An ongoing failure to invest in hospital emergency departments is costing lives as existing medical staff struggle to cope with a dramatic growth in the number of patients, the president of the Irish Association of Emergency Medicine has said.
Prof Conor Deasy acknowledged spending has increased but said additional funding and resources intended to cope with the winter surge had been pulled leaving hospitals like Cork University Hospital, where he is based, ill-equipped to deal with the substantially higher numbers.
“There’s 117 patients in the emergency department at CUH right at this minute,” he told RTÉ's Morning Ireland on Thursday, adding the emergency department had 35 clinical spaces in which to treat those requiring attention. “That in effect means that we’re running at mas 300 per cent capacity,” he said.
“The sickest, with the high triage categories, have all been seen, but there are patients who are of lower triage categories who are less sick who have been waiting since seven o’clock last night and obviously that is dreadful for them.
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“It’s very difficult to for our staff to try and deliver care in this type of environment. We’ve got 45 trolleys in our emergency department right now. These are admitted patients who are waiting on inpatient beds; we’ve got 14 extra trolley patients on trolleys across the hospital as extras up on wards which, again, is not in any way like what it should be.
“These patients deserve to be in a hospital bed, a ward bed and they’re being accommodated on the corridors of the wards to try and create space in the emergency department so we can offload the next ambulance that comes in. So we simply have a massive capacity issue with a baseline lack of capacity,” Prof Deasy said.
Prof Deasy said the hospital’s emergency department traditionally sees a substantial increase in patients over the winter period but that numbers this year were up by 33 per cent generally and 40 per cent in relation to over-75s. And those over-75-year-olds are more complex, they’re more frail, their needs are greater,” he said.
He said there had been a determination across the health service that hospitals could not go through the sort of overcrowding levels experienced last year and a move announced from “winter plans” to a three-year strategic plan intended to address the situation. He added, however that elements of the funding required for implementation had been “pulled” leaving hospitals and their staff to cope as best they could.
“We were very supportive of that [move to longer term planning], but what we heard coming into this winter was all about cost savings, all about embargoes on new employees ... the very people that we needed to employ to rectify the situation that we are seeing year in year out.
“So, it is an issue that we have become immune to, it would seem, the level of crowding in our departments but this crowding is costing lives.”
He said hospitals were doing what they could to deal with the situation and cited the example in his area of the South Infirmary, an elective hospital, that was now “seeing patients it never would have” but this “brings its own risk,” he added.
Asked how the situation could be so bad when the Minister for Health, Stephen Donnelly, said there has been a substantial investment in improving the capacity of EDs, Prof Deasy acknowledged the additional spending and extra staff it has funded but said it is not keeping pace with the demand.
“We’re just not investing to the level that’s required to honour the patients that are coming through our emergency departments.”
He said the fact so many GPs are struggling to see everyone seeking an appointment was also contributing to the problem.
If people are sick, he suggested, but cannot see a GP, “they will inevitably come to the emergency department. And what we don’t want is patients who really need medical attention missing out on medical attention, for fear of long queues and chaotic emergency departments.
“It’s not a good reflection on us as a society that we are continuously on the media. asking patients to seek help in other places. Help should be available in the right places when the patients need us,” Prof Deasy said.
Asked about the comments, a HSE spokeswoman said: “Improving patient experience at our emergency departments is a major HSE and health service priority. This week many of our hospitals are facing substantial pressure with very high levels of attendance due substantially to ongoing high illness admittance due to winter respiratory viruses.
“A number of surge measures have been put in place as part of the HSE Urgent and Emergency Care Plan to reduce the number of patients waiting on trolleys for an acute bed and reduce the number of patients over the age of 75 waiting in emergency departments after a decision has been made to admit them for ongoing care and treatment.
“We have seen significant improvements in 2024 versus 2023. While we have seen increased attendances of close to 15 per cent, we’ve seen some improvements in the number of patients delayed in hospitals, the average trolleys every week, and also the statistics for older people where we put a particular focus on to ensure that those patients over 75 were all seen within 24 hours.
“We have set ourselves a target that across our 29 Emergency Departments at 8am every morning, there should be no more than an average of 320 patients awaiting admission on trolleys – between July and December 2023 we achieved that target on 70 per cent of days. We are, however, in no way complacent on these numbers and they are being exceeded significantly this week. Every part of our health and social care system is focused on the least number of people possible waiting for care.
“The HSE is urging the public to consider all available care options, including injury units, their GP, and local pharmacy if they have a minor ailment.”
The Department of Health echoed many of the points made in the HSE statement, saying there had been a significant increase in staff numbers, a particular focus on improving the experience of the over-75s as a ‘priority patient group’ and a fall generally in the number of patients on trolleys.
“This does not mean the system is fixed,” it said, “but we are moving in the right direction”.
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