Protocol castrating bed management, says consultant

Surgeon Peter O'Rourke: 'The situation is ridiculous.'

A consultant orthopaedic surgeon, who had to cancel four out of five hip operations yesterday, has blamed the health minister’s new escalation protocol which he said “effectively castrates local bed management”.

Peter O’Rourke, orthopaedic surgeon at Letterkenny General Hospital, said he was in theatre for 8.30am yesterday and out again by 9.55am because all but one of his planned operations were cancelled.

Mr O’Rourke said he was “sick to death” of hearing about the emergency department crisis when the real problem was a bed shortage.

“If you have 400 people on trolleys every day, then the problem is a shortage of 400 beds. Yet they are throwing money at the EDs. In part, it’s due to political pressure to make the ED crisis go away and in part it’s due to the new protocol,” he said.

The escalation protocol, issued as a directive to acute hospitals last November by the minister, Leo Varadkar, makes it compulsory for hospitals to take specific steps to address emergency department overcrowding when it reaches crisis levels, including cancellation of non-urgent surgery. Hospitals who do not comply are subject to penalties with resources re-allocated.

However, the upshot of this approach for Mr O’Rourke and his colleagues had been repeated cancellation of surgeries in the past two weeks. “Last week a colleague had to cancel three joint replacements and another colleague had two cancelled on Tuesday,” he said.

Mr O’Rourke said it meant phoning patients at home on the morning of their scheduled surgery to tell them not to come in.

“They’re at home with their bags packed, ready to come in and we have to tell them not to,” he said.

Mr O’Rourke described the emergency department crisis as “a myth” and Mr Varadkar’s comments last weekend that hospitals slow down when not under pressure as “ridiculous”.

He said the consequences of the new escalation policy would be ongoing cancellations of planned surgeries and longer waiting lists: “Ironically, hospitals will be criticised for the length of their waiting lists and the HSE will force surgical treatment to be outsourced to private hospitals, which will run down public hospitals.

“Funding that could be used to increase bed numbers will be dissipated into the private sector in a self-perpetuating prophecy.”

Mr O’Rourke said health officials needed to start listening to staff “other than those working in the ED”, “otherwise we will end up with hospitals attached to EDs, rather the EDs attached to hospitals”.

Meanwhile, Beaumont Hospital confirmed last night that all non-urgent procedures for today and tomorrow have been postponed due to the large volume of people attending its emergency department.

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