Hospital overcrowding is a symptom of the failure to reform the health service

Health reform is excruciatingly slow and we are seeing the results

Hospital overcrowding potentially affects every woman, man and child in this country as there are times when each of us may need urgent care and a hospital bed. It is in all our interests that this matter is resolved with urgency and forever.

Current teeming emergency departments and insufficient public hospital beds are a symptom of the failure to reform our health system, to implement many of key pillars of Sláintecare – the current cross-party and government plan to realise universal access to timely, quality, integrated care.

We hear talk of the “winter plan”, of every resource being made available to help solve the “crisis” in Emergency Departments yet winter happens every year. What we need to do now is not just to firefight the current situation but invest in and plan for next year and the years after.

The public hospital system has been running at or over 100 per cent capacity for decades. Internationally, acute hospitals are meant to operate at 85 per cent so there is slack in the system for surges, for crises, for infection control, for teaching, for care.


Due to Covid-19, Ireland has invested more in the public health system. There are many examples of improvements brought about by these investments and from the agility demonstrated during Covid-19.

We have more public health system staff and hospital beds – but not enough. We still have beds closed due to staff shortages, vacancies and absenteeism and we don’t have sufficient staff in the right places, especially in the community. How many people brought their relative to an emergency department this Christmas or new year because they could not find another way to access healthcare?

If the Sláintecare promises of universal primary care and elective hospitals were resourced and delivered in its first five years, there would already be many more routes into our health system. Early in the pandemic, many of us experienced how a call with a compassionate, informed nurse can empower and inform us to care for people at home or to go to the right place for urgent and non-urgent care. New care pathways, introduced rapidly during Covid, should be kept in place where useful.

Sláintecare recommended opening six new elective-only hospitals so that no matter how busy acute hospitals got, surgery and treatment could go ahead as planned for patients who are not emergencies but need timely care regardless. Separating emergency and planned hospital care is one of the fundamentals to address our inhumanely long hospital waiting lists. Yet 5½ years on from Sláintecare’s publication, there are two elective-only hospitals in the planning ‘pipeline’.

Ireland needs to train and hire more healthcare professionals. Of course, we need more doctors but equally importantly we need all sorts of healthcare professionals who provide essential tasks, supporting and alleviating the pressure on the medics – nurses, physiotherapists, occupational, speech and language therapists, dentists, diagnosticians, medical laboratory scientists, psychologists, public health, health promotion and care staff; These are needed to provide actual multidisciplinary care to the public. The good news is that we train proficient and dedicated professionals but we need to ensure better conditions and evidence of a reforming health system to keep the clinicians and carers we currently have and to attract other highly skilled and trained professionals home from abroad. We also need to incentivise the provision of care outside of hospitals as appropriate.

A Sláintecare initiative implemented during Covid-19 was to facilitate GPs access to diagnostics for people with medical cards. This initiative needs to be available to everyone, as many of those who end up in emergency departments are going to access essential tests they can’t get elsewhere unless they pay privately. We need to invest in the diagnostic capacity of the entire public health system instead of contracting out this care to the private sector, as is currently the practice. We should leverage the innovative bottom-up practices devised during the pandemic to maintain important changes across the system.

There has been other progress during Covid-19, evident in the introduction of public health consultants and the allocation of individual health identifiers to all who accessed Covid-care. But Sláintecare’s implementation is excruciatingly slow – for example the new public-only consultant contract was released for consultation with medical bodies just last month and is yet to be introduced while the roll-out of electronic health records has not happened, requiring significant digital health investment and training.

Overcrowded emergency departments and hospitals are frightening and potentially lethal places for patients. Our healthcare professionals are utterly overwhelmed from stepping up to the mark during three long years of Covid-19, on top of decades of working through perpetual crises. Those currently on the front line are saying they are under siege, that this is the worst ever, yet they continue to go to work every day providing the best care that they can.

This all leads one to ask in whose interest is it that reform is not being realised? Who is actually responsible for health reform since the resignations of Sláintecare leadership in 2021?

When Leo Varadkar resumed the role of Taoiseach the week before Christmas, he spoke about how the pandemic showed us what “was possible when we mobilised the real power of our State – the true capacity of government”. Outlining his top five priorities, health was noteworthy in its absence. If the Taoiseach, a medic and ex-health minister, is serious about tackling the life-and-death matter of hospital overcrowding, then he would have health up there in his top five. And he would recommit to delivering Sláintecare, because Varadkar knows what can be achieved when there is a sustained, driven leadership and oversight at the highest political level.

Dr Sara Burke is Associate Professor and Director of the Centre for Health Policy and Management in the School of Medicine, Trinity College Dublin