The current state of our health system is extremely concerning. Our hospitals are under
enormous pressure due to capacity issues and unsafe staffing. The Irish Nurses and Midwives
Organisation (INMO) have been compiling a Trolley Watch in our hospitals around the
country since 2004. It counts the number of inpatient boarders meaning the patients being
detained on trolleys in Emergency Departments after the decision has been made that these
patients require hospital admission. According to INMO Trolley Watch figures, 11,842
patients were admitted to hospital without a bed in December 2022. Over 121,318 patients,
including 2,777 children, went without a bed in Irish hospitals in 2022; the worst year for
hospital overcrowding on record. But fears are mounting that the start of 2023 is only going
to see situations deteriorate future based on previous experience. The concern is in the first
weeks of January, trolley figures could have the potential to nearly double. Hospitals have
never seen this high level of activity and the overcrowding situation is impacting care in
hospitals large and small. Our health system is not equipped to deal with providing
emergency care, COVID care and elective care at the same time.
I experienced the mayhem first hand having spent several days in Sligo University Hospital
in late December due to breathing difficulties. It was one of the top 5 most overcrowded Irish
hospitals in December. In order- University Hospital Limerick 1,528, Cork University
Hospital 1,355, University Hospital Galway 767, Letterkenny University Hospital 834 and
Sligo University Hospital 685. I waited for 6hours on IV antibiotics and oxygen in an
ambulance on the hospital grounds being attended to by remarkable paramedics who had
worked almost a seventeen-hour day by the time I got into the hospital.
Inside the situation was equally grim and hard for everyone. Many patients faced long waits
before being admitted to a trolley. Young and old were lying on trolleys with no family
assistance due to the risk of spreading covid. I waited a future 16 hours on a trolley in the red
zone in the emergency department before being admitted to Sligo general. In the Emergency
department, I watched as the healthcare professionals around me fought intolerable
overcrowding coupled with highly transmissible viruses and infections. I witnessed a fragile
health service being held together by an exhausted and burnt-out workforce. And my hat
comes off to them. The hospital staff unfortunately ended this year how they started, working
in a constant state of crisis and my hearts went out to them. There is now a real concern that
our healthcare system cannot provide safe care when conditions are so difficult, and rosters
so stretched.
HIQA’s overview Report of their monitoring programme into emergency departments was
published mid-December. The report compounded what the Irish Nurses and Midwives
Organisation (INMO) has been consistently highlighting – the stark conditions when it comes
to safe staffing in our hospitals. According to HIQA, of the seven emergency departments
they inspected, only one hospital was properly staffed whilst over 70% of the hospitals they
inspected were over capacity. As a result many nurses are leaving emergency departments
due to the conditions that they are faced with. This phenomenon cannot continue into 2023.
The Irish Association for Emergency Medicine (IAEM) has highlighted for several years the
serious safety risks of patients being detained on trolleys in Emergency Departments after the
decision that these patients require hospital admission has been made. Excess time spent on a
trolley, or an inadequate bed has negative health implications for patients and comprises
patient safety. Despite on-going representations, there has been no significant improvement
in this number of inpatient boarders.
The HSE have acknowledged that things are going to get worse in our hospitals before they
get better but have not outlined what precise supports will be made available to hospital staff
in the coming days and weeks ahead. There has been a silent acceptance from the Irish
Government and the HSE alike on this type of overcrowding for far too long. The HSE has a
duty as an employer and as a service provider to take the necessary steps to scale up capacity
and to make have a realistic plan before it allows further drift in this dangerous situation
emerging in hospitals across the country. The INMO has asked that emergency measures are
put in place to prevent the unnecessary continuation of these inhumane and undignified
conditions for patients and unhealthy working conditions for nurses, midwives and other
healthcare workers. INMO General Secretary Phil Ní Sheaghdha said: “The State cannot
walk into the next week unprepared for what could be a severe overcrowding crisis and have
called on the HSE to do everything necessary to protect the physical and mental wellbeing of
nurses and midwives”.
The top 5 most overcrowded hospitals in 2022 include:
1 University Hospital Limerick 18,028
2 Cork University Hospital 12,439
3 University Hospital Galway 10,150
4 Sligo University Hospital 8,136
5 St Vincent’s University Hospital 7,513