Though hospitals are busy and under pressure, it is the threat of what could happen this winter that really exercises the minds of health bosses.

Ireland is clearly in the grip of yet another wave of Covid-19 and though cases are projected to peak at the end of this month, there is not a great deal of confidence in this prediction. Another uncertainty is the rate at which cases translate into hospital cases; this may be reduced as booster shots are given to vulnerable populations.

Unlike last year, hospitals are trying to provide something equating to normal service to non-Covid patients. This latest surge in infections has forced the cancellation of elective work in 21 hospitals, according to the Health Service Executive.

Hospital Report

So far, only about 10 operations a week have been cancelled in these sites, but this number is likely to rise as the month goes on.

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The big fear is of the return of flu in significant numbers, as happened three winters ago. So far, there is little sign of winter's traditional scourge, but the strain beginning to circulate in parts of Europe appears to hit older people hardest.

Surge

The busiest emergency departments (EDs) now are those treating children, due to a big surge in the RSV respiratory virus as well as norovirus (winter vomiting bug). The combination of viruses circulating is proving challenging for the immune systems of some children, and the fact there was no flu last year has led to fear they could be extra-vulnerable this winter.

The number of people attending EDs at present is up on last year but roughly similar to 2019, as are admissions to hospital.

In the last week of October, for example, almost 24,000 people attended an ED, up 21 per cent on the same week last year, during the pandemic, and down 6 per cent on the previous week. Just over 6,000 of those patients were admitted, up 9 per cent on the previous year.

Attendance and admissions among potentially the frailest group of patients, those aged over 75, is also up on last year by about the same amount.

It says a lot about the state of the health service that one metric used to gauge performance is whether patients attending ED have been either discharged or admitted within 24 hours. Thankfully, 96 per cent were meeting this target in late October.

Over the past eight weeks, only 56 per cent of patients aged over 75 were discharged or admitted within nine hours, according to another performance metric. This in spite of research showing that patient mortality increases exponentially after nine hours.

Or put it another way, more than 1,000 of the oldest patients were forced to wait in ED for nine hours or more to be dealt with. And that doesn’t even include the time it take to get registered on arrival at ED.

Trolley numbers

In terms of the number of patients waiting to be admitted to hospital, this winter is so far proving to be twice as bad as the same time last year. Yet trolley numbers are down by a third on the pre-pandemic time of 2019.

Despite the yearly variations, the regional pattern follows similar lines, with the greatest overcrowding in tertiary hospitals outside Dublin – Galway and Limerick. In the last week in October, hospitals in Drogheda, Waterford and the Mater in Dublin were also experiencing high levels of ED presentation.

The congestion in the system can also be seen in higher numbers of patients waiting for transfers out of hospital. A huge effort was made to reduce the numbers of delayed transfers of care at the start of the pandemic, in recognition of the pressure the system was going to come under and the risks Covid-19 could pose for many of these patients.

The number of delayed transfers of care was kept stable at around the 400 mark for much of the pandemic, but has crept up this year towards the 500 mark. This is still 30 per cent lower than in late 2019.

In summary, the health service is coping, but this winter is likely to be the hardest for years. The HSE’s winter plan, to be published shortly, cannot come soon enough.