Emergency department overcrowding 'breaches human rights'

Health and safety watchdog Hiqa said it was observing overcrowding in public hospitals 'with significant and growing concern'
Emergency department overcrowding 'breaches human rights'

Patients on trolleys  at Cork University Hospital. Overcrowding in acute public hospitals is putting patients at risk of harm and 'breaches their human rights', according to the Health Information and Quality Authority.

Emergency department overcrowding in acute public hospitals is putting patients at risk of harm and “breaches their human rights”, an unpublished paper by the State’s health and safety watchdog has warned.

A record 118,367 patients waited for a bed on trolleys in 2019, according to figures by the Irish Nurses and Midwives Organisation, which is generally accepted as the measure of emergency department overcrowding.

Figures for 2020 were considerably lower due to hospital restrictions that were imposed in response to the Covid-19 pandemic. 

Numbers on trolleys

However, the number of people on trolleys steadily increased in the months following the first lockdown, from a low of 497 patients in April, to 4,353 in December.

In a draft position paper, obtained by the Irish Examiner under Freedom of Information laws, the Health Information and Quality Authority (Hiqa) said it was observing overcrowding in public hospitals “with significant and growing concern”.

The authority described the overcrowding as “unacceptable” on a year-round basis, adding it becomes “more severe in January due to extra – yet predictable – demands on the health service”.

“The continued and, in fact, worsening overcrowding in our acute hospitals is in direct conflict with the national standards for safer better healthcare,” the paper states. 

These national standards are not remotely close to being achieved in the current overcrowded health system.” 

The paper was written largely in advance of the Covid-19 pandemic, however, it acknowledges that overcrowding “increases the risk of the cross-transmission of infection, and is contrary to the national standards for the prevention and control of healthcare-associated infections in acute healthcare services”.

The watchdog said the “harm that delayed treatment and prolonged waits on hospital trolleys has on patients” is also of “increasing concern”.

Ireland has opted for a six-hour target for admission to hospital from the ED. However, Hiqa said the target is “routinely breached” and that “waits in excess of 12 hours are routinely seen”.


To tackle the issue, Hiqa said it strongly endorses the Sláintecare programme and welcomes the plan to re-orientate care into the community setting and enhance bed capacity to required levels.

It also suggested a “more stable future environment” enabling Hiqa to issue enforcement proceedings to individual hospitals “would act as a protection for patients”.

In response, the HSE said it had recently outlined a “range of initiatives” to “enhance community capacity and decrease acute hospital demand”.

“Sláintecare sets out a strategy that would see healthcare move away from an acute-focused delivery model towards enhanced community care,” a spokeswoman for the HSE said.

Some of the initiatives include a “targeted work programme” to provide an additional 4.76m home support hours in 2021 to support those with high and moderate levels of frailty, the ongoing provision and extension of community assessment hubs, and the provision of community health services through community health networks which will provide integrated care locally.

The HSE also received an unprecedented funding allocation this year in the budget, which it said would help bring the Sláintecare programme to fruition.

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