Stephen McMahon: Time for a new beginning with action, not promises, on hospital issues

Stephen Donnelly has promised another plan to tackle overcrowding in our hospitals. We need action, not more plans, writes Stephen McMahon, Non-Executive Director of the Irish Patients Association 

Patients on trolleys at the emergency department in University Hospital Limerick earlier this year. Health Minister Stephen Donnelly is sending in a Performance Management Improvement Unit for four to six weeks in an effort to tackle overcrowding. Picture: David Raleigh

When I read Minister Stephen Donnelly’s statement about taking control of the emergency department at University Hospital Limerick, my initial reaction was, “Holy God, Minister — not another plan".

Reading the well-crafted statement, it appears a lot is happening now, but there have been red flashing lights about overcrowding for many years, from many informed sources, such as Hiqa, emergency consultants, nurses, advocates and politicians.

Is this a case of building flood defences when you’re up to your knees in it? Better late than never, we hope.

The Minister said he met various officials “to discuss immediate responses to the pressures currently being faced by the 29 emergency departments” across the country. The key word is “currently”, which gives the impression this is a problem that has only recently arisen.

Management of overcrowding in many emergency departments has been a dismal failure for years, with last winter probably the worst.

The most dangerous emergency department is at University Hospital Limerick. Mr Donnelly is now sending in a Performance Management Improvement Unit to Limerick for four to six weeks in an effort to tackle the overcrowding. 

Earlier this year, the Irish Patients Association produced a winter league table of the most overcrowded hospital emergency departments. We issued these to politicians, the HSE, the health minister, and the media.

We consistently asked how was it that Beaumont Hospital, with a catchment area of 200,000 people, had no patients on trolleys while Limerick’s emergency department was bursting with patients. Interestingly, no one came back to us to better inform our analysis or offer a solution.

The Minister's statement this week continued by saying a new Performance Management Improvement Unit “will ensure that all necessary immediate steps are taken to address the safety issues.”  The kicker is when they say a “detailed plan” will be urgently developed to ensure that the problems do not reoccur.

We already know that, following any Hiqa inspection, the hospital will submit a detailed plan to meet their concerns. So that means after all the reports over the years, we will now have another plan for the Minister.

Hiqa and others have clearly identified what needs to be done. The minister made no reference to the hugely important review from Professor Tom Keane following inspections of nine underperforming hospitals.

This report was not published until the Irish Patients Association released it in April 2022, having received it under the Freedom of Information Act from the health department, 30 months after its creation in January 2020.

The documents released said the HSE’s view was it was no longer relevant following innovations implemented during Covid-19 while the Department of Health did not agree at all with the analysis.

That independent review was eye-watering in its assessment of UHL’s emergency department. Among their findings was that “the medical model needs to be re-examined”. 

They found patients on trolleys and inappropriately placed on “any bed anytime, anywhere, even and including mixed-gender”.

As a member of the Emergency Department Task Force, we and the Irish Nurses and Midwives Organisation have been calling for the urgent recall of this task force which has only met three times in the past year. We even wrote to the minister in recent weeks but to date, no response.

It is extremely serious there are more deaths arising from overcrowding in our Emergency Departments than occur on our roads. Recently 1,400 travellers missed their flights during the massive overcrowding in Dublin Airport.

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In response, the Government called for urgent action plans to be submitted within days, yet 20,000 patients missed operations or appointments the previous month due to strike action and it was quickly forgotten.

We know thousands of patients waited on trolleys and wards to be admitted — many over-75s waited longer — yet there was little outcry and we’re still only working on plans. 

I no longer receive useful weekly data on the emergency department performances. This information should be public, as was the daily information during the Covid-19 pandemic.

Irish Patients Association spokesman, Stephen McMahon: "Management of overcrowding in many emergency departments has been a dismal failure for years, with last winter probably the worst." Photo: Laura Hutton/Photocall Ireland.

More recently the failures of leadership and governance in the Child and Adult Mental Health Services in Kerry created conditions for error which should have been picked up by an engaged problem-sensing leadership and not one which seeks only to find comfort in a hear no evil see no evil style.

We can all play an important role in bringing real reform to our health services. There should be no more commenting on the situation by those whose job it is to do the work, no more comfort-seeking situational analysis but rather actions on what has already been identified.

Patients and caregivers everywhere in Ireland deserve better than the way things are today. It is time for a new beginning not built on promises but on performance.