Overcrowding in hospital accident and emergency services (A&E) now amounts to a national emergency, according to Tánaiste and Minister for Health, Mary Harney. Her statement begs two questions: what has the Minister been doing for the past nine years as the crisis developed? And does this mean that the Government's handling of hospital services is about to change?
Shortly after taking over from Micheál Martin as Minister for Health in 2004, Ms Harney published a 10-point plan designed to solve overcrowding in A&E departments. However, as the head of the new Health Service Executive, Brendan Drumm, admitted last week, it has not worked and the problem "seems to be larger than ever". So it is a case of back to the drawing board. But, if the views expressed by Taoiseach Bertie Ahern in the Dáil yesterday are to be taken at face value, the Government's approach will be based on long-delayed administrative reform.
There is no doubt that work practices within health services and hospital management systems must be changed. It makes no sense to close X-ray and other expensive hospital diagnostic services at night and during weekends. In the same way, it should be possible to discharge patients at weekends in order to make beds available to seriously ill people. And community health services must be developed so that a greater number of people can be treated in their own homes. These measures will contribute to a solution. But our rapidly growing - and ageing - population will also require an increase in the number of hospital beds.
Professor Drumm has proposed a mixture of long-term solutions and short-term measures to deal with the A&E situation. He has warned there is no "quick fix" solution. But, while he has maintained that sufficient resources are being made available by Government, most hospitals are incapable of coping with the influx of patients caused by seasonal factors, such as the winter vomiting bug and flu-like illnesses. At the very minimum, a strategic reserve of staff and beds will be needed to respond to those annual pressures. And planned medical assessment units for Tallaght, St Vincent's and Beaumont hospitals in Dublin must be brought on stream as a matter of urgency.
Changes in work practices identified by both the Taoiseach and Tánaiste will have to be agreed with the various interests concerned. Those negotiations will take time. It is vital, however, that they do not become bogged down in the kind of unproductive skirmishing that has marked such discussions in the past. Providing optimum use of X-ray and diagnostic facilities will, of course, involve unsocial hours. And community healthcare and step-down facilities to cater for less seriously ill patients in recovery must be provided on a more extensive basis. Accidents and emergencies do not happen according to schedule. If staggered, working hours by healthcare professionals can reduce or eliminate the number of sick old people spending time on trolleys. That is the way to go.