A&E crisis needs urgent action not more reviews and taskforces
We have had a capacity problem in our hospital services since the early 1990s. This deficit has manifested itself in overcrowding and delays in A&E units as well as unacceptably long waiting lists for elective admissions. Now that the reality of this longstanding emergency has at last been recognised, let us hope we will not engage in a time-wasting and debilitating exercise of endless taskforces and reviews to avoid taking decisive decisions to relieve the crisis.
A comprehensive bed-stock review was published in 2001 and the National Health Strategy of the same year targeted an increase of 3,000 acute hospital beds over a 10-year period. Today, we are nowhere near delivering on this target. Instead, we are embarking on further studies of acute bed capacity requirements.
The Economic and Social Research Institute has been commissioned to view acute bed requirements to the year 2013 and the HSE has just announced that it is also undertaking a bed-stock review.
I fail to understand why we must engage in further reviews to tell us what every national and international study has told us - that our ratio of three acute beds per 1,000 population is the lowest of the OECD and is inadequate.
Furthermore, we know the population will increase by one million over the next 15 years. In addition, the percentage of people over the age of 65 will increase from 11% to 16% during the same period. Through reliance on the CSO population predictions, we know now what our hospital requirements will be in 2021. Why, then, can we not address the capacity issue to meet the requirements of today and of the future?
We have a recently-established taskforce with the remit of studying the A&E problem setting pie-in-the-sky targets of all patients being seen within a specific number of hours or admitted to a bed within a target period. These targets will remain pie in the sky unless acute inpatient beds are available for patients in A&E units awaiting admission. Patients are on trolleys and on chairs because of a lack of acute beds.
The problem of having 450-600 acute beds inappropriately occupied by long-stay patients has also been with us for more than a decade. Again, we know the number of people over the age of 65 will increase by 70% over the next 15 years. This has been known for years but what concrete steps have been taken to anticipate the demands of this age cohort? An estimated 65% of bed days in Britain are occupied by patients over the age of 65. The estimate for Ireland is 50%. We will reach the British levels within two decades.
As far back as 1999, the Irish Hospital Consultants Association (IHCA) proposed that there should be a more flexible routine hospital working day, with all services to both emergency and elective patients available from, say, 8am to 8pm. This is the period during which 80% of patients attend A&E units.
In proposing this change to the hospital working day, the association emphasised that many groups within the service would require changed working practices and the appropriate negotiations to bring these about. In the intervening seven years, I am not aware of a single meeting with any group of hospital-based workers regarding this matter.
I get weary of statements that there are no simple solutions to our hospital problems. The bed capacity problem must be addressed in conjunction with a move towards more flexible work practices.
It has been the IHCA’s objective since its foundation that hospital services should be delivered in a dignified manner, within a medically-acceptable timeframe and to the highest medical standards. I believe our medical standards are on a par with the developed world but far too many patients wait too long for the service which they require and, when they get it, all too frequently it is not in a dignified and patient-centred surrounding.
The analysing and talking has been done, it is now time for action.
Finbarr Fitzpatrick
Secretary General
IHCA
Heritage House
Dundrum Office Park
Dublin 14
