The recent report by the Health and Safety Authority (HSA) into conditions in hospital accident and emergency departments confirmed what has been obvious for some time: overcrowding has led to an unsafe environment for both staff and patients.
A cursory examination of the document might not go beyond this significant conclusion, but as the work of four highly trained health and safety experts who visited 11 of the Republic's A&E departments during the last two months, it deserves deeper analysis.
The HSA inspectors were especially concerned about the prevalence of overcrowding in the majority of hospitals visited. They listed the specific consequences of this for both patients and staff. "Overcrowding may increase the risk of injuries due to slips, trips and falls, manual handling [ problems], aggression/violence from frustrated patients and may also lead to an increased risk of infection." They also highlighted the potential for fire evacuation to be compromised and the risk of stress to staff.
Given the prevalence of complaints by patients and relatives about blood, vomit and other body fluids in casualty departments, a section dealing with chemical and biological agents is particularly interesting. It found evidence of a "lack of spill control policy and procedures" and "staff non-compliance with chemical waste policy" in some hospitals. Against a background of increased hospital acquired infection, these findings are not compatible with the standards which can be legitimately expected in a State that spends in excess of €10 billion a year on health.
In accordance with the best principles of risk management, the HSA has directly informed each hospital of the specific issues relevant to it and invited them to submit a comprehensive action plan. However a sticking plaster approach to remedying the health and safety and other unsatisfactory aspects of the service available to patients in A&E units will not in itself improve a dire situation. What is needed is a whole system approach to tackling the cause of overcrowding.
However, adding additional capacity, in the form of extra beds and more hospital consultants, is not a short term option. The 10-point plan put forward late last year by Minister for Health Mary Harney will not, by her own admission, produce tangible results until this autumn. And in the absence of definite improvements in the health and safety factors outlined by the HSA, the authority has a statutory obligation to intervene. This would mean the closure, albeit temporarily, of individual casualty units.
There is one option available to Ms Harney in the short term. She could instruct the HSE to add capacity by increasing the number of beds within existing wards and units. This move would not be popular with the health service unions. But with little room for manoeuvre and the State's health and safety watchdog breathing down her neck, it is a step she may be forced to take.