An endless carousel

Public hospital system shows little evidence of implementing reforms that are urgently required in the interest of its patients

 

A row over the appointment of a new chief executive at Beaumont Hospital, revealing “serious concern” on the part of the director general of the Health Service Executive (HSE) about the flagship hospital’s performance, offers disturbing insights into our ailing public hospital system.

Tony O’Brien specifically criticised Beaumont’s financial instability, an unaffordable rise in staff numbers and lengthening waiting times in correspondence with the hospital board. Beaumont ended last year with a €13 million deficit and the number waiting on trolleys in the emergency department rose by about 11 per cent last spring compared to the previous year.

In response, hospital chairwoman Ann Fitzgerald blamed growing patient demand and limited capacity for the ongoing problems. Beaumont has one of the highest cohorts of older people living nearby, a deficit of long-term beds and is facing a “phenomenal” growth in demand for cancer services, she told Mr O’Brien.

The correspondence reflects tensions apparent nationally in the funding and the management of our health system. Capital spending in health has never recovered from the budgetary constraints imposed during the recession. The Republic currently has 276 inpatient and day-case beds per 100,000 population.

This compares to a western European average of 449 beds per 100,000 people. With the inclusion of private hospital beds, Ireland’s figure still rises only to approximately 358 beds per 100,000 population. The Irish Medical Organisation says 1,600 acute hospital beds have been removed from the public health system since 2009. Allowing for an appropriate increase in day case activity, it is clear there is a substantial shortage of beds.

But there is also the issue of the appropriate management of existing resources. In this regard, Beaumont is one of a small number of major hospitals that have failed, over a protracted period, to improve the quality of service it offers patients. This suggests unacceptable management shortcomings within the hospitals themselves.

Like many teaching hospitals, Beaumont must juggle its highly specialised tertiary role with the quotidian secondary demands of its local population. The evidence, unfortunately, is that it properly meets neither obligation. Long waiting times for beds clog up its emergency department. This in turn means routine, but still urgent admissions, are cancelled.

Patients of its national neurosurgical service then experience admission delays that threaten their survival. And patients with less life-threatening illnesses, but whose condition has deteriorated following multiple admission cancellations, must then join the queue at the hospital’s overstretched emergency unit.

As a never ending carousel, this unnecessary threat to patient safety is unacceptable. When will it stop?

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