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Winter of discontent ahead?

The HSE’s €40 million winter initiative plan, which sets out a range of actions and measures across community and hospital services, to increase the availability of community care, facilitate timely discharge from hospital, and increase hospital capacity, has received a largely negative response from the medical unions.

Both the Irish Association for Emergency Medicine (IAEM) and the IMO maintain that the plan will not make any difference in the long-term and is just a drop in the ocean compared to the substantial additional investment in healthcare that is required in Ireland.

Dr Peadar Gilligan, Consultant in Emergency Medicine at Beaumont Hospital and Chairman of the IMO Consultant Committee, said while any extra resources for the health services are welcome, the addition of 55 acute beds into the public hospital system, which has seen 1,600 beds cut, is no way near addressing the additional capacity needed in acute hospitals to deliver adequate care to our population.

As Dr Gilligan rightly points out, the focus on winter is misleading as we now have a year-round bed crisis in our public hospitals. Worryingly, this summer saw record numbers on trolleys, at a time that traditionally has low such numbers.

The summer rise in trolley numbers comes against a background of continuing difficulties in recruiting nurses and consultants, with a significant amount of unfilled posts in hospitals around the country.

Indeed, while the HSE points to the extra 300 beds opened last year as part of the previous winter initiative, the reality is that many of these beds are now actually closed due to staff shortages.

The Irish Nurses and Midwifes Organisaiton (INMO) has warned that the HSE’s announced additional services, either in terms of acute beds, step-down beds and/or community intervention teams, are dependent on there being additional nursing staff.

It has also been pointed out that demand for hospital beds this year will rise in part because of the decision last year to cancel elective surgeries when overcrowding reaches a certain level in hospitals and due to the ongoing pressure being put on larger regional hospitals due to smaller hospitals being downsized.

Furthermore, while a targeted reduction in the number of delayed discharges in acute hospitals from the current approximately 640 to “no more than 500” sounds positive, this is still far too high a number and represents the equivalent of a hospital the size of University Hospital Limerick being effectively unavailable, the IAEM has pointed out.

One can only hope that there will not be a major flu outbreak or cold snap this winter, or trolley numbers could well exceed the previous record high of 600 patients, not to mention the negative medical outcomes and misery such overcrowding brings.

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