Trolley crisis: Seven suggestions to end overcrowding

Hospital overcrowding has worsened slightly today, with 557 patients on trolleys in emergency departments and wards.

That’s the fifth worst figure since records began a decade ago, but below the peak of 601 recorded early last month.

Minister for Health Leo Varadkar has an emergency department taskforce working on the problem, but here are my seven suggestions for ending overcrowding and getting rid of trolleys:

1. Expect, but never accept, overcrowding

It is in the nature of hospitals to be full, so let’s start by accepting that. But equally, when framing an approach to the problem, let’s start from the position that overcrowding is never acceptable. It’s awful for patients, and unsafe too, and it’s awful for staff.

2. Open more beds

Overcrowding demands a crisis response. Chronic overcrowding tells us something more fundamental is wrong - there are too few beds in the system. Of course, beds need to be staffed by teams of qualified medical personnel, so that means spending money. That doesn’t seem unreasonable given the cuts of recent years.

3. Create the seven-day hospital

For years now, hospitals have been talking about moving from a five-day to a seven-day operation. Yet the reality falls shy of this objective, and there are still stories of well patients having to wait over the weekend to be discharged on a Monday. Illnesses don’t operate on a nine-to-five, part-time basis, so neither should hospitals. And while we’re at it, abolish Christmas. The two-week festive season, often falling bang in the middle of the winter flu season, is incredibly disruptive of proper hospital organisation.

4. Sweat the assets

Public hospitals are chock full of expensive medical equipment, much of its lying used half the time. It wouldn’t happen in the private sector. Doctors should be able to order scans from early in the morning until late at night, not just during business hours, in order to reduce delays and increase patient throughput. That means hiring more staff to run the machines.

5. Generalise the problem

Overcrowding is a problem for the whole hospital not just the emergency department. But corralling trolleys in EDs makes it seem otherwise. Move some of the trolleys up into the wards in order to ease the trolley crisis in the ED. If one trolley were placed in each of 10 wards that would significantly ease the overcrowding in ED. US experience shows those patients get the treatment they require and their presence encourages staff to discharge well patients more quickly.

6. Stop just talking about primary care

More than half the current crisis is the result of the delayed discharge of patients who are clinically fit to leave hospital but for whom no stepdown care of home help is available. It’s time to put serious funding into primary care so that older people can be looked after at home, where possible. It’s also time to move the management of chronic conditions out of hospitals and into the community. And we need to simplify the application process for the Fair Deal scheme, as well as funding it better.

7. Empower staff

Employ professionally trained managers and release doctors to clinical duties. Convert locum and temporary positions into permanent posts. Give nurses the power to order diagnostics and refer patients. Reform the law in order to lessen the “fear factor” behind so much medicine. Reward excellence.