The most drastic action or “last resort” available to hospitals when dealing with emergency department (ED) overcrowding has already been deployed 1,600 times this year.
The Full Capacity Protocol (FCP), the final step in hospitals’ escalation plans where additional beds are placed in wards and hallways, rather than packing patients into overcrowded EDs, is being used by some hospitals on an almost daily basis.
University Hospital Limerick deployed the measure on 153 occasions for the first 165 days of 2019. Sinn Féin health spokeswoman Louise O’Reilly, who obtained the figures via parliamentary question, said when the protocol was first mooted by the HSE a number of years ago “they gave categorical assurances that it would be an emergency measure only”.
Ms O’Reilly, who was national nursing officer for Siptu at the time, and was “in the room” when the measure was being discussed, said the unions were vehemently opposed to it.
“They [the HSE] said they didn’t envisage it being used much,” Ms O’Reilly said. “But if we have hospitals that are using it almost permanently, it’s on the basis that they are in a constant state of crisis.
The HSE needs to look at additional measures because hospitals can’t operate in crisis mode all of the time.
By June 14 this year, University Hospital Waterford had deployed the FCP 151 times, Cork University Hospital used it 137 times, and University Hospital Galway used it 135 times. Dave Hughes, deputy general secretary of the Irish Nurses and Midwives Organisation, who previously said that the sanction to use the protocol “was likely to be abused”, said last night that his predictions had come true.
“I think all that I predicted has happened,” he said. “Nurses know that it’s not the right thing to do, and that when you let hospitals do it at all, it becomes a habit.”
He said UHL, CUH, and UHG were evidence of that, while hospitals such as the Mater and St James’s in Dublin rarely, if ever, used it. He said the FPC led to wards being overcrowded, in addition to the emergency department, while adding to nurses workloads, making caring for patients more difficult.
The directive which allows for placing extra beds on wards as a “last resort “ was signed in November 2015 by then health minister Leo Varadkar. Mr Hughes said it had “become a way of taking in more patients, which creates a risk”.
He said the alternative was “timing” as envisaged in the National Escalation Framework; that hospitals should work through a series of steps in a timely manner, such as additional consultant ward rounds to discharge patients, and warnings to the public to avoid EDs, rather than going straight to FCP.
“It’s not a panacea, but it would reduce the amount of times hospitals use the FCP.”
Asked if it was concerned that a “last resort” measure was being used on a daily basis to deal with ED overcrowding, the HSE said the continuing growth in demand for urgent and emergency care “continues to impact our acute hospitals capacity to timely access, hence the need to implement the national escalation process to deploy more capacity at times when the pressure on hospitals is most acute”.
The HSE said demand for urgent and emergency care “continues to grow year-on-year with the first five months of 2019 showing a 4.2% increase in ED attendances compared to the same period last year”.
The HSE also confirmed that its ED task force met only once this year — in January — “to formally close-out the implementation of the ED Task Force 2015 Report”.
“A revised future structure of the ED Task Force is now under consideration,” the HSE said.
Separately, the INMO said new figures show nurses are the victims in nearly nine in 10 assaults in HSE hospitals. Of 279 assaults in public hospitals this year, 249 were against nurses. The union blamed the problems on “understaffing, overcrowding and under-capacity... creating a ‘pressure cooker’ environment”.