A crisis in acute healthcare


A chara, – Simon Harris should not cancel his St Patrick’s Day trip to the Netherlands and Belgium (News, March 14th).

Many will be disappointed at the absence of an Irish Minister from their activities, and his presence might have yielded some political benefit in Europe. His presence in Ireland will be of no benefit whatsoever. Had he been on an extended holiday for the past three months, the emergency department chaos would not be worsened in any way. We would have been spared the rapid-fire, selective statistics, the vapid promises, the hapless apologies, the draining of the word “unacceptable” of all meaning. Bon voyage, Mr Harris! – Yours, etc,


Baile Átha Cliath 5.

Sir, – I spent 31 hours this week on a hospital trolley in the emergency department in a Dublin hospital. The definition of a trolley is “a wheeled cart for moving goods”; they are not suitable for people to sleep on and are certainly not suitable for people who are ill, many with pre-existing conditions.

At about 28 hours on the trolley lacking sleep, I came to breaking point. I no longer cared if I had a life-threatening condition, and I wondered what to do next. Do I discharge myself, and would I die as a consequence? I debated my options to myself over the next few hours and was determined not to spend another night on a trolley.

After about 31 hours, I was moved to a bed in a hospital ward, as were five others near me on trolleys. We were all so traumatised from our previous 30 hours or so no one spoke to one another or interacted, as people normally do in these situations. We were all ill and now broken in spirit. I heard the man next to me say that he wanted no more treatment.

Clearly Simon Harris, Leo Varadkar and this Government are incapable of running this health service. Simon Harris should do the honourable thing and resign. This health service is in total chaos! – Yours, etc,


Rathfarnham, Dublin 16.

Sir, – Over the last few days, and indeed for years, the Irish Association for Emergency Medicine and others have been describing the unacceptable conditions for patients and staff caused by the boarding of admitted inpatients in emergency departments. Lack of bed capacity on hospital wards is the single greatest threat to acute healthcare in Ireland.

Having spent yesterday appraising young doctors who are training to be consultants in emergency medicine in Ireland, I am very aware that maintaining staff morale is difficult. Public perception of emergency medicine is poor. And yet within the emergency department, every day, I see humane and expert care being given by dedicated, although exhausted staff.

Emergency medicine is assessing and treating increasing numbers of patients every year, over 1.2 million attendances last year. All patients arriving at emergency departments in public hospitals are prioritised on the basis of clinical need only. Private health insurance is not a factor. We treat and discharge (without the need for a hospital bed) over 70 per cent of those patients. We have adopted new ways of working to improve care and prevent admissions, for example minor-injury streaming in all departments, clinical decision units for short-stay care, chest-pain pathways, ultrasound, resuscitation and critical airway skills. We have been at the forefront of improvements in stroke and heart attack care, pre-hospital and trauma care. We have a detailed document explaining where we need to go, The National Emergency Medicine Programme Model or Care.We are training doctors to consultant level and striving to keep them at home.

Because of patient need, and by sheer force of will by staff, emergency medicine is growing in Ireland. We are delivering in departments that are appallingly overcrowded with patients that we have seen, treated and referred for admission to a hospital bed. Emergency medicine is not the problem. Hospital bed capacity is the problem. – Yours, etc,


President of the

Irish Association

for Emergency Medicine,

Royal College of Surgeons

in Ireland

St Stephen’s Green,

Dublin 2.

Sir, – What do you do with a doctor, who was a minister for health, and then left the hospital service in a worse state than he found it? Promote him to Taoiseach! – Yours, etc,



A chara, – My 70-year-old mother spent 26 hours on a trolley in A&E in St James’s Hospital in Dublin at the weekend. It doesn’t shock people to hear this, and it seems 26 hours really isn’t that long. Wasn’t she lucky that it wasn’t 36 hours or 48 hours! Why has this become normalised? Why aren’t we all demonstrating outside Leinster House, saying “Enough”? Because in my own case, I thought it would never happen to my family. I thought it was something that I saw on the news and Prime Time, and then I went off and had a cup of tea saying, “God, I hope we never have to go there”.

Sadly it is only when you see your elderly mother or father or aunt or uncle or friend, with other older people, the most vulnerable in our society, lying on a trolley in a corridor, that you think, “How have we as a society accepted this?”

What I saw on Thursday night and Friday really saddened and shocked me.

We need to hold not only our leaders to a higher standard, we must hold ourselves as a society to that same high standard. We need a collective belief that things in the health service can and must change. It is a tragedy seeing older people on trolleys in hallways, and that is what motivates me to write, to demand change. It could be you writing this letter. It could be you on that trolley next week or someone you love. – Yours, etc,



Co Kildare.