Who'll be next? It could be any of us

MEDICAL MATTERS: May is a nice month

MEDICAL MATTERS: May is a nice month. Summer holidays have still to be taken, the harshness of winter has gone and outdoor hobbies are in full swing, writes Dr Muiris Houston

So in asking you to project forward to the dark evenings of October and beyond, I am aware I am going against the tide. But I must highlight a threat to our health while there is still some time to prevent unnecessary suffering. Our health system, which has been tottering along uncertainly for some years, has avoided meltdown. It has come close: it took several public appeals last winter, for example, to allow accident-and-emergency departments to pick themselves off the floor after being overburdened with patients.

Such is the chronically poor state of hospital access, however, the best these departments ever manage is to rise back onto their knees. For the hard-working and conscientious staff in casualty units, the days of working in a planned and optimally structured way are but a dim and hazy memory.

The past few weeks have brought more bad news with the potential to make the coming winter tragic and defining. The six Dublin hospitals that provide an emergency service in the capital have announced more than 250 bed closures. Similar shutdowns may yet affect hospitals throughout the country.

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In addition, at least 350 acute beds are inappropriately occupied, mainly by older people who are medically fit to be discharged but cannot live independently.

The effect of the closures are twofold. Not only do they signal a serious reduction in planned elective treatments - the Dublin teaching hospitals have said they must treat 14,000 fewer patients this year - but also they create an even tighter bottleneck for emergency cases that need to be moved from casualty into hospital proper.

For those lucky enough to have private health insurance, there is at least an option when having planned medical treatment. Hip replacements, hernia repairs and gall-bladder removals can be performed privately after relatively short waits.

But none of us knows when we might be struck down with severe acute chest or abdominal pain or develop a serious infection. Complaints such as these require immediate investigation and admission. And although some private hospitals can admit a limited number of emergency cases, acute illness does not differentiate between public and private patients. We rely on our local accident-and-emergency departments when serious illness strikes.

So as the bottlenecks in casualty become more acute, people can expect to spend even longer being "treated" in accident and emergency. With no beds available in wards, the now standard three-day wait will become a five- to seven-day one. This is simply not acceptable. Nor is it safe.

Last week The Irish Times reported the case of a 79-year-old woman from Firhouse, in Tallaght, who died after spending five days on a trolley in the accident-and-emergency unit of the Adelaide & Meath Hospital. According to her son, she was unable to keep food down. Her symptoms could not be investigated until a bed was found. It would be wrong at this point to attribute her death to the time she spent in an inappropriate clinical environment, but the incident should nevertheless ring alarm bells for the families of older people.

There is a practical solution. A few hospitals, notably St Luke's in Kilkenny and St James's in Dublin, have developed acute medical assessment units where patients are rapidly treated and admitted. The Mater's equivalent, however, has been the victim of bed cuts: a clear example of how fragile even worthy innovation can be.

Why pinpoint October as the time of crisis? Simply because it is when people with chronic heart disease and chronic breathing difficulties are affected by the seasonal increase in infections. These illnesses quickly tip already fragile patients over the edge, to the point where they need emergency treatment.

Put this burden on top of a system that the Government acknowledges is 3,000 beds short, and now has an additional 700 beds effectively closed, and you have a recipe for disaster. It could be my mother, your father or any of our friends or neighbours who are the victims.

Patients' lives may be lost as a direct result of the shortage of hospital beds this winter. Separate from the need for health-service restructuring, emergency funding must be made available before it is too late.

You can e-mail Dr Muiris Houston at mhouston@irish-times.ie. He regrets he cannot answer individual queries