Leo Varadkar directive will see hospitals penalised if patient left on trolley for more than nine hours
The directive makes it compulsory for each acute hospital to take specific steps to tackle emergency department (ED) congestion, under what is called an escalation plan, with the threat of having resources reallocated if they fail to do so.
Mandatory measures include undertaking extra ward rounds to facilitate discharges, the postponement of non-urgent elective surgery, and close liaison with the ambulance service to ensure workload is more evenly spread across hospitals. As a last resort, extra beds would be placed on wards.
Significantly, the directive removes the discretion of individual hospitals to implement their escalation plan. All acute hospitals must act whenever their ED experiences overcrowding.
The directive requires that each hospital regards ED congestion as a key issue for the whole hospital, and for primary and community care services.
Mr Varadkar signed the order against the backdrop of a small improvement in trolley figures, a trend he is keen to cement.
He said the most recent trolley counts from the Irish Nurses and Midwives Organisation (INMO) and the Department of Health’s special delivery unit showed there were fewer people on trolleys this month, compared to November 2014.
On weekdays, the number of patients on trolleys tended to peak at around 300, falling to 150 by the evening.
“While not acceptable, this is a far cry from the 500 to 600 we witnessed in January,” he said.
Mr Varadkar said the situation had eased because of a number of measures, including more staff and more beds in hospitals, nursing homes, and community facilities.
“Nonetheless, there are still far too many people waiting too long in our emergency departments, so further measures now need to be taken to escalate this response to ensure that the progress is sustained,” said Mr Varadkar.
INMO general secretary Liam Doran said the order would be “potentially helpful” in dealing with hospital overcrowding.
“It will assist in any discussions in relation to the pending dispute because it is one of the four issues we have identified as requiring attention,” said Mr Doran.
“We want proper, full and 24/7 implementation of agreed escalation policies to minimise overcrowding in both EDs and wards.”
He agreed recent trolley figures looked as if they were marginally down on November 2014.
INMO members will target some of the hospitals worst hit by the trolley crisis next month when they walk out of EDs as part of a series of two-hour rolling work stoppages.
“We have consistently said that hospitals are not applying the escalation policy — they are ignoring it,” said Mr Doran. “All they are doing is putting beds up the wards but that should be the last step.”
Mr Doran, together with HSE director general Tony O’Brien, co-chairs the ED Implementation Group that is due to meet on Monday, when the order will be discussed.
The HSE said on Tuesday it would seek the intervention of the Workplace Relations Commission as soon as possible to avoid industrial action taking place, however, Mr Doran said the INMO had yet to receive an invitation to the WRC talks.
Meanwhile, outspoken consultant ophthalmologist Michael O’Keeffe, who is based at the Mater and Temple Street hospitals in Dublin, has criticised hospital managers for not having the courage to speak up when things go wrong.
And consultant oncologist and senator John Crown said he has given up hope that the health system could be reformed.
“So for the record, I am despondent,” said Prof Crown. “I don’t think the health service is going to get fixed in my lifetime.”
News: 30
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