Is consultants working Saturdays the solution to the trolley crisis?
Some 424 patients in hospitals on Wednesday were finished treatment but could not be discharged due to gaps in supports.
Almost 600 sick people were admitted to hospitals on Wednesday but could not get a bed, as Jennifer Carroll MacNeill joined a long line of health ministers in being “quite alarmed” at the overcrowding crisis.
While this winter started well, real delays for patients are now growing.
Over the last few days, the minister acknowledged this.
She said of St Brigid’s weekend: “This very high level of hospital congestion has not been seen since January 2023.
"The impact on patients and their families is too great for this to remain unresolved.”
She linked the crisis to low numbers of consultants working weekends and bank holiday Saturdays, highlighting in particular University Hospital Limerick (UHL).
This is not a new position, with former minister Stephen Donnelly also very focused on the productivity of doctors and hospitals.
She raised concerns about a slower rate of patient discharges at weekends.
She called for “a full complement” of doctors working bank holiday Saturdays in an interview with RTÉ.
Is the solution to the trolley crisis that clear-cut?
Dr Matthew Sadlier, consultant committee chair with the Irish Medical Organisation, expressed frustration at the focus on productivity.
“The minister will only talk about these hotel aspects of healthcare; how many people in, how many people out,” he said.
"We should be judging by life expectancy, mortality, morbidity, and the quality of care, not the quantity of care.”
Emergency departments do more for people now than 20 years ago, and he said: "That all takes time."
About 61% of the more than 4,400 public consultants between full-time and part-time doctors are now on a new contract.
The uptake has been lower in UHL than expected and it is not clear why.
The contract covers Monday to Friday, 8am to 10pm, and Saturday, 8am to 6pm, over 37 hours weekly.
“If you were just to roster the current complement of consultants on Saturdays, you wouldn’t create any more efficiencies because you would be creating gaps in the system on other days of the week,” he said.
He added: "Extended working days means in certain specialities, there’s going to have to be an increase in numbers.”
Some 424 patients in hospitals on Wednesday were finished treatment but could not be discharged due to gaps in supports.
That figure is not hugely better than the 434 on Saturday.
“The ability to discharge a patient has more to do with what is going on in the community than the hospital," Dr Sadlier said.
"So is that patient’s pharmacy open on a Sunday, that patient’s public health nurse available, is there a delivery company to deliver the wheelchair, the zimmer-frame, and the paraphernalia needed?”
Ms Carroll MacNeill mentioned University Hospital Waterford (UHW) as a site with regularly low trolley numbers.
Former UHW manager Grace Rothwell previously told this newspaper: “I will very much say that it is not a one-size-fits-all, but very much in my opinion it is about having somebody in charge, it’s about knowing who is in the house.”
Now the national director of acute hospitals she recently led a review on overcrowding at UHL.
This found “it is unclear from an operational perspective as to who is in charge on the UHL site on any given day”.
Nurses already work across seven days, but the Irish Nurses and Midwives Organisation are also concerned about the overcrowding their trolley count reveals daily.
Many UHL nurses could soon be lost to a new private hospital being built in Limerick, Mary Fogarty, assistant director of industrial relations, told Limerick Live95 on Friday.
Ms Carroll MacNeill also attempted to dampen the fires around delays to funded HRT, pledged for the start of January.
Speaking in the Dáil on Wednesday she insisted she is looking for a solution, and said: “Please allow me a couple of weeks to do that”.
A spokesman for the Irish Pharmacy Union confirmed they are working with the minister.
So no date in sight yet for women counting on saving money this winter.
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