Bearing The Brunt.

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That our healthcare system is a source of fright for many isn’t anything new. it’s a dreaded rites of passage nearly to be left propped up on a trolley in a corridor as the numbers stuck waiting for bed reach an all-time high. Paul Dillon talks to the people that have turned tracking trolleys into one of the main statistical tropes of the crisis in our healthcare system about why it matters.

Trolley watch is a campaign which releases the numbers of people queueing for beds in our hospitals. It has been a staple of media health reporting for over ten years now. The Irish Nurses and Midwives Organisation use the publicity to draw attention to the scale of the problems in the hospital system, and the pressure on nursing staff in particular.

It’s a problem that shows no sign of abating. Indeed, all the evidence is that the issues are worsening. The trolley crisis is now at its worst point since records began. Numbers hit a new high in the second week of March 2018, with 714 counted on trolleys in one single day.

If it wasn’t for the INMO, the extent of the trolley crisis would not be known. The nurses union began counting trolleys in 2005, as nurses on the coalface wanted to raise awareness of a problem that was only then emerging: too many patients for too few beds. In 2011, an agreement was struck with the HSE whereby figures would be supplied on a daily basis to the unions.

Dave Hughes, the long serving INMO Deputy General Secretary told rabble: “We used to ring our reps to establish the figures for Trolley watch. But the HSE disputed our figures. So we did a deal with them. The figure is taken from the bed managers on the wards, or the head of the Accident and Emergency.”

According to Hughes, “Trolley watch counts the number of people who have been admitted to hospital and should be in a bed. The trolley watch figure is essentially the queue for a bed, not the number of people who are on trolleys, which is much bigger. The real figure is actually worse. We believe there is gaming going on. The numbers are being underestimated. For example, people are being sent off for tests before trolleys are counted, or people who are due to get a bed in an hours time are not being counted.”

“We have been doing this since 2005,” continues Hughes. “The numbers have doubled since 2013. The numbers are gone off the Richter scale. This is the worst years we have ever had. I can’t imagine how anyone works in hospitals anymore. It is bedlam.”

Hughes sentiments are borne out by the facts. The trolley crisis has been getting worse and worse. Between 2006 and 2018, there has been a 73% increase in the numbers of patients on trolleys. Over the course of January 2018, 12,201 found themselves on trolleys. The figure in January 2017 was 10,365.

The generally genial and gently spoken Hughes changes tone when asked to describes the impact of these numbers.

“Trolleys are distributed onto wards. The only people who are impacted by this are patients or nurses. It is dangerous. People end up not having access to life saving equipment. Infectious diseases are being spread in hospitals. You can no longer bring flowers into a patient, but you can have a situation where infectious diseases are spread around hospitals by people arriving in A&E, with say diarrhoea then that person being put into ward.:”

He continued, “Mistake are being made all over the place, and we never know of the full extent of the mistakes. There no doubt that people are being neglected.”

For Hughes, there is no escaping the issue of a lack of capacity in the health service.

“The overall solution is we need more capacity. A hospital should run on 85% capacity, to allow you to deal with 15% admission. Our hospitals are running at 100% capacity, meaning they cannot deal with emergencies.”

“Their other real problem is shortage of nurses. The freeze in public sector recruitment hit nursing. The numbers went rapidly down as people emigrated-9,000 nurses left between 2008 and 2014, nurses that are gone and won’t return. Nurses in Ireland are now paid less now than they were paid in 2008.”

The government response has been to dispute the extent of issues in the health service, or to divert attention towards the HSE at least until the issue leaves the front pages.

In the debate on the Irish health services, such as it is, it has often been claimed that spending on health is “at the EU average”. Indeed, it has been a hallmark of the debate for some sources to claim that spending in Ireland is above the EU average.

The facts tell a different story. The OECD, the Paris based intergovernmental organization is the go to place for research on stats on the economy and public spending.

Ireland’s health spending is currently 7.8% of GDP, 13th from bottom in the OECD 35. In 2009, this figure was 10.5%.

In 2015, the most recent year we have figures available from, Ireland had 3 beds per 1,000 people. This put us 25th in the list of the 35 OECD countries for hospital beds numbers. By 2016 Ireland was 5th from the bottom with 2.6 beds per 1,000 people. The pre-crisis read figures more favourably: in 2008, Ireland ranked 18th out of the OECD 35, with 4.8 beds per 1,000 people.

These figures may mask the impact of true health spending cuts. For example, the impact of the closure of thousands of beds in the late eighties and early nineties took years to catch up on. Similarly, the health service will now need years to catch up the impact of cuts during the recent crisis years. The figures also belie an interesting and little remarked upon feature of health spending in Ireland. The proportion of our health spending coming from private sources, like health insurance, is the 3rd highest in the EU.

The story behind the figures is one which is likely to continue and worsen. It’s what happens your friend or family member is admitted to a hospital and ends up on a trolley for a day and a night. Or what happens to overworked hospital staff, dealing with the legacy of cuts and underfunding on the frontline.

We have grown used to scenes of hospital chaos, which enter the media momentarily and pass as quickly as they entered. The crisis will worsen, and no amount of private health insurance, or government spin will address the fact that the public hospital infrastructure needs serious and sustained investment.

In the meantime, nurses and hospital will bear the brunt and most of us will count ourselves lucky that we are not the ones queuing for a bed.

Photos by Jeff Adair & Geoff Stearns

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