LAST UPDATE | 6 Jan 2023

THE NUMBER OF patients on trolleys has halved over recent days, according to Health Minister Stephen Donnelly who today urged patients to attend minor injury units, where possible.

Speaking to reporters in Dublin today, the minister said over next few weekends senior decision makers will be required to work in a bid to ramp up hospital discharges.

Donnelly said he would be meeting with the HSE senior management team this afternoon, stating “more needs to be done”. 

His comments come as the interim CEO of the HSE has said that despite this week being the worst week on record for hospital overcrowding, he cannot say for certain that “it won’t get worse before it gets better”.

Stephen Mulvany said the health service is taking steps “to avoid that as much as possible and manage it, where it’s not possible to do that”.

A record 931 patients were without beds in Irish hospitals earlier this week, the highest figure ever recorded by the Irish Nurses and Midwives Organisation (INMO), amidst a surge in Covid-19 and influenza cases.

This morning, the INMO reported that 535 admitted patients were waiting for beds, with 417 patients waiting in emergency departments and a further 118 on wards elsewhere in hospitals.

Donnelly said through the weekend the focus will be to keep up the level of discharge insofar as is possible.

“There’ll be more senior decision makers on site, they will be looking for access to things like radiology, and critically, they’ll also need access to community services so that we can discharge patients home. The focus now this weekend and the next few weekends, is getting patients treated as quickly as possible,” he said. 

Minor injuries 

The minister urged members of the public to make themselves familiar with the minor injury units that might be in a location near them. 

“They’re not available everywhere. Where they are, it’s a very useful alternative,” he said, adding that emergency department teams he has spoken to have told him they’re seeing quite a number of people coming into the emergency department who could be very successfully treated in the minor injury units.

Minor injury units can treat broken bones, all sprains and strains, minor facial injuries, minor scalds and burns, wounds, bites, cuts, grazes and scalp lacerations, small abscesses and boils, splinters and fish hooks, things stuck in eyes, ears or nose and minor head injuries, according to the HSE.

“What we’re seeing this year doesn’t happen every year,” Donnelly said, blaming a “perfect storm” of Covid, flu and RSV for record breaking overcrowding in hospitals.

The minister also said it is not acceptable to him or the HSE that some people are waiting for more than 24 hours on trollies or on seats.

When asked if he has had much pushback from doctors in relation to being asked to work over the weekends, the minister said many healthcare staff have worked tirelessly over the last three years. 

Many, he acknowledged, already work weekends or on call over Saturday and Sunday and oftentimes are required to come in. 

“I believe there is an opportunity for for some additional senior decision makers to be on site where that is possible. It’s more difficult, for example, in the smaller hospitals, where they have much smaller contingency staff, but in some of the bigger hospitals where they do have more staff, it’s something that will help with discharge,” he said.

Speaking on RTÉ’s Morning Ireland, Mulvany said that trolley figures will likely be at their highest on Mondays and Tuesdays. 

“Yes, it’s a crisis, and yes, the numbers are substantially down at the end of the week. The numbers for this morning will be in shortly but we would expect because it’s a normal cadence that in every week, Monday and Tuesday are the worst days and it improves over the week,” he said.

He said the trolley numbers had fallen this week because of a “huge effort” was made by hospital staff in ED most importantly, across the hospital and in the community to try to move patients safely through as much as we could”.

Mulvany, who is visiting University Hospital Limerick, which has been one of the worst hit hospitals in terms of overcrowding in its Emergency Department (ED), said it is difficult to say what the situation will look like next week. 

“The main purpose is to be on the ground and to understand directly from staff and managers and clinicians what’s happening,” he said.

“It’s part of our whole system response to what, as you said, is a clear and present patient safety danger, and this week, while it has been the worst week on record, we can’t be at all certain that it won’t get worse before it gets better.

“In terms of next week, it’s difficult to say. The reality is, in particular the influenza virus, has not yet peaked. We can’t say that we’ve reached a peak, so therefore, we can’t see what the numbers will be next week.”

At a briefing on Tuesday, the Government said flu cases are much higher than in previous years, with the number of people being hospitalised more than doubling compared to pre-Covid.

Compared to 2019, there were 2,331 lab confirmed cases of flu identified up to Christmas week. This is in contrast to 1,000 cases in 2019.

Of the 2,331 cases, a total of 637 people hospitalised which compared to 350 people on past figures.

Mulvany said all hospital staff have been asked to work across weekends “as much as possible” over the next few weeks in order to discharge more patients on Saturdays and Sundays and “drive down, as much as possible, that trolley number that we would expect typically to be highest on a Monday and Tuesday”.

Bed capacity

Mulvany also said that the health service is going through “every single piece of capacity in the community” unit-by-unit in order to find beds that could be reopened in both the public and private sector. 

So far, 50 beds have been identified across two or three sites that can be reopened or have already reopened in some cases.

“We’re also working with our private hospital association colleagues. So we’ve secured an additional 145 beds up to Thursday, and 140 patients were actually in those beds by Wednesday or Thursday.”

He said that of the 2,200 beds in the private hospital sector, 600 are day case beds which “are not appropriate”, and another 150 provide a type of care “that is different to what we need”. 

“So we’re talking about another 1,450 [beds]. We already have about 10%. The issue is we will take every additional bed that they can provide and those conversations are ongoing.”

Asked how many beds the health service needs, Mulvany said: “We have about 550 patients whose transfer of care, whose discharge, is delayed, a substantial majority of those are waiting long-term care or transitional care.

“So you could take it that if we could find 300 or 400 beds, which we won’t, we could certainly use them, and that’s why, as I said, the private hospital association context is so important.”

He said the health service is looking for capacity “across the whole system” in order to manage overcrowding over the next 10-12 weeks.

“In terms of the longer term use… it is absolutely the case, and it’s clear in Government policy and in Government investment, that additional hospital beds as well as additional other capacity, particularly in the community, is required.”

Asked if the €23 billion allocated in Budget 2023 is enough to deliver an adequate health service, Mulvany said the figure is a “huge resource”.

“Are we getting value from that resource? We are. Could we get more value? Is there improvements we made? Could we improve the processes so that we can get more efficient? Of course we could,” he said.

“Again, doesn’t help us in the short term, but absolutely, that €23 billion including capital will need to increase as the years go ahead. It needs to increase ahead of demographic and other pressures, there’s strong commitment from Government to that.

“But equally, just resource, just beds, just any one type of capacity without the improvement in integrated working and in processes, won’t actually be sufficient. So it is about more than one thing.”

Meanwhile, paramedics across the country are to be sent ballot papers as they prepare to vote on potential industrial action.

Siptu members of the National Ambulance Service (NAS) are to receive the ballots in the early days of next week and will be asked to cast their votes on action up to and including strike action.

A regional organiser for Siptu confirmed the news to The Journal, speaking on condition of anonymity. An official statement on the process is due to be released today.

Paramedics have long threatened the action over what they have described as unprecedented pressure being placed on staff. The majority of the nation’s paramedics belong to the Siptu trade union.

With reporting by Christina Finn