Letters

Hospitals in crisis

Where is the winter crisis plan?

Wed Nov 16 2022 - 00:12

Sir, – I have a child who requires 24-hour care who has been home-cocooning since the pandemic began. He is very medically complex, immunosuppressed and he suffers from chronic pain. He uses a wheelchair. He has a profound intellectual disability, is non-verbal and is tube-fed around the clock. Unfortunately he contracted Covid a month ago and has been ill ever since.

We have attended the emergency department in Children’s Health Ireland (CHI) at Crumlin, Ireland’s largest paediatric hospital, three times in the last three weeks. He has been admitted twice. We are currently in hospital. The first time, on October 24th, he needed a chest X-ray and bloods to ensure he was okay as he had been on antibiotics for a week at that stage but was still extremely chesty. We were eight hours in the emergency department (ED). We were able to go home and to continue nebulisers and rest. The second time, October 30th, he was given an X-ray and bloods again and he had pneumonia in his left lung so was started on IV antibiotics. He was on a trolley for two days and two nights. We arrived on the Sunday morning at 11.30am but didn’t get a bed on a ward until 3.30pm on the Tuesday. He was two nights on a trolley. I lay on the thin mattress beside him on the floor but had no pillow. I requested that he be given a bed to lie on at least while we waited for a ward and he got one in the ED at 11.30 on the Tuesday morning. But he had still endured 48 hours on a trolley in the ED. This is totally unacceptable in this day and age, and in such a prosperous country it is shameful.

The emergency department was running a full ward and an accident and emergency service. This is dangerous.

Jack was discharged but a little too soon so we had to return. This prospect was not appealing and I tried to nurse my son at home as best I could. I have a nebuliser, suction machine and oxygen at home but I am not a doctor or a nurse and so can only do my best. So eventually I had to return as my son was not getting any better. This time we were 12 hours in ED and we are back on the ward and my son is back on IV antibiotics.

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I have witnessed the nurses struggling with their workload as there are not enough nurses and especially senior nurses. It is too much pressure and is not safe.

It’s not fair on our wonderful nurses and care assistants and certainly not fair on the sick children.

We knew this winter was coming, and we knew that the children who would be exposed to respiratory illnesses for the first time would mean a surge in attendances to emergency departments.

We knew this but where is the winter crisis plan? Where are the extra beds? Where are the extra staff?

Telling people not to come to the ED and to attend their GP sounds great in theory but is often impossible as some people have no GP and others can’t gain access urgently. There is a national shortage of GPs and this also needs to be addressed immediately.

This is unacceptable. It’s shameful. Above all, it’s totally unsafe. – Yours, etc,

AISLING McNIFFE,

Ardclough,

Co Kildare.

Sir, – Can we stop using the unit cost of a hospital bed in public discourse and among the medical community when discussing the value of community initiatives?

Around 80 per cent of hospital costs relate to salary costs. Trolley and corridor beds are free unless you employ more staff to service them. In modern hospital care, there is no such thing as an empty bed.

If we have more empty beds they will be filled with patients from emergency department or elective admissions for surgery, etc, which would be very welcome. In the 1980s and 90s nurses were employed on temporary “year one” contracts and when beds were closed in summer, they were let go for three months. Thankfully generally this doesn’t happen anymore but you won’t save a significant of money in hospital services unless you reduce staff numbers.

I fully support the development of community services to treat patients closer to home but we shouldn’t fool ourselves that that there won’t be a considerable cost to this, which won’t be offset by reduced hospital admissions.

Using bed days saved as a financial argument to justify community initiatives is a lazy and nonsensical way of measuring their effect. Measuring health gain, although more difficult, is a much more robust and honest way of measuring impact, and places the patient rather than costs at the centre of the discussion. There must be very strong governance to ensure effectiveness of these initiatives. Staff involved in developing these new services commonly come from the hospital service. In the current recruitment climate, we are commonly robbing Peter to pay Paul, with increasing difficulty in employing hospital-based staff to replace those leaving. – Yours, etc,

Prof KEN MULPETER,

Consultant Geriatrician,

Letterkenny,

Co Donegal.

Sir, – I note with interest your article on unsafe conditions at University Hospital Limerick (“Patients ‘left unseen for days’ in ‘unsafe’ Limerick hospital, claim doctors”, News, November 14th), as this has been a topic of discussion in my extended family for the last few days. On Thursday afternoon, after collapsing twice at home, my 84-year-old grandmother was taken by ambulance to the hospital emergency department.

A total of 60 hours on a trolley later at 3am she was awoken and told there was a bed in a ward available. Once she was taken to the ward she was told the tests she needed were not carried out there and she was returned to the emergency department.

It was 72 hours before a bed was found.

Unacceptable and disgraceful are insufficient to describe this level of care. – Yours, etc,

CLAIRE O’TOOLE,

Dublin 24.