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The simple cause of the housing and hospital crises

By Mindo - 01st Nov 2019

The worst solution for the trolley crisis came from an engineer. “Remove all trolleys,” he said. That will force the system to respond with efficiencies. It was around the time former Minister  for Health Mary Harney declared a national emergency, because almost 500 people were waiting for a ward bed.

Since then, beds have closed. Since then, the population has gone up by half a million. In housing, it’s understood that a rising population needs more houses. In health, we need more wards. Unfortunately, that logic is rejected. Any other answer is acceptable.

Minister Harney’s solution was co-located private hospitals. Could her plan have worked? The original co-located private hospitals – The Mater and St Vincent’s – haven’t solved the problems of the adjacent public hospitals. In The Irish Times recently, a columnist described spending 24 hours on a trolley in St Vincent’s Hospital; medical staff said it was a “quiet” night. The Sláintecare proposal to remove insured patients couldn’t work either. Why not? A key issue is the lack of NCHDs in private hospitals, especially at night. That’s why those radio ads say “we’re there for you”, but mostly nine-to-five and not too much at weekends.

This year, I’ve seen editorials in two national newspapers proclaiming that all health service problems are because there are too many hospitals. Oh dear.

Think of the brilliant staff in University Hospital Limerick (UHL), who struggle daily to care for patients from all across the Mid-West. When trolleys are on the news, the only certainty is that the new emergency department (ED) in Limerick will be at the top. That was not always the case. The TrolleyWatch Archive shows that trolley numbers rose inexorably as services, and wards, in Ennis and Nenagh hospitals were closed.

Limerick often has 60 patients admitted, but still on trolleys. Next year, 60 inpatient beds will open. What will happen to the trolleys? My view is that the similarity in the numbers is spurious. The trolleys will fill again, maybe not as fast, so UHL will drop out of the headlines.

The “too many hospitals” narrative (weirdly) presumes that patients can safely be absorbed by neighbouring hospitals, even though all are full. I think that’s based on the idea that hospitals outside Dublin are small. I noticed even the excellent Dr Ciara Kelly made this mistake, when writing about the mortuary problems in Waterford. (Check the figures: Waterford is big and busy!)

I get irritated when there’s talk about growth in the elderly population, rather than all age groups. Then people notice the “bed-blocker” numbers are similar to trolley numbers. So that leads to another simple solution: Community supports and nursing home beds. Hmm… there are a couple of snags.

What matters is the patients on trolleys  and the HSE has no idea what age they are, because there’s no HIPE data. They only know what Joe Duffy and the tabloids tell us and that’ll always be the most tragic story. Anyway, some years ago, guided by the phoney parallel between trolleys and delayed discharges, money was put into nursing home care. And it didn’t work. Why not?

The patients on trolleys change constantly. They’re a mixture of young and old; some need a short inpatient stay, some longer. In contrast, patients usually become “delayed discharges” because they are fragile and complicated. Many are not fit to be moved and many die before discharge.

My engineer friend would like the “efficiency” solution which turns everything into a day case or outpatient. It’s a nice theory, but in practice has created a monster: Waiting lists. Hospital admission used to be a one-stop-shop where several problems were sorted. Now, patients stay the same number of days, but only one problem is addressed. Every other issue goes on a waiting list.

The debate about better and fairer pay for doctors and nurses will help patients, even if trolley numbers don’t change much. What’s worse than being ill and on a trolley? Answer: Ill on a trolley without appropriate doctors and nurses. As for GPs, it’s astonishing that women have to go to EDs to get routine ante-natal care because there are not enough GPs. Again, more GPs is good for patients, but won’t banish trolleys. If the HIPE data existed, it would probably show that most trolley patients are referred by GPs.

So it looks like we need more money, for wards and staff. Of course, someone will say Ireland spends more than anywhere else on health. I don’t know enough to dissect this. But I know international comparisons ignore capital spending, a persistent weakness of the Irish system. And I’m pretty sure some irrelevant stuff is included in our health figures.

Houses and hospital wards, it’s the same problem – we need more.

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