Sir, – Your editorial ("Worse is yet to come", January 11th) is a welcome, if somewhat imperfect, contribution to the debate on a subject that should be of vital importance. Discourse to date has often been characterised by hand-wringing, ill-informed commentary or various interest groups offering "solutions" that are little more than attempts to garner additional funding for their own services. Those calling for investment in primary care as a purported solution to emergency department (ED) crowding miss the point that the current difficulty is caused by the warehousing of admitted hospital inpatients in EDs, not the patients who could be more appropriately treated in primary care, a group which certainly do not end up languishing on trolleys.
While nobody disputes that investment in primary care is a good thing, suggestions that such investment will unburden EDs are well wide of the mark when the problem is a lack of timely access to inpatient beds.
Undoubtedly we need a sustained programme to develop additional bed capacity both in acute hospitals but also in community facilities. More suitable facilities for those with chronic medical conditions and a greater capacity to better care for those elderly patients who need more acute, though not necessarily hospital care, are also urgently required.
Given that some 300 to 350 members of our community die avoidably each year as a direct result of ED crowding (frighteningly, twice the number that die on Ireland’s roads), I agree that this major public health issue should feature prominently in the upcoming general election. It should have featured in previous campaigns but perhaps the penny has finally dropped that sacrificing the lives of the equivalent of the population of an Irish village each year is not something that any government of a first world country could be proud of, particularly when the solutions are in its hands. – Yours, etc,
Dr FERGAL HICKEY,
Consultant
in Emergency Medicine,
Sligo University Hospital.