I worked as a doctor for seven years including four years in hospital medicine between 2003 and 2007.
This included the Christmas and January period in St James’s on the wards, Beaumont, Blanchardstown and Crumlin in the emergency department, and Blanchardstown in medicine for older people. I also worked in Tallaght, Navan, Wexford and Holles Street, though not at Christmas or in January.
The experience in each hospital was different and has certainly helped form my views on the problems in our hospitals. I do have to remind myself that I am 10 years out of hospital medicine and things may have changed, although I fear not enough.
Blanchardstown was a new, well-run emergency department in which there was overcrowding, but never to the extent that there were trollies on corridors. Patients always had dignity and privacy. In Crumlin, parents could wait for hours but the sickest kids were always seen quickly and received very good care.
Tallaght was tough. You regularly had patients lining the corridors with only screens to give them any privacy. St James’s was run like a well-oiled machine and despite having one of the most deprived catchment areas in the State, and lots of social problems, it always worked well and bounced back quickly.
Beaumont’s infrastructure was much older, the space was very limited and patients were regularly left on chairs and side-by-side on trollies in the middle of the floor. I found it very hard to deal with. There wasn’t even space to examine patients sometimes. I know it’s improved a lot since in terms of overcrowding but the infrastructure is much the same.
Over-stretched staff
Everyone who is on duty works very hard. That goes for nurses, doctors, healthcare assistants, porters, radiographers and all other staff. You regularly don’t get your breaks and have to stay late beyond your shift to finish up work or make sure a patient was sorted out.
There are also a lot of staff out sick in the new year which would mean a delay in getting someone in to cover. I never understood why this wasn’t factored in.
I remember Dominos sending pizza to all of us one Christmas Eve, and some celebrities coming to visit on Christmas Day. I really appreciated that. Everyone who’s in over Christmas, on bank holidays and weekends works really hard. Too hard.
Because there aren’t enough people rostered for those periods in hospitals, the staff are over-stretched and patients have their treatment delayed. And when social and medical community services aren’t available, the hospital becomes the default option.
I’ve had the unusual experience of seeing the health service from several angles, as a hospital doctor, GP, constituency TD, health Minister and Taoiseach. Working in different hospitals, though, definitely gave me a sense of how good systems and good management are as important as staffing levels and bed capacity.
Mounting problems
Unfortunately, overcrowding happens all year round but it spikes pretty much every Tuesday with a peak or “crisis” period after a bank holiday or a run of bank holidays. These peaks occur because we largely run our hospitals on a Monday to Friday, 9am-5pm basis with a limited emergency only or on-call service the rest of the time, or most of the time, especially when it comes to diagnostics. So patients admitted on a Friday or during a holiday period regularly don’t get the tests, scans, or procedures they need until the Monday or even Tuesday or Wednesday after they are admitted. They take up a bed for days, just waiting, which means others end up on trollies.
Problems simply mount up. I know the frustration of having to fight for scans, procedures to be done on that Tuesday after a bank holiday, or during those days in between Christmas and new year that aren’t either a bank holiday or a Saturday or Sunday. It takes about a week to get back on top of things after a bank holiday and maybe two weeks after the Christmas and new year period.
It’s frustrating that this problem seems intractable. During years of cutbacks it didn’t get any worse. During three years now of extra staff, extra beds and extra financial resources, it’s not got any better.
I am sure that with a rising and ageing population, we will need to continue expanding our health service. I am equally convinced that as it’s currently structured, with underdeveloped primary and community care, hospitals working on a 9am to 5pm, five day out of seven basis, and general poor performance management, we won’t see much return for the extra staff or capacity.
The RCSI Hospital Group is leading the way when it comes to reducing overcrowding. They are the best performer every day on the TrolleyGAR, having been the worst, and have record low overcrowding. I met them over the summer to hear what they were doing right. The answer is that it’s the obvious good management practices. There’s no mystery to it. I just don’t know why best practice is not mainstreamed.