Tackling of this hospital trolley scandal is long overdue
LOOK at the cold, hard numbers, because as ever while promises can over time be altered, the numbers never lie.
On March 28, 2006, after the first meeting of the inaugural emergency department taskforce set up to tackle the trolley count crisis, then health minister Mary Harney declared it a “national emergency”.
Describing the fact 495 people were waiting on trolleys in overcrowded emergency departments as a breach of “basic human dignity”, Ms Harney said anything less than ending the scandal “is not acceptable to the public, not acceptable to me, and not acceptable to the HSE”.
Since the watershed moment, when the inhumane trolley crisis was finally called what it really is, the “national emergency” record rate has been broken 102 times.
It has been dwarfed by records of 500 people on trolleys in January 2010, 569 in January 2011, 601 in January 2015, 612 in January 2017, 656 in January this year and 714 just this week — in March, a month not normally associated with surging trolley figures.
Instead of fixing the problem, Ms Harney’s national emergency figure of 495 trolley figures was topped once in 2010, twice in 2011, 15 times in 2015, 20 times in 2016, 31 times in 2017 and 43 times this year alone.
The figures don’t lie. The annual trolley count rates have nearly doubled from 55,720 in 2006 to 98,981 last year, with more than 35,000 people already faced with trolley waits this year.
So while the minister in charge of the health sector has changed, the crisis not only still exists, but has worsened.
Yet, asked for a response in recent days, Health Minister Simon Harris and Taoiseach Leo Varadkar have pointedly declined to admit the obvious.
“I’m not one for labels, my predecessors put labels in the past and I’m not sure it helps.
“But if the question is do I accept there is a need for a real urgent and renewed focus on hospital overcrowding — ‘absolutely’,” Mr Harris told reporters as he attended the emergency department taskforce meeting on Monday in response to that day’s 714-person trolley count.
Asked a similar question during his whistle-stop St Patrick’s festival trip to the US in Oklahoma, Mr Varadkar was equally reluctant to name the elephant in the room, controversially claiming it is “not entirely clear” what is going wrong before referencing the recent snow storms and “very long flu season, but that’s not an excuse”.
Since 2006, the current Fine Gael-led Government, its Fine Gael-Labour predecessor, and the boom and bust Fianna Fáil-led coalition have all published comprehensive plans on how to address the trolley scandal.
However, instead of fully implementing the reforms, the reports’ recommendations have too often been reduced to bit-part roles in the wider reform agenda, either not being properly acted on or not receiving the supports required.
In the aftermath of Ms Harney’s 2006 “national emergency” admission, the newly formed emergency department task-force put forward a number of suggestions for how the crisis could be addressed.
However, the pay plan was quickly shot down due to employment law while the six hour target soon fell by the wayside. And the 2,000 new beds initiative soon fell victim to the economic crash.
A year later, in June 2007, a damning independent PA Consulting report for the HSE leaked just days before the general election said seven emergency department were “unfit for purpose”, including the Mater, Beaumont, the Mercy University Hospital in Cork, Wexford General, Cavan General, Our Lady of Lourdes in Drogheda and Letterkenny General.
As such, the HSE repeated its waiting time target, to be reduced in months to six hours, and claimed the report “crystallised” the problems so they could now be resolved.
However, the subsequent economic crash meant that instead of increasing bed capacity, upgrading existing emergency department units and retaining and raising staff numbers, financial needs meant none of this occurred.
Between 2008 and 2011, a series of cuts to hospital budgets saw the HSE’s budget slashed by €2.7bn and nursing levels cut by 5,000.
The situation was further exacerbated by a well-intentioned attempt to re-configure hospital services between 2011 and 2013 which saw emergency departments at Bantry, Ennis, and other areas shut so they could be centralised in larger hospitals.
While in the health minister hot seat between 2011 and 2014, Dr James Reilly had some success with his Special Delivery Units (SDUs), which was specifically designed to force hospitals to comply with the still in place but largely ignored 12 and six hour waiting time limits.
However, while HSE director general Tony O’Brien said the SDUs would be used to ensure “no stone will be left unturned”, since 2014 the emergency department figures show the initial reduction has been short-lived.
Late last year, Health Minister Simon Harris published the latest plan to fix the health service. The bed capacity review called for 2,500 new hospital beds to increase capacity over the next decade — with a similar call being made by the cross-party Sláintecare report.
However, like the reports of the past, the latest plans have no guarantee of being acted on, with Taoiseach Leo Varadkar lukewarm at best on Sláintecare and 10-year bed increase plans too often becoming the victims of financial misfortune.
Twelve years on from Ms Harney’s “national emergency” admission, the crisis remains just that— a national emergency.
Ignoring the numbers will not end the scandal, but a decision to stop ignoring the well-aired plans that should be fully implemented will.
By the numbers
Mary Harney declares the trolley count a “national emergency” at the inaugural meeting of the emergency department taskforce after 495 patients are treated on trolleys.
55,720.
A detailed HSE review finds seven emergency department are “unfit for purpose”: The Mater, Beaumont, the Mercy University Hospital in Cork, Wexford General, Cavan General, Our Lady of Lourdes in Drogheda, and Letterkenny General.
The HSE repeats its 12-hour waiting-time targets, to be reduced in months to six hours.
50,402.
Staff at Our Lady of Lourdes Hospital in Drogheda warn conditions are “inhumane” after 40 people are treated on trolleys, including 15 for a number of nights. The number of people on trolleys this month averages 450.
63,713.
For the first time, 500 people are treated on trolleys in a single day.
75,859.
The 500-person daily rate is broken twice, with new records of 511 and 569 set.
86,481
James Reilly’s special delivery unit brings initial reductions to trolley numbers, with the 500 mark not hit again, but nurses and doctors continue to warn of an ongoing overcrowding crisis.
66,308 in 2012, 67,863 in 2013, and 77,091 in 2014.
The 601 daily trolley count means that for the first time there are more than 600 people being treated on trolleys at any one time. The HSE deputy national director of acute hospitals, Angela Fitzgerald, cannot say A&Es are safe, despite being asked on RTÉ’s Morning Ireland programme eight times.
92,998.
A new record is reached, with 612 people treated on trolleys in a single day. The 600-mark is broken twice more this year: On January 4 (602 on trolleys) and February 1 (601 on trolleys).
98,981.
Another record is set, with 656 people treated on trolleys in a single day. Despite the previously unheralded prospect of a 600-person daily trolley count, over the following month the ceiling is broken another four times, including a new 677-person record on January 3, 668 on January 23, 601 on January 24 and 644 on January 30.
Over a 13-day period, the 600-person mark is broken a further four times, with 623 people treated on trolleys on February 14, 643 on February 19, 621 on February 20, and 638 on February 26.
Over an unprecedented five-day period, the 600-mark is broken five days in a row: 654 people treated on trolleys on March 5, 620 on March 6, 613 on March 7, 614 on March 8 and 601 on March 9. The HSE and the Government blame the snow storms and a longer-than-expected flu season.
As repeatedly warned by emergency department staff in recent weeks, the 700-person mark is finally broken, with a shocking 714 people treated on trolleys in a single day. While the rate drops to 649 the following day, the Irish Nurses and Midwives Organisation insists the Government must declare an A&E national emergency.
