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The number of patients waiting on trolleys in hospitals across the State, which reached a record 656 on Tuesday, could get worse before it gets better, the HSE has warned.
It is only the fourth time the number has exceeded 600, according to the Irish Nurses and Midwives Organisation’s (INMO) “Trolley Watch”, which monitors overcrowding in hospital emergency departments on a daily basis.
The previous highest figure was 612, which was reached this time last year.
The beginning of January typically sees the highest trolley numbers of the year following the Christmas break and as a result of the spread of flu.
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HSE national director Damien McCallion said much of the problem has been caused by the spread of flu over the winter period and that flu season is still “three or four weeks” away from its peak.
He said Tuesday’s figures are the result of a “perfect storm” caused by the flu season and the Christmas and New Year holidays.
Mr McCallion told The Irish Times "we'll have to wait and see" if the flu causes overcrowding to get worse.
“We’ll certainly be trying to manage that. The actual peak is still a number of weeks away.
“We’re trying to encourage people to get their vaccine if they haven’t already, particularly older people. It may, at a minimum, prevent the flu but also actually help avoid hospitalisation if someone does get the flu.”
These latest figures were anticipated, he said, and the HSE has implemented a number of measures to lessen the time people spend on trolleys in wards or emergency departments.
All non-urgent elective surgeries have been cancelled and home care is being increased to allow existing patients leave hospital early. The opening hours for diagnostic services and assessment units have also been extended in an attempt to relieve the pressure.
“We’ve also increased the number of ward rounds being done today to try and see if there are patients who could go home with supports or go to a step-down facility,” Mr McCallion said.
He said staff leave over the Christmas has been “a challenge”, but is not a major factor.
Can’t cope
Newly appointed INMO general secretary Phil Ní Sheaghada said she is not sure the health services can cope if the flu epidemic continues to worsen as expected.
“Our concern is, if this gets worse, what plans are there in place to ensure the maximum availability of beds?” she said. “We’re hoping the HSE will have plans in place to demonstrate to us that they can cope.”
Australia and New Zealand have both seen hospital admission numbers double this winter due to the spread of flu.
An emergency meeting is to take place this week to discuss the record number of people waiting for hospital beds. Members of the HSE's Emergency Department Taskforce are to meet the INMO to discuss measures to speed up admissions. It is understood the meeting will take place on Wednesday or Thursday.
The INMO said there were 460 people waiting on trolleys and 196 in wards waiting for hospital beds on Tuesday morning. However, the figure is likely to be higher as St Vincent’s Hospital did not provide numbers for those waiting in its wards.
According to the INMO count, St Luke's Hospital in Kilkenny has the highest number of people waiting for beds (57), followed by University Hospital Limerick (55) and South Tipperary General Hospital in Clonmel (45).
There are an estimated 1,400 empty beds in nursing homes which could be used to alleviate overcrowding in hospitals, according to the representative organisation Nursing Homes Ireland. These could be used for long-term patients as well as for short-term respite, rehabilitative and transitional care needs, it said in a statement.
Earlier, the HSE's assistant national director for health protection, Dr Kevin Kelleher, called on people to still get the flu vaccine, saying flu season could run for six to eight more weeks.
Hospitalised
Dr Kelleher said 190 people had been hospitalised with the flu so far this winter, with 65 of these in the week before Christmas.
He told RTÉ's Morning Ireland that the virus, which is being referred to as the Australian flu, is actually the same virus that was in Ireland last winter.
He said the current flu virus is a combination of two viruses: the A (H3) and B viruses. The flu vaccine covers the A virus, but not the B virus. Dr Kelleher said it is important for people with pre-existing conditions to get the vaccine.
He said while the health system had plans in place for handling cases of flu, some scheduled operations would have to be cancelled to create capacity to deal with the flu.
“It is a balancing act. We try to reduce planned activity. We had this flu virus last year and it was one of the worst flu seasons in the last decade. We can’t say if this will be as bad – it is difficult to predict.”
Emergency medicine consultant Dr Fergal Hickey said the acute shortage of hospital beds was exacerbating the problem. Children are on trolleys at the three paediatric hospitals, a situation which was unheard of before, he claimed.
Dr Hickey welcomed the full-capacity protocol which had been implemented in a number of hospitals. This was the safest option, he added, but “it is a sticking-plaster solution” to a very serious problem.
The Irish Hospital Consultants Association (IHCA) said the record number of patients on trolleys was both “entirely predictable and unaccaptable”.
Dr Tom Ryan, president of the IHCA, said the crisis had been caused by the number of acute hospital in-patient bed numbers being cut by 1,400 over the past 10 years when when they should – at a minimum, he said – have been increased in tandem with the country’s growing and ageing population trends.
Dr Ryan said that the lack of capital investment in acute hospitals had resulted in a year-round crisis, with hospitals struggling to provide a proper standard of care to their patients.
Dr Ryan said that minister for health Simon Harrris’s committment to more beds was welcome but it was essential that these were commissioned urgently.
Highest spending
Ireland’s hospital bed figures are among the lowest in the OECD while health spending is among the highest, he said. However, there needs to be significant capital spending across the system, not just on two major projects.
The INMO on Tuesday said that nearly 100,000 patients deemed to require admission to a hospital spent time on a trolley prior to being placed in a bed last year.
It also forecast that hospital emergency departments would face a surge in the coming days in the aftermath of the Christmas holidays.
The organisation said the number of patients on trolleys increased 6 per cent last year. It said that throughout 2017 a total of 98,981 admitted patients were recorded as waiting for a bed after being determined by a doctor to require admission to a hospital. This compared with 93,621 in 2016.