The symptoms of dysfunctionality within health services
Providing additional Emergency Department nurses will not, in itself, solve a wider problem
The eleventh-hour postponement of strike action by emergency department (ED) nurses in seven of the State’s acute public hospitals is welcome. But the dispute is just one symptom of long-standing problems in a dysfunctional health system and the terms of the proposed settlement may yet trigger knock-on claims and further industrial unrest elsewhere.
Though the number of people waiting on trolleys in hospital EDs has begun to stabilise, even Taoiseach Enda Kenny has acknowedged that at least one is not fit for purpose. And others have been described as being in a state of bedlam.
This means a continuing and unacceptable threat to patient safety. Overcrowded departments make it difficult for staff to access and adequately monitor patients and add to the risk of cross-infection. There is also a threat to the health and safety of frontline health professionals. Chronic understaffing multiplies each of these risks.
The Irish Nurses and Midwives Organisation (INMO) is entitled to highlight these issues by means of limited industrial action but many of the solutions which will now be put to a national ballot of nurses appear to focus on contractual gain for HSE employees.
And union general secretary Liam Doran has predicted that the proposals, if accepted, will cause non-emergency waiting lists to lengthen. This is because overcrowded hospitals will be required to cancel or defer elective procedures to reduce the number on ED trolleys.
A HSE culture that owes more to sclerotic decision-making than problem-solving is reflected in the pattern of the latest negotiations. With the basis for a deal in place for some time, the drama of late-night solutions being offered when patient appointments and operations had already been cancelled was unnecessary.
This dispute, however, is merely the latest symptom of an ill health service. Providing additional ED nurses will not, in itself, solve a wider problem. This requires additional hospital beds and continued expansion of the Nursing Homes Support Scheme.
In combination with more acute beds, some 200 of which are already on stream, and more transitional care facilities, these measures would ensure a smoother flow of patients from ED to a bed to timely discharge.
Other elements in the jigsaw of healthcare must be improved too. Patients who wish to return home must not be delayed by the tardy provision of necessary supports.
And, more fundamentally, the HSE must commit multi-annual funding to reorientate the care of people with chronic illness from hospitals to the community.
All of which stands in stark contrast to the reality of the HSE service plan for next year which was considered by the Cabinet yesterday. It warned of a €100 million shortfall in hospital funding and of waiting lists for hospital treatment and home help and homecare packages.