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Diarmaid Ferriter: For over a quarter century, winter headlines have warned of hospital crises

Enduring trolley overcrowding in A&E departments has come to be seen as an inevitable part of the system rather than an intolerable failure

Any future museum devoted to our recent history will surely have to include a display of a hospital trolley. Such is the endurance and frequency of the overcrowding problems that we now have an abundant archive of trolley stories and related tales of distress in our hospital settings.

At the Fine Gael Ardfheis in 1994, party leader John Bruton singled out the issue as indicative of the failure to provide quality public services and, crucially, cater adequately for “the rights of those who are ill”. He cited the case of “one Dublin man who was admitted to hospital suffering from chest pains who spent 30 hours in casualty on a trolley”. The following year, nurses in Beaumont highlighted the plight of a pregnant woman with a history of miscarriages who spent two days on a trolley in A&E, and they asserted that the A&E situation had reached “breaking point”.

In January 2005, there was, at 422, a “record level” of patients on trolleys after a €70 million 10-point plan for the HSE to deal with the problem had been approved. In July 2007, minister for health Mary Harney told the Dáil: “As for trolleys, some people spend all their time, perhaps 24 hours, being observed on a trolley. Recently, a close friend of mine who would be known to many members had such an experience in a Dublin hospital. He told me it was a very pleasant experience. There will always be people on trolleys and many people are treated on them. The issue is the length of time someone must wait to be dealt with in an accident and emergency department.” When Fine Gael TD Charles Flanagan put it to her that she should not suggest the general experience of being on a trolley was pleasant, Harney replied: “It is for many people.”

In January 2011, Dr Pat Plunkett, consultant in emergency medicine at St James’s Hospital, said the HSE had “talked the hind legs off improving” processes to alleviate the problem. It was pointed out by the Irish Association of Emergency Medicine that as the number of patients on trolleys was over 500, patients’ lives were being put at risk and that the failure to provide adequate bed capacity “cannot and should not be blamed on seasonal influenza”.


Simon Harris told journalists that he wanted to be the minister who ‘breaks the vicious cycle of annual overcrowding’. But that declaration crashed and burned

In December 2014, up to 20 patients a night were being treated on chairs at Beaumont Hospital, and the Irish Nurses and Midwives Organisation (INMO) expressed dismay that some patients were spending up to 70 hours on trolleys; the minister for health, Leo Varadkar, formed a taskforce on the issue.

By January 2015 a “record high” of 601 patients on trolleys was reported, which a spokesman for the HSE said was “not an acceptable situation”. In September of that year, Minister Varadkar sent an email in which he warned “a head or heads will have to roll” if the situation did not improve; he backed down on this threat a few weeks later, suggesting the message was “just an expression of my personal frustration”, but he did not want to set a target by which the number of trolleys would be reduced.

In 2017, a 103-year-old woman was left on a hospital trolley for 15 hours. Minister for health Simon Harris admitted that year that the HSE was not prepared for the predictable annual hospital crisis; he told journalists that he wanted to be the minister who “breaks the vicious cycle of annual overcrowding”. But that declaration crashed and burned; in January 2018 a “record figure” of 677 patients were on trolleys. This week, the number on trolleys went over 900, with the INMO referring to the situation as an “out and out crisis” demanding an unprecedented response.

Annual fire-fighting

It is remarkable that a small, wealthy republic creaks annually on the hinge of this issue. For over a quarter of a century, winter and new year newspaper headlines have screamed “crisis”, “breaking point”, “record numbers” and “perfect storm”, but below those headlines there have been constant reminders of the need to plan for the long-term instead of relying on annual fire-fighting and riding out the peak of winter viruses.

We fill out our census forms every four years for very sound reasons of planning and predicting, but such is the endurance of the trolley problem that it has come to be seen as part of our system rather than an appalling indignity that sufficiently embarrasses or generates a solution.

In 2017, the GP committee of the Irish Medical Organisation insisted one thousand additional hospital beds were needed immediately and 325 additional beds would be needed annually “for the next two decades”. It also pointed out that there would be about 20,000 more people over the age of 65 every year until 2040. This week, health professionals emphasised 5,000 additional beds are needed.

Guess what is going to happen next January.