Chaos in our A&Es is for life.... not just post-Christmas

He may draw unfavourable comparisons with the Grinch who Stole Christmas, but Leo Varadkar’s call for a clampdown on Christmas leave as a solution to the post-festive chaos of our emergency departments is, ostensibly, as obvious as the nose on your face, writes Catherine Shanahan

Keep essential services ticking over such as diagnostics and labs, keep the EDs fully staffed, treat patients as they present, so that the numbers don’t keep adding up and, hey presto, come January the EDs will be no more overcrowded than any other time of the year.

No more overcrowded than we are used to, on a daily basis, as the trolley numbers reflect.

As for trolley numbers themselves, come January, what with everyone working flat out, they should be OK too, no worse than they are, say, seven weeks before Christmas when, as of yesterday, 591 patients were on trolleys, waiting for hospital beds.

As health unions point out, ED chaos is not confined to two weeks after Christmas; both the Irish Midwives and Nurses Organisation (INMO) and Irish Association of Emergency Medicine (IAEM) say the busy period now lasts from October to March.

The Taoiseach’s suggested solution to the perennial January chaos sounds good.

The barstool preacher thinks it’s an excellent idea. Sure isn’t it a basic tenet of running a successful business that you upscale resources in anticipation of peak demand?

But when resources can’t meet demand on a daily basis, how can they be upscaled? And how can cancelling leave make an impact when the INMO says current leave policies mean the bulk of their 40,000 members have no more than two days’ leave left come Christmas?

Besides, the HSE will argue it has already factored the need for less leave into its rosters over the festive period.

Emergency medicine consultants, who should also cancel Christmas, are probably the most overworked element of the entire consultant cohort.

And as Emily O’Connor, president of the IAEM, pointed out to this newspaper, for the health system to function effectively around the clock, it needs buy-in from all areas — general practice, allied health professionals, community care — and not 24-hour hospital EDs.

And how can patients move from EDs into hospital beds if there’s nowhere to send those fit for discharge, due to a shortage of step-down care and home care packages?

And what of the Winter Plan, details of which are still unavailable with less than two months to go to EDs imploding?

The HSE told this newspaper it “is at present examining the options in terms of deliverability and impact for this winter in the context of the additional €10m once-off funding, and a final plan will be submitted for approval this week”.

Bottom line is: it was an easy line for Leo to take although why he took it, and not his health minister, remains a mystery.

Equally mysterious is his failure to adopt a similar tack during his own tenure as health minister, given the winter plan has failed, irredeemably, for years. It was an easy line because while it sounds good, there’s no onus on him to follow through.

That’s down to the HSE you see, because as Leo pointed out, “ultimately under law, the health service is run by the HSE”, not, as many would believe, by the minister.

Maybe Leo should roll up his own sleeves, as per the Twitterati, and bring his doctoring skills to bear, leading by example over the festive season, while his fellow politicians enjoy their three-week Christmas break.


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