ALMOST DOUBLE THE number of public hospitals were operating with unsafe levels of bed occupancy in the first three months of this year compared to the same period in 2021.
Over 60% of acute hospitals (30) had an average bed occupancy above the internationally recommended level of 85% from January to March this year, compared to under 40% of hospitals (16) in 2021.
HSE data obtained by Noteworthy through a Freedom of Information (FOI) request also showed that the national average bed occupancy for these three months in 2022 was 90%, compared to 81% in 2021.
A bed occupancy of 85% is generally considered to be the limit at which hospitals are able to work safely and effectively.
“It is no surprise that bed occupancy rates are consistently at such high levels – this is a challenge that consultants see on a daily basis,” Professor Alan Irvine, president of the Irish Hospital Consultants Association (IHCA) told Noteworthy.
Irvine said that “while these figures are still impacted” by Covid, “there are longer term issues here as well” and added:
“The very obvious and ongoing twin deficits of hospital capacity and consultants in our health service having been mounting for over a decade and have directly led to a situation where there are record numbers of people waiting far too long for the care they need.”
Bed occupancy has been historically high in Ireland but dropped during the pandemic from over 95% in January 2020 to a low of 61% in March that year. However, these figures reveal that it has been climbing back towards pre-pandemic figures in recent months.
“Our hospitals are severely overcrowded and were running well above safe levels before the pandemic,” according to Sinn Féin TD and health spokesperson David Cullinane.
“The fact that, even now with the experience of Covid, hospitals are running above 90% occupancy is directly putting patients at risk,” he added.
Cullinane put this down to “a failure of successive Governments to invest in the health services” and said “a serious, multi-annual capacity plan from the Government to address overcrowding in our acute hospitals” was needed.
Acute hospitals under pressure
Five hospitals had an average monthly bed occupancy of 100% or more from January to March.
University Hospital Limerick (UHL) and St Vincent’s University Hospital (SVUH) in Dublin had the highest bed occupancy during this time at 108%.
UHL consistently has the highest number of people on trolleys and management told Noteworthy during an on-site visit last month that full capacity protocol – allowing additional temporary beds on wards – is being used “nearly every week” which “has a huge impact on” scheduled care.
UL Hospitals Group’s Chief Operations Officer and Deputy CEO Noreen Spillane said:
“It’s not the care that we would want to give our patients… When we built our new emergency department, we never said it would solve the crowding problem because we didn’t get the beds at the time, but… we never envisaged the numbers attending would continue to rise in such high numbers.”
A highly critical HIQA report was published two weeks ago. It found that “demand for services exceeded the emergency department’s capacity and was a major contributing factor to overcrowding”.
Highest rates in Europe
Ireland was one of just four OECD countries with a bed occupancy higher than 85% in 2019, alongside Canada, Israel and Costa Rica. For years, it has consistently had the highest bed occupancy amongst European countries with comparable data.
Rates hit over 94.5% in 2019, reduced to 81% in 2020 but went back to 86% in 2021, taking an average of monthly national acute bed occupancy figures provided by the HSE to Cullinane in response to a recent parliamentary question (PQ).
“International evidence indicates that high bed occupancy is associated with a number of adverse factors,” according to the HSE’s latest capacity review in 2018.
These include “increased risk of healthcare associated infections such as MRSA, increased mortality, increased probability of an adverse event, risks to staff welfare and reduced efficiency in patient flow”.
“Occupancy levels have been persistently high for many years and need to be addressed”, according to the review which stated:
“To reach international standards of bed occupancy would see the need for an immediate injection of the equivalent of an additional 1,260 beds in the system.”
The review estimated 16,300 (gross) beds would be needed in 2031, though reduced this to 12,600 (net) if reforms including healthy living, enhanced community care and patient flow are also implemented.
Since this review, over 680 additional beds have been added, according to latest data we obtained through FOI (available here). This shows that there were just over 11,530 inpatient beds in public acute hospitals as of March 2022.
When asked what it is doing to address high bed occupancy, a spokesperson for the HSE provided Noteworthy with the additional acute inpatient beds “being delivered to support capacity needs”.
Over 1,200 extra beds were promised between the Winter Plan 2021/22 and the National Service Plan 2022. Of these, 813 were delivered last year and 41 have been delivered to date this year.
That leaves 370 to be put in place which the HSE broke down as 197 beds in 2022, 149 “expected to be delivered” in 2023 and 24 for which a date is “to be confirmed”.
Noteworthy recently asked the Department of Health what it is doing to address overcrowding. A spokesperson stated that “the Government provided additional investment of €1.1bn in budget 2021 to expand capacity, increase services and support reform”.
This article was supported by reader contributions to Noteworthy, The Journal’s community-led investigative platform. If you like this and our other work, consider contributing here.
It is a follow-up to our recent investigation into overcrowding which you can read now>
To embed this post, copy the code below on your site
have your say