THE ONGOING OVERCROWDING issues in Irish hospitals often lead to distressing stories of elderly or infirm people waiting on hospital trolleys for long periods.
Given the nature of providing healthcare, even one horror story can be upsetting for those involved. So measuring improvement, or indeed a worsening of the problem, can be a blunt instrument.
The most common measure for gauging how Irish hospitals are coping with the number of people they treat in emergency departments is the number of people on trolleys.
Whether this number has increased in the past 12 months is often seen as the barometer of how the HSE and the Department of Health is doing their jobs.
In the Dáil last week, Tánaiste Frances Fitzgerald had an exchange with TDs Louise O’Reilly and Joan Collins about emergency departments, and particularly about hospital trolleys.
During the exchange, the Tánaiste said that, it was “unacceptable to all of us that hundreds of patients are on trolleys for long periods of time.”
She added however that:
The trolley numbers for January are lower this year than last year.
On the surface, it’s a straightforward enough claim, but is it true?
(Send your FactCheck requests to factcheck@thejournal.ie, tweet @TJ_FactCheck, or send us a DM).
Claim: There were fewer people on hospital trolleys in January than last year.
The facts
We asked the Department of Health for the numbers that support the Tánaiste’s claim and for the source of those numbers.
The Department of Health said that the data she was referring to comes from the Health Service Executive (HSE).
The department pointed to figures from the HSE which showed 10,650 people on trolleys in January 2017 and 10,841 on comparable days in January 2016, a 1.8.% decrease.
Let’s talk about what they mean when they say ‘comparable days’.
When comparing trolley data, the HSE uses the ‘same day’ principle.
This compares the same day in the previous year and not the same date (e.g. the fourth Tuesday of the month in 2016 with the fourth Tuesday of the month in 2017).
The HSE does this to avoid comparing weekdays with weekend days and to account for the cyclical weekly flow in emergency departments. In general, there are fewer people on trolleys at the weekend.
As January 2017 ran from a Sunday to a Monday, the HSE compares it with 3 January 2016 to 2 February 2016 because those dates also run from Sunday to Monday.
The HSE records the number of people on trolleys three times a day in a system called TrolleyGAR (Green, Amber, Red).
The colours are there to highlight the severity of the overcrowding problems in the specific hospitals.
The headline figure is the count that is taken in at 8am across all adult acute hospitals (in the below example it is at 380).
Patients on trolleys in children’s hospitals are recorded by the HSE but they are not included in the headline figure.
The daily number in children’s hospitals on trolleys are often small and do not usually reach double figures, but we will nonetheless take a look at that later.
The HSE’s TrolleyGAR is published daily and there’s an archive going back a number of years.
FactCheck went through the HSE’s recorded figures added up the total number of people on trolleys for January 2017. We found it came to 10,659.
Not exactly the same as what was provided by the HSE but just nine off and in this case not significantly different.
FactCheck also looked at the HSE’s same day principle from 2016 and arrived at the same figure of 10,841 as provided by the HSE for 2016.
This confirmed a 1.7% decrease in the number of people on trolleys.
However, if one compares the days as a calendar month from 1-31 January on both years, it yields a different result.
After collating those figures, FactCheck found that there were 10,402 people on trolleys during the calendar month of January 2016.
That’s compared to the previously discussed 10,659 figure for January 2017 and would mean that trolley figures last month actually increased by 2.5% compared to last year.
The HSE would of course argue that the comparison is not as relevant because January 2016 was a five-weekend-month, whereas 2017 was not.
For the sake of thoroughness, we’ve also included the children’s hospitals on the same two bases.
Including children’s hospitals, there were 10,776 people on trolleys last month.
Using the ‘same day’ principle, there were 11,052 on trolleys in January 2016, meaning there was a 2.5% decrease this January compared to last.
Using the calendar month dataset, there were 10,610 people on trolleys in January 2016, that means that there were 1.6% more this year.
INMO
All of the above was based on the HSE’s TrolleyGAR figures.
The Irish Nurses and Midwives Organisation (INMO) also undertakes a daily count of the number of people on hospital trolleys and their figures are used more often by the media in reporting.
There are two noteworthy differences between the INMO’s figures and the HSE’s.
Firstly, the INMO’s Trolley and Ward Watch series also counts the number of people who have been admitted to a hospital ward but are still on a trolley
The HSE’s trolley figures do not include those in wards.
Secondly, the INMO’s Trolley and Ward Watch series does not provide weekend figures.
These factors mean that the INMO’s and the HSE’s numbers are different. They do, however, usually follow the same trend.
But do they in this case?
Taking into account that weekend figures are not available (and neither are those for the public holiday on Monday 2 January 2017), FactCheck used the INMO’s figures to compare this year and last year in the same two ways we did for the HSE’s.
Firstly, using the calendar month.
In the 21 days available last month a total of 10,365 people were on trolleys.
This is compared to 9,345 in 2016, and would mean that trolley were up by 11% this January. Last year however only 20 weekdays were counted in the figures because it was a five-weekend-month.
So for a more accurate comparison, we’ll add an average day onto that, bringing the January 2016 total to 9,812. That translates into a 5.6% increase this year compared to last.
We’ll now look at the same day principle using the weekdays we have information for.
For this year it begins on Tuesday 3 January and the total remains the same at 10,365, but for 2016 we’ll begin on Tuesday 5 January and count 21 days.
That gets us 9,756 and means that trolley numbers were up this year by 5.9%.
4 out of 6
So let’s recap over the six ways we’ve run the numbers and see what it means for the claim that the trolley numbers for January are lower this year?
Using the HSE’s figures
Using the INMO’s figures
Conclusion
In response to FactCheck, the Department of Health said the Tánaiste was referring to the HSE’s TrolleyGAR figures when she used the term “the trolley numbers for January”.
Based on those figures, the Tánaiste was correct in her statement.
The statement itself does not provide details as to where they come from. While it makes sense that the government would quote the HSE’s figures over the INMO’s, the union’s figures are in fact regularly used by politicians.
The Department of Health itself publishes them regularly on its website.
Had the Tánaiste’s mentioned the INMO’s figures, she would have had to say that they contradict the HSE’s figures and point to an increase in the number of people on hospital trolleys.
The Department of Health told FactCheck that the trend in the INMO’s figures usually matches that in the HSE’s, but this was not the case here.
As shown above, there are six reasonable ways to measure whether the trolley numbers are down in January this year. And the Tánaiste’s claim was true in two of them.
Despite the omission of the INMO’s figures, it is certainly worthy of consideration that January 2016 had more weekend days and trolley numbers may have been artificially low on a calendar date basis.
It could therefore be argued that the HSE’s ’same day’ method is especially relevant in this comparison. Using this method, numbers were down using the HSE’s figures but were still up using the INMO’s.
Again though, this was not clarified in the statement and we are therefore rating the Tánaiste’s statement as Half True.
As our verdicts guide explains what the different ratings mean.
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