Possibility of over 1,000 people on trolleys is truly terrifying

Health Service Executive bosses were shy about identifying targets at the launch of this year's winter plan for the health service, but one hospital manager summed up its ambitions pithily when talking to The Irish Times recently.

“The definition of success will be to get through the winter without having 1,000 trolleys on any particular day,” he said.

The ominous four-digit figure was first predicted by the Irish Medical Organisation last autumn, when it forecast a "perfect" storm caused by a lack of emergency department resources, a lack of beds and a lack of recruitment.

Last winter was bad enough, with a new record of 714 patients waiting for admission to hospital set on one day in March. The possibility of more than 1,000 people on trolleys is truly terrifying, and appears to have sparked a greater urgency about planning for the traditional surge in admissions over the winter period. It must also have set off alarm bells in a Government expecting to call an election next year.

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Healthy exchequer tax receipts have facilitated a loosening of the purse-strings for health since then, so extra money has been found for additional hospital beds (75 acute and 66 in the community) and 550 home-care packages.

The extra funding is coming very late in the day – as is the winter plan itself – with the result that much of the additional resources will only come available next year. They also seem woefully inadequate for a system that is running at over 95 per cent capacity and therefore has little ability to cope with surges in demand.

The main elements of the plan have already been leaked extensively – longer working hours for X-ray services and injury units, more senior decision-makers on the wards to ensure a better throughput of patients, and a one-month “focus period” over Christmas/New Year on nine hospitals with the biggest trolley numbers (itself something of a reward for poor performance).

Older patients

The aim is to minimise unnecessary admissions – so-called frailty intervention teams will try to ensure that older patients are given home supports to obviate the need for a hospital stay – and to ensure patients are discharged as soon as they are well.

The trends are ominous: the number of hospital admissions was up 3.5 per cent last winter and the number of delayed discharges has crept up in recent months.

So how bad will it be? In truth, no-one knows. An overstretched health system is at the mercy of external events, and can only react like the boy with his finger in the dike when a surge in demand comes along.

Last winter saw the worst flu outbreak in nearly a decade, as well as a major weather event in the form of last March’s snow. The most prevalent flu strain hit older people particularly hard, and led to 45 deaths, twice as many as in the previous year. The health service will be hoping there is no repeat of these events.

It’s early days yet, but it seems the H1N1 strain of the flu, the same as was associated with the swine flu epidemic a decade ago, is going to predominate this winter. This strain hits the young, pregnant women and other vulnerable groups particularly hard, and is linked to a high admission rate to intensive care units.

The good news is that this year’s flu vaccine gives good protection against this strain. The public can also help reduce the spread of disease by staying at home when they have symptoms of respiratory infections or vomiting bugs, the HSE says.

The effects of overcrowding in emergency departments will be felt throughout hospitals. It is clear many outpatient appointments and even serious surgery will be cancelled if trolley numbers start to rise.