Election 2024: Health — Pace of progress not reflecting the emergency in our hospitals
Porters Everyone Nurses To From Patient University Not Agrees And Bed Limerick, To Space Consultants Numbers Hospital Do Numbers Match At
Hospitals are the visible tip of the iceberg in health services: they are easy to see when things are going well and also visible when a crisis hits.
Whoever the next health minister will be after the election, they will have their work cut out to meet expectations in this area.
One big question is whether their plans to build hospitals and hire staff will keep pace with rising patient numbers.
When Ireland’s population hit five million during the pandemic, it was celebrated as an achievement. The reality seems to be trickier to manage.
At University Hospital Limerick, everyone from porters to nurses to consultants agrees bed numbers and space do not match patient numbers.
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Last year, over 80,000 people passed through the doors of the emergency department. That is over 16,000 more than when the unit was opened in 2017 and the impact is becoming clear in the tragedies that occur.
It cannot be an easy place to work either, with one report noting exhaustion among staff amid “persistent overcrowding” and “ongoing adverse publicity”.
Dr Colin Pierce, vice president of the Irish Hospital Consultants Association, said that "not easy" is the reality for staff on the ground.
A consultant at UHL, he said it has the lowest number of beds and consultants in the country and called for creative solutions.
Sandra Broderick, the new regional executive officer locally, has big plans but has been open about the challenges she sees for the coming months.
Construction nears completion for extra beds, but only a 16-bed unit will open this winter.
Nationally, there is much debate about waiting lists for elective care. This could be anything from cancer care to hip replacements.
For September, the lists included 7,140 adults and children waiting longer than 18 months.
There are numerous signs that things are not functioning well, from the delays faced by children with scoliosis to the people travelling by bus from Kerry to Belfast for cataract care.
Niamh Conroy, a bowel cancer patient, said even within the brilliance of the reformed cancer service, delays are creeping in. She waited over six weeks for one set of scan results.
A waiting list action plan has seen results for many but the HSE have warned more people are being added on than being taken off in many areas.
Last year, 3.8 million outpatients passed through hospitals, a 10% increase on the year before. Similarly, the 1.9 million inpatients and day-case attendances had an 11% increase, the Department of Health said.
HSE CEO Bernard Gloster and health minister Stephen Donnelly sing off the same hymn sheet on this. They say it is not so much about the numbers on lists as the time people spend waiting.
They have pushed back against union campaigns on staffing gaps despite more and more workers raising concerns. Among the positives they highlight are that the last three years saw a 58.5% reduction in patients waiting over 12 months — over 169,000 people.
Outpatient waiting times dropped from 13.2 months in July 2021 to 7.2 months by September this year. The numbers waiting over 18 months dropped by 17% since September last year, although the existence of such a list at all must be worrying to anyone on it.
More beds is an obvious solution, but how fast can they be delivered? And how quickly can the staffing levels be increased to go with them?
In Sinn Féin’s new health plan, the party pledged to deliver 5,000 new hospital beds out to 2031. It would fund “a major workforce plan and a doubling of undergraduate places” to fill gaps in staffing.
“The situation in hospitals is an emergency and needs to be treated as one,” the plan presented by Waterford TD David Cullinane reads.
The current pace of construction of new facilities certainly does not reflect the emergency, especially for someone stuck on a trolley in UHL, while the long-running saga surrounding the Children's Hospital is a persistent source of concern.
Long-awaited elective hospitals in Cork and Galway are only at design stage, while a Hiqa review of the situation in the Midwest will not report until next summer. Some have gloomily predicted it could be seven or eight years before a new hospital is built, if recommended.
It is almost 10 years since plans to relocate three maternity hospitals in Dublin were announced, work has only begun at one.
The thing about health is whether the next Government builds the hospitals or not, hires the staff or not, the patients will just keep on coming in through those doors. Whoever sits in the health department next will have to answer to them.