I write as someone who has worked at the healthcare frontline for decades, and who continues to care deeply about the difficulties faced daily by so many patients and staff within our EDs.

Now, the ailments of the urgent care system (overcrowding, understaffing, and delays in diagnosis, treatment, and discharge to a ward or home) are well-rehearsed, and have been articulated ad nauseam.

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A classic complaint, for example, is that of Noel Reilly, who passionately argued that “the present conditions of service for young doctors in Irish hospitals are so unattractive that they would prefer to emigrate than to stay at home”.

But, lest any reader thinks he was referring to the annual exodus of our newly minted medics, I should point out that this Dr Reilly was speaking on behalf of the Irish Medical Association, precursor of the Irish Medical Organisation, in May 1970.

And it was in the dying days of the 1980s that then health minister Rory O’Hanlon was nicknamed ‘Dr Death’ because of the ‘savage cuts’ he made in our public hospital bed numbers.

In fact, similar reductions were made in the ‘austerity years’ following the global financial crisis of 2007, but it was the earlier ‘merger mania’ (mirroring the Thatcherite closure of small UK hospitals) that was probably most damaging to hospital capacity and morale.

For instance, Dublin’s Beaumont Hospital, which was to be Ireland’s state-of-the-art hospital with 600 beds to cater for the patients who formerly attended Jervis Street, the Richmond, Whitworth and Hardwicke hospitals, opened in 1987 with a mere 300 beds, and the complement of beds of the former hospitals was never restored.

The net result of the politically instigated bed closures, according to one analysis, is that the hospital bed stock has gone from about 17,600 in 1980 to roughly 15,000 today, although the population has increased in the same period by 2m (including many older people).

Mind you, we don’t just know why there are fewer indigenous healthcare professionals willing to work in our hospitals, fewer beds for the growing number of patients, and more disgruntled people in our waiting rooms.

We also have a better sense of the costs of the consequent delays in treatment. The Irish Association for Emergency Medicine says “there is one excess death for every 82 patients who have to wait more than 6-8 hours in the ED for a hospital bed to be provided [and] this excess death rate increases as the delay to admission increases. The risk of death and adverse outcomes is thus substantially greater for patients over the age of 75, as so many end up staying in the ED overnight for want of an inpatient bed”.

Of course, it is not just the elderly who die for want of a bed. Every sick patient in an overcrowded ED is at greater risk of delayed diagnosis, deterioration, and death. Even perfectly healthy young people can succumb in overwhelmed facilities, as has been described in so many tragic court cases of late.

My urgent messages

So here are my urgent messages to those whose ambition is to contribute to the noble and vital work of Dáil Éireann:

• Please understand that the origins of the decades-long bed shortage — which is the primary pathology causing ED dysfunction — are political. So too are the solutions;
• Please recognise that, while we face many international crises, the two great domestic challenges of our era are those of housing our growing population and providing proper healthcare. Understand that, when hard political or medical choices have to be made, decisions must reflect the urgency of the issue, the availability of solutions, and the results of (relative) inaction.
• Please be reassured that our ED malaise does not reflect a want of enthusiasm, expertise, or innovation. Irish emergency physicians and nurses are among the best trained and most ambitious in the world. They know how to expertly and efficiently treat every conceivable kind of health crisis. What they singularly lack — due to a lack of real political will, I believe — is the capacity to decongest their work-space, so that their treated patients can be moved expeditiously to the next appropriate bed (at home, in hospital, or in ‘the community’). If one wanted to visualise the issue, it is as if trainloads of patients are arriving at the ED platform daily before the previous trainload has exited the station.

More beds have been prescribed for years but they have been delivered at a snail’s pace — so the new government must make their delivery the top priority in healthcare for the next five years.

Here’s the starting point for every (would-be) politician. Make sure you visit your local ED this week (and often) to ensure you get the scale and perniciousness of the problem and its consequences.

Talk with the staff. Get to know them. And don’t avoid contact with anxious families. As we have seen ‘across the pond’ recently, popular anxiety and resentment can have profound political consequences.

Finally, while I don’t mean to be unreasonable, if a candidate for the Dáil knocks on a reader’s door in the coming days, they should be asked when they last inspected their local ED.

If a clear answer isn’t forthcoming, I would respectfully suggest that a vote in their favour shouldn’t be forthcoming either. Because, when it comes down to the needless misery and tragedies in our EDs, indifferent or ill-informed politicians are at least as culpable as anyone working in the health service.

• Dr Chris Luke is a retired consultant in emergency medicine and a freelance writer