CALLS have been made for greater resources for Cork healthcare amid record overcrowding, thousands of lost bed days, concerns about patient and staff safety, and lengthy hospital waiting lists.
While overcrowding at Cork hospitals appears to be on the rise, some hospitals in Dublin have witnessed dramatic improvements in the area.
Beaumont Hospital saw more than 8,200 patients waiting for a bed in 2015. Last year, the hospital had just 2,900 in the same position. Increased resources — in the form of community beds, more staff, and private sector help — have all been highlighted as reasons for this improvement.
Calls have been made for increased resources in the Cork region in the hope of seeing similar improvements rather than the recent, seemingly relentless increases in the number of people left on trolleys in hospital corridors.
“Looking back over historical figures, the problem used to be far worse in Dublin, with relatively low figures outside of the capital,” a spokesperson for the INMO said. “That problem was eased by the introduction of more community beds.
“Beaumont Hospital used to be the worst in the state by far. They introduced extra step-down and community beds and, while they still have problems, they no longer feature in the worst-hit hospital lists
“So, for us, the answer is staffing and capacity. Increase the staffing in the hospital and in services around the hospital, and you should be able to reduce the number of people going to and staying in the large hospitals.
“This is, in part, what Sláintecare is supposed to do, but Government funding for that reform package hasn’t been forthcoming,” the spokesperson concluded.
For staff on the ground, increased resources cannot come soon enough.
In three of the last four months, more than 1,000 patients have been left waiting on trolleys or in wards for a bed at CUH alone.
Dr Chris Luke, an emergency medicine consultant, and Adjunct Senior Lecturer in Public Health at UCC, explained: “If you’re working in the public emergency departments in Cork, it just feels like it’s getting worse and worse and worse.
“It seems to be absolutely, relentlessly, deteriorating. Forget summer, forget winter — there’s no break or pattern any more — it’s almost always bad.
“It’s mostly just dealing with overcrowding, and it’s very difficult.”
Dr Luke questioned whether the introduction of a number of private hospital emergency departments (EDs) in Dublin had a positive impact on the trolley situation in the capital.
“I think that would be one reason you might have a bit of a difference,” he said. “In Dublin, you’ve now got the Mater Private, Beacon Private, Blackrock Private, Hermitage Private, and the Bons.
“I think there are around five private A&Es in Dublin and it’s making a difference. “In Cork, we only have the Mater Private and the Bons.
“We have 1.5 public EDs between CUH and the Mercy compared to Dublin’s six public ones and five other private ones.”
As well as seeing an increase in the number of private emergency departments (EDs), Dr Luke said a possible recent increase in staff has had a positive impact on the overcrowding situation in the capital.
“It’s possible that more consultants have been appointed to the six larger EDs in Dublin which means patients can be seen quicker,” he explained. “The CUH ED sees around 65,000 people a year, while the Mercy sees 35,000, which is astonishing.
“CUH has four or five consultants in emergency medicine I think,” he added.
“There’s no consultants in the Mercy full time, only visiting ones, while a number of consultants left Cork recently and haven’t been replaced.
“I think in Dublin, they probably have almost 20 consultants.
“They appear to have more doctors in training, more beds, and the private sector support — so there are factors in Dublin that are affecting overcrowding and the feel of hospitals for staff.”
As well as highlighting Dublin as an area where increased staff and resources has had a positive impact on hospital overcrowding, Dr Luke looked at international examples of best practice.
He visited a large emergency department in the Melbourne area in March this year.
“I was visiting a friend who is a consultant in emergency medicine and who worked in Cork in 2003,” he said. “He is familiar with both sides and he also employs a lot of Irish doctors and trainees over there.
“He has around 20-plus consultants in emergency medicine in his department and they see fewer patients than CUH. They have around 30 or 40 doctors in training as well while CUH probably has around 15.
“The department itself is incredibly modern, recently built and fitted with new computers and a huge staff area for timeouts and so on.
“It all comes down to resources really.”
Dr Luke also highlighted a funding and recruitment drive in the UK almost two decades ago, which he said had a huge impact on UK hospitals at the time.
“In the early 2000s in the UK, Tony Blair’s government funded a massive increase in the number of emergency medicine consultants in the UK,” he said. “They set a four-hour target for patients to be seen, and if they weren’t admitted or discharged within four hours, the chief executives or senior managers were sacked, or there were serious sanctions.”
He said these changes made a measurable difference that lasted for years.
“That target has slipped recently and it’s at about 85% compliance but they’re still massively ahead of us and have many more consultants,” he said. “We only have about 100 consultants for emergency medicine in the State for 30 emergency department — so that’s roughly three consultants per ED.
“In some hospitals like the Mercy or Clonmel, there is no permanent consultant in emergency medicine.
“In Manchester or Liverpool, where I used to work, they have 15 to 20 consultants in hospitals,” said Dr Luke.
“That’s what modern-looking EDs look like in the modern-day English speaking world but not in Ireland.
“So we have a long way to go yet,” he warned. “Staff are working like hamsters in Irish hospitals — I know I have for the past 20 or 30 years or more.
“Emergency department workers, physicians, nurses, and so on have fixed, and addressed, numerous issues and situations over the years.
“But without the resources, the problems with overcrowding and a lack of capacity that we’re seeing on the ground today will persist.
“It comes down to resources and if you want to see proof of that, just look at the UK and Australia.”
The reality of the lack of bed capacity in both the acute and community setting in Cork was thrown into sharp relief in recent weeks after it was revealed more than 17,600 bed days have been lost in Cork hospitals this year due to delayed discharges.
“The lack of beds in the community setting and the lack of home care packages means that some patients cannot be discharged from the hospital wards safely,” explained Dr Conor Deasy, consultant in Emergency Medicine at CUH.
“This is not good for patients and their families.
“Hospital-acquired infections and loss of confidence and independence are very real challenges for patients and their families,” he added.
Dr Deasy said delayed discharges result in more pressure in Emergency Departments, as patients needing an in-patient bed cannot access this vital resource if it is being used for patients who could be discharged to a different care setting.
Dr Luke, meanwhile, said the “spectacular” amount of lost bed days reflect the vast number of beds missing from the system.
“It also reflects the huge number of beds that have been deducted from the system over the last 30 years or so,” he explained.
Between 1980 and 2000, a third of the 17,000 acute bed capacity in Ireland was removed from the system.
“We are not even beginning to replace the beds we lost, never mind the extra beds we need for our elderly, growing population,” added Dr Luke.
“Until we get enough social care beds or step-down healthcare beds, we’re going to see the use of high-tech hospital beds for the elderly and those who could be discharged, grow relentlessly because there is nowhere for them to go.”