Crowded emergency departments the ‘new normal’ in health system - IMO

Dr Mick Molloy says patients on waiting lists for years view emergency departments as a way to fast-track surgery

The Irish Medical Organisation (IMO) has said that crowded emergency departments were the “new normal” in the health system.

“This is no longer a surge, This is our new normal. This is the level of attendance across the country, it’s not one individual hospital,” Dr Mick Molloy of the IMO’s Consultants Committee told RTÉ Radio’s Morning Ireland.

A total of 553 admitted patients were waiting for beds on Thursday morning, according to the Irish Nurses and Midwives Organisation (INMO). Some 415 patients are waiting in the emergency department, while 138 are in wards elsewhere in the hospital.

Patients who had been on waiting lists for years viewed emergency departments as a way to get their surgery, he said. “They see the emergency department as the only solution. Now, add to that we’ve got a rapidly ageing GP population and not enough people coming in to replace the GPs who retire. And the extreme difficulty there is with getting GP appointments at the moment because of the limited number of GPs and the capacity deficits,” he said.


The hospital system has been under intense pressure leading into the St Patrick’s Day weekend, with trolley numbers climbing and University Hospital Limerick (UHL) cancelling non-urgent surgery.

The HSE said patients attending EDs this weekend can expect to experience long waiting times. Hospital teams across the country, together with the HSE national team are working hard to do all they can to reduce the length of time patients wait in Emergency Departments – particularly as we come in to what is traditionally a very busy weekend in our EDs,” it said.

UHL said it had cancelled non-urgent surgery due to “high numbers of inpatients and extremely high numbers of sick patients presenting at the Emergency Department”. It asked the public “to consider all available healthcare options, to help avoid long waits for assessment in the ED”.

Mr Molloy described EDs as “the pressure valve in the system”.

“So those who enter the emergency department don’t all need to be admitted. Of the 100 patients who come into the emergency department, only about 20 to 22 of those need to be admitted to the acute system,” he said. “We just don’t have the bed capacity to admit all those patients now. So there were bed capacity reports done over two decades ago when the current Tánaiste was Minister for Health, which promised an additional 5000 beds by 2011. That has never happened.”

Every hospital was trying to perform “far in excess” of how they were planned, he said.

“In fact, the hospital system and the health service wasn’t really planned in an organised way. It’s developed over the last 200 years. We’re now in a situation where the population demand is so much that the current bed capacity, and indeed the bed capacity has been recognised for two decades, is insufficient to deal with the population we have,” Mr Molloy said.

He added that overcrowding was a direct result of not investing in bed capacity. “It has to be developed in two particular ways. One, the acute bed capacity, which would supply the patient demand coming from the emergency department, needs to be significantly enhanced. And secondly, bed capacity in the elective hospital system, which really is very minimal at the moment, also needs to be developed to a point where people don’t see an emergency department as the only way into a hospital,” he said.

Mr Molloy said people waiting years for surgery “turn up” in EDs until they get admitted to have their surgery. When asked about plans for new units, Dr Molloy responded: “There are lots of plans, but I think you could build a house with all the plans and you could certainly build a hospital with all the reports that have been published, you’d certainly have enough material for foundations,” he said.

“If half a million people came from abroad today and there was no hotel accommodation for them you would not have the same situation the next year. That is the volume of people potentially who are left without beds every single year because there’s no hospital capacity and it’s a year-on-year problem,” he said.

“But the issue is we should never have a single person on a trolley. There should always be capacity for that. Our hospital system shouldn’t be operating [at] greater than 85 per cent capacity in the largest hospitals and medium sized hospitals should never be operating [at] more than 75 per cent capacity. In fact, some of the hospitals are already operating at 100, 110 and 130 per cent on a daily basis, which is unsafe, and people do die unnecessarily because of this,” he added.

The general secretary of the INMO, Phil Ní Sheaghdha, said stronger powers for statutory agencies to implement recommendations were needed. Speaking on RTÉ Radio’s Today with Claire Byrne show, Ms Ní Sheaghdha said that the powers of statutory agencies like Hiqa and the Health & Safety Authority were “too weak.”

A report on conditions in University Hospital Limerick during an unannounced Hiqa visit last March had made recommendations in relation to non compliance, she said, but her members did not believe that the situation there had improved.

“I do not believe that it has improved. The members we represent don’t believe that it has improved when you have 117 people on trolleys yesterday. So what is the point in having all of the reports when you don’t give the agency the power to do something about this?”

“We know that going into bank holiday weekends, our services get much busier. But going in with over 117 patients on trolleys as Limerick Hospital was facing yesterday, just simply means there isn’t a possibility of care that could be described as safe.”

Vivienne Clarke

Vivienne Clarke is a reporter