Health service implicated in chronic problem of access

While the country convulses itself over plans to move a maternity hospital less than 4km across Dublin, the real-life problems faced by the sickest patients trying to access healthcare continue to worsen.

New figures obtained by Sinn Féin health spokesman David Cullinane from the Health Service Executive reveal the extent of this deterioration in hospitals across the country over the past seven years.

Four out of every 10 patients coming to emergency departments (ED) have to wait at least 12 hours before they are admitted or discharged, the figures show. In the worst-performing hospital, Tallaght University Hospital, a patient has to wait an average of 24½ hours before this happens.

In this context, the HSE’s “patient experience time” target of six hours seems almost meaningless, with less than one-third of patients dealt with in this time.

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International research show the longer a patient languishes in ED, often on a trolley or chair, the longer their stay in hospital will be, and worse their chances of survival.

The period has of course been marked by Covid-19, which has forced the closure of beds, made discharge more difficult and led to thousands of staff being off sick. However, the figures show the rot started before the pandemic and continued as it ebbed and flowed.

They also show the wait times suffered by seriously-ill patients seeking to be admitted to hospital vary hugely across the country.

Throughout the period, plan after plan has been promised. Some were even started only to be derailed by coronavirus surges. The bottom line is that nothing has changed in terms of outcomes, despite huge investment in health in recent years.

It was only in the last month that Minister for Health Stephen Donnelly sent a team in to run the rule over University Hospital Limerick, for so long the hospital with the worst overcrowding.

Only this week, Donnelly was talking about the need to identify whether EDs have enough staff, whether consultants are on call 24/7 or whether discharge arrangements are in place. Should this not have been done years ago?

St Luke’s in Kilkenny

The figures obtained by Cullinane show there is nothing inevitable about long waits in emergency departments. Patients at St Luke’s hospital in Kilkenny, the best-performing hospital, are admitted or discharged in under three hours.

This is no accident. St Luke's operate a unique admissions system which assigns huge influence to the recommendations of local GPs. There are five or six routes into St Luke's for sick people; in other hospitals, nearly all routes to a hospital bed go through overcrowded, under-pressure EDs, a system critics liken to allowing crowds entering Croke Park to enter through just one gate.

The approach taken in St Luke’s is no secret. And yet the rest of the system seems to have learned very little from the Kilkenny experience since then.

The pandemic has clearly affected hospitals very badly, though for some the sting has come in the tail. St Vincent’s hospital in Dublin reduced wait times to admission from 9.7 hours in 2020 to 7.1 hours in 2021, before it mushroomed to 23.1 hours in the first three months of this year.

Beaumont and Connolly hospitals, while not performing spectacularly, have lower patient experience times this year than they had in 2015. Both belong to the RCSI hospital group, which has a reputation for aggressive bed management that succeeds in freeing up resources effectively.

There is a sense of helplessness about the chronic access problems in the health service that feeds a lack of interest among the public. And yet some of the solutions to the misery this creates are to be found in the health service itself.