You can’t cut beds, staff and home help without consequences

SUCH rampant overcrowding at this early stage of the year does not bode well, writes Liam Doran

AT this stage some patients waiting on trolleys will have been there over 24 hours, some for 48 hours to 72 hours, and their living environment is intolerable. People side-by-side, with no space between them, or head-to-toe on the trolleys; staff cannot get oxygen or suction to them, meals are delivered in sandwiches with cups of tea, toileting is done with a curtain rail around them or they are escorted to the toilet with a gown half open — it is a shocking, undignified situation and should not be experienced by anyone.

This has been a problem for eight years and nothing has been done about it. You have political neglect, political disinterest. The reality of it is that it was declared a national emergency in 2006. In fact, in late 2006 and early 2007, the situation did improve because they improved the level of home help, access to long-term continuing care beds, and they opened closed beds. Progress was made, and our public statements at the time would confirm that.

What happened then was the HSE introduced its own recruitment embargo. You then had a decreased level of political commitment in dealing with A&E problems. You then had an increased focus on economic and banking difficulties and all political interest in this problem dissipated completely.

The silence today from the Department of Health and Children confirms that. If the minister, Mary Harney, is away, where is the junior minister?

The Government set the agenda for the HSE, for the recruitment embargo. The HSE has to deal with the cards that they have been dealt. There has been absolutely no political support for the health service in the last 12 to 18 months.

Proof of that is best encapsulated by the renegotiation of the Programme for Government in December 2009 when the Greens prioritised education. Where was the Programme for Government with regard to the public health service? All you get is “you do more with less”.

You have to make a choice. The outgoing government or the incoming government will have to make a choice here. Is the government of the day saying we are going to consign hundreds of patients every day on trolleys, for one, two, three days?

If we can find €50bn-plus to bail out the banks, then I make no apology for saying, if banks are of systematic importance to the economy, then a fully functioning health service is of fundamental importance to the Irish people. That is still, even in these darkest of days, a question of choice and politically they have walked away from it.

Here’s an example: there is much criticism levelled at the public health system and staff. This the common mantra from the minister. Yet in first nine months of last year, the HSE West had a service plan to do so many treatments, so many home visits, and so on, and it exceeded all of its targets. What was its reward? It had its budget cut. It was told it had overspent its budget and that it had to close beds and curtail resources. That was the reward for the staff for their hard work. The mentality was “you’ve done wrong”. It lacks honesty.

Patient representatives need to have the courage of their convictions and call for closed wards to open and for them to be staffed properly. Overcrowded wards was a common phenomenon in the late ’80s and at that time it was found to be a source of cross infection, of increased length of stay and something to be avoided. The unit cost of re-opening a bed is quite manageable because when patients are in an emergency department you have to get extra staff to look after them anyway. Closing beds doesn’t save that much money, it just looks like we are cutting back. People will still get sick. It’s just the quality of care available to them will be diminished.

The fact that we have reached such unprecedented levels on January 5 is very bad news and confirmation that what we have been saying: that you can’t continue to close beds and cut back home helps and cut back on staff without the problem surfacing somewhere. It is surfacing in emergency departments because people have no where else to go.

Liam Doran is CEO of the Irish Nurses and Midwives Organisation (INMO)

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