THE GENERAL SECRETARY of the Irish Nurses and Midwives Association (INMO) is asking Stephen Donnelly to initiate early talks with private hospitals on contracting additional bed capacity for the winter at a high-level meeting set for today. 

Speaking to The Journal ahead of the multi-stakeholder meeting, Phil Ni Sheaghdha said that if the Government waits until December to start negotiations with private hospitals, as it did last year, it will be “too late – with disastrous consequences for patient outcomes”. 

Ni Sheaghdha is looking for key assurances from Donnelly at today’s Emergency  Department Task Force meeting – which he agreed to in response to the union’s demands in light of soaring trolley numbers. 

“Last winter was an extremely hard one for patients and staff due to the extreme overcrowding hospitals faced,” the nursing union chief said. 

“The Government waited until mid-December to start negotiations for extra bed capacity with private hospitals. Those conversations need to happen much earlier this year if we want to avoid another dangerous winter,” Ni Sheaghdha said. 

At the height of the hospital overcrowding crisis at the start of January last year, during a surge in respiratory illnesses, a record 931 patients were admitted to Irish hospitals without beds in one day. 

At the time, the Health Minister said the situation was likely to worsen before it got better.

Donnelly’s team have agreed to present an update on the progress that has been made on establishing the three elective hospitals that were promised under Slaintecare planning. 

We now understand that the elective hospitals in Cork, Galway, and Dublin will now be for day patients only. We think that is a mistake. 

“It isn’t day patients that are blocking up the system, it is patients who are in overnight.

“We need to know if there is any chance of those new acute hospitals being on the pitch come January.

“Going into this winter without them in place, we don’t believe that we will have a story this year that is any different to 2022,” Ni Sheaghdha said. 

What’s the plan? 

As the recently appointed Health service CEO Bernard Gloster announced at the INMO conference, this winter will be the first in many that will see the HSE operating without a Winter Plan in place. 

His idea, which was met with enthusiastic applause by work weary nurses back in May, was that overcrowding in Ireland’s hospital is now a year-round crisis, that needs to be planned for constantly. 

That line has recently been echoed by politicians, including Taoiseach Leo Varadkar just a few weeks back. 

It worked for Gloster at the time as an soundbite which indicated that under him, the HSE would be doing things differently.

In July, the health service’s Urgent and Emergency Care Operational Plan was published. 

It consisted of more than just theoretical guidelines, and gave ambitious targets for the service to meet: 

• No patient aged over 75 years will wait for more than 24 hours in our EDs
• Hospitals would not exceed 440 cases of delayed transfers of care at one time
• No more than 320 people should be waiting for beds on trolleys each day. 

Already, the HSE has failed to meet its target for reducing the number of patients left waiting on trolleys every day since the aim was set, bar five. 

Ireland had the worst July and August for overcrowding since the INMO began recording trolley count figures in 2004. 

More children waiting on trolleys

Last month alone, 9,720 patients were admitted to hospitals without a bed, with University Hospital Limerick and Cork University Hospital being the most overcrowded. 

The number of children admitted without beds rose to 167. 

Ni Sheaghdha told The Journal that all the information the INMO has available to it suggests that when this winter presents the usual surge in respiratory illnesses and increased ED attendance, hospitals will once again be pushed to crisis point. 

“It is not a coincidence that the increase we have recorded in children waiting on a bed on trolleys coincides with the extension of free GP care to an older age cohort of children. The GPs have come out and said they cannot provide additional care to any more patients. So where do those children end up? In emergency departments, and in some cases, on trolleys without a bed. 

“What we need to know after this meeting is what the actual dates are for the opening of the new Children’s Hospital,  and what is being done in terms of workforce planning, because we know that without staff in place, it will not be able to open,” she explained. 

The INMO is going to raise the impact that the housing crisis is having on the ability of hospitals to recruit and retain staff. 

Ni Sheaghdha said that recently, Our Ladies Hospital in Navan advertised 7 permanent staff nursing posts, and received 100 applicants who were all already working in Dublin hospitals and nursing homes. 

“They were all seeking to move employment in order to have cheaper rent, and a lower cost of living. The migration of healthcare staff out of Dublin to other hospitals is just going to cause serious staffing issues in some of the city’s biggest hospitals down the line. 

“Graduate and early career nurses need more support to live in Dublin and other cities, when the cost of living is so high,” she added. 

Ni Sheaghdha further explained that the HSE will be providing performance updates on different hospitals, including on conversion rates. 

“What I mean by that is, the amount of patients who are being admitted when they attend EDs in each of our 29 admitting hospitals. If there is variance in the figures hospital to hospital, we are going to be asking what has caused it,” she said. 

University Hospital Waterford has taken an alternative policy approach to solving  hospital overcrowding, which has been hailed as a success by figures in the medical community. 

The hospital has purchased hospital beds locally (including step-down beds in local nursing homes) to help ease its capacity issues, and has put in place a culture of getting patients who enter through the ED as quickly as possible, even if it means cancelling elective procedures in some cases. 

Ni Sheaghdha said that the INMO will be asking the HSE and the Minister if this plan can be rolled out in other regions. 

“Waterford’s policy of de-escalation is working. It means that when patients are all over the place on chairs and trolleys, staff work extremely hard to get them into beds. It means that their waiting lists is are longer than other hospitals, but that is because it has accepted that it cannot provide two services at once with its current bed capacity. 

“We know coming into winter that that is a dilemma every hospital will face, we know that the hospitals that continue to try to do both will copper-fasten and make worse the trolley numbers and waiting times. 

“If we are constantly aiming to try and increase our bed capacity, but don’t change the way we use those beds, we are not going to see improved outcomes,” Ni Sheaghdha added.