Minister needs to get a handle on overcrowding before winter sets in

As of Monday of this week, the number of patients waiting on trolleys at Our Lady's Hospital, Navan, was three and at Our Lady of Lourdes Hospital in Drogheda (which now carries heavy relevance to County Meath) the number was 29 (according to the Irish Nurses' and Midwives' Organisation Trolley Watch). In the case of Drogheda, this number might seem high in view of the fact that the weather is relatively benign and we are not yet into the full throes of winter. In Navan, the figure seems relatively low but can fluctuate as high as 12 or 15 on occasion. The next few months will tell a tale on the progress being made by Minister of Health James Reilly on his promise shortly after his appointment that never again would there be 569 people on trolleys in hospitals as there were earlier this year. Most reasonable people would accept his stated contention that problems of overcrowding in hospital emergency departments are complex and will take time to resolve. However, that will not wash if the numbers of people on trolleys again soar to these heights. The nurses' organisation claims that record levels of overcrowding were reached in the emergency departments during August, amounting to 6,624 people and an increase of 35 per cent on the same period in 2010 (4,924 patients). Naturally, there is concern about these increases, not least from the point of view that these high figures are existing in the summer rather than in winter when emergency departments would expect to be busier. Because of the alteration/cutback in the level of services available at Our Lady's, Navan, Meath people have a higher dependence on services at the Lourdes. It's very much in their interests to take note of what goes on there. This was reflected in a motion before last Monday's meeting of the North-East Regional Health Forum when Cllr Michael O'Dowd, in a motion put before the forum, called on its members to acknowledge the "distress caused by overcrowding in accident and emergency services" and called for an action plan to be put in place to deal with the "chronic overcrowding" at the Drogheda hospital. The minister has said it was clear various hospitals had differing capacity to tackle the relevant issues. "The solution, therefore, is complex, too, and will require an enhanced capacity by hospitals to deal with the inter-related issues involved." He said that he had established the 'special delivery unit' run by senior adviser Martin Connor to implement new strategies to deal with waiting lists and the number of patients waiting on trolleys. "Since his appointment in June, Dr Connor has been evaluating the issues involved, has commissioned essential research and has formulated a set of responses aimed at improving the capacity of hospitals to better manage its throughput of patients," he said. The focus of the special delivery unit will be to reduce trolley waits in emergency departments and on cutting inpatient, day case and outpatient waiting lists in the health service. The Lourdes is involved in a two-pronged approach to manage chronic overcrowding. The clinical director and group general manager are engaged in managing scheduled care and unscheduled care under the direction of Dr Martin Connor. This weekly process started on 7th September and, in addition to reviewing peaks and troughs in presentations, how to anticipate these peaks and respond to them, the group is also contingency planning for the winter period to ensure senior decision-makers are available at all times. The Louth-Meath Hospital Group is also actively engaged in the implementation of the National Clinical Care Programmes which will see the acute medical assessment unit extending its opening hours to 24 hours a day, seven days a week. This is the unit which provides an alternative appropriate location for the high numbers of medically unwell patients that attend the emergency department and seeks to, by using protocols, assess and provide rapid diagnostics to determine the appropriate care for the patient. This may amount to admission, discharge or follow-up as an outpatient. The HSE has said the extension to 24/7 requires additional staff or their redeployment and associated service curtailment. It also requires considerable changes in practice for physicians and their rotas which are being agreed and implemented. "This capacity will go some way to alleviating the high numbers of patients waiting for admission to the department," it adds. Considering his very vocal and belligerent stance on health issues during his time on the Opposition benches, Dr Reilly will be judged harshly if he fails to come up to the mark on this elementary factor of healthcare which affects so many people.