cared for on a cardiac ward, while patients with lung disease should be admitted to a respiratory ward. What happens is that additional patients are put on wards that are unsuitable.
This leads to the movement of patients – in some cases patients have been moved two, three, four, even five times in a week’s stay at a hospital. Excessive movement of patients increases the risk of transmission of infections and, although these practices are condemned in UK Healthcare Commission reports, they are now regular occurrences in Irish hospitals with AE difficulties.
In the UK in 2004 and 2005, more than 200 patients were affected by outbreaks of Clostridium Difficile at Stoke Mandeville Hospital and 38 patients died. In Maidstone and Turnbridge Wells, 150 patients were affected and 60 deaths were recorded where Clostridium Difficile was definitely or probably the main cause. And that is only one of the many infections that can rapidly spread through an overcrowded hospital.
The disastrous consequences of overcrowding are not confined to the spread of infection alone. The extra beds are usually accommodated in the middle of wards or behind doors. These beds have no privacy, no facilities, no oxygen and no suction, and can obstruct access at critical times to patients in distress or in cardiac arrest.
I visited hospitals in Canada and the US where beds up the wards or “hallway nursing” has now reached full capacity – that is, what started with one or two beds is now causing severe fire, health and safety risks, and it has not addressed the lack of capacity issue or resolved AE overcrowding.
Since October 2009, 1,378 beds have closed throughout the State, including 62 in Beaumont Hospital. There are also 883 patients in acute beds who could be discharged to continuing care facilities but have no bed to go to (HSE figures), and another 3,500 beds are to close during the lifetime of the Croke Park agreement. This crisis brings misery, loss of dignity and loss of privacy to patients, and intolerable workloads and stress to frontline nurses and other staff.
Moving extra patients to wards where there are no extra staff and, in most cases a reduced number of appropriate staff due to staffing embargo, is not the answer. The first thing that employers, Government and other stakeholders must acknowledge is that whatever they are doing is not enough and it is not working. Additional beds and services to meet an ever increasing demand is the only answer and an acknowledgement of this with firm actions is now required to address this national crisis.
This was acknowledged by a report published by CAPITA Consulting in 2003, commissioned by the Health Service Employers and nursing unions, which identified that addressing the lack of sufficient rehabilitation, step-down, nursing home and long-term care beds for patients who remain in the acute care beds is the single biggest issue which could alleviate much of the national crisis.
The INMO is continuing to work with all stakeholders to see how emergency overcrowding can be resolved – there is no one simple solution. There is one thing I am sure of however, nurses and midwives are well aware of the daily realities of endeavouring to provide nursing care in horrendous conditions, on a 24/7 basis, and neither they, nor indeed the INMO, are the problem with our health service, we are part of the solution, if listened to.
It is unfortunate that Dr Gilligan cannot see the full picture and is misguided in his simplistic views of what he thinks the solution is. He would do well to do more research on the issue, including looking at the work practices of his own colleagues throughout the hospital, before making ill-advised public comments about my organisation and the nursing and midwifery staff we represent – the INMO will be happy to supply him with our research information.
Sheila Dickson is president of Irish Nurses and Midwives Organisation