Sarah Harte: We would do anything to avoid hospital emergency departments. How did we get here?
Ward Of Picture: And Aoife’s Emergency Kate The Tragic Eamon Sister Second In Department Uhl's Johnston Is Their Megan Death Anniversary Tomorrow
The American public’s attitude to the shooting of United Healthcare chief executive Brian Thompson by alleged shooter Luigi Mangione has been polarising.
Since his arrest, in some quarters Mangione has become a type of folk hero glorified for bringing crippling healthcare costs into the foreground of public debate. Other commentators are horrified, interpreting the lionisation of Mangione as opening the door to terrorism.
You will find no such polar views in Ireland among those who have experienced Irish hospitals' emergency departments. Tomorrow is the second anniversary of Aoife Johnston’s tragic death. As you will know, she was 16 when she died from sepsis in an overcrowded emergency department (ED) at University Hospital Limerick (UHL).
She is not the only person to have died on a trolley in an understaffed, overstretched Irish ED. Almost 240 patients died on trolleys at UHL between 2019 and 2023. More than 500 people died on ED trolleys over the last five years waiting for admission to hospitals in Castlebar, Galway, Sligo and Ballinasloe.
Yet, Aoife’s death stands out because of her youth and because her death was entirely preventable. She died after 13 hours on a trolley as her frantic parents begged for antibiotics. The words "warzone" and "deathtrap" were used at the inquest into her death to describe the ED on that night.
Two close friends whose parents were unfortunate enough to be admitted to EDs in hospitals at opposite ends of the country over the last seven days have used words like warzone. Their experiences are uncannily identical.
Both have spoken angrily of the ED being like something in a “war-torn country” or “Angola”, with rows breaking out leading to gardaí being called and security attempting to quell fights. Both friends' parents are in their eighties. They waited on trolleys before being admitted, one for six hours and the other for 48 hours.
For one parent, a rectal examination was carried out in a harshly lit corridor with no screen around him. Can you imagine watching that happen to your parent? On the trolley next to him, a heavily pregnant woman, also without a screen, had a vaginal examination, and all they could do to protect her dignity was look the other way.
Beleaguered staff did their best, with one demoralised senior nurse confiding she intended to give up her job as she couldn’t take the dysfunction anymore.
In the other hospital, my friend was frantic his mother would die on a trolley. The friends were “up the walls” (both used that exact phrase), with one bursting into tears in the car park. They felt utterly hopeless at not being able to help their parents, and neither, let me tell you, are shrinking violets. The psychological trauma of all of this is incalculable.
Ambulances waited outside the hospital, stacked up like aeroplanes waiting to take off, containing patients waiting to be admitted. Toilets were filthy, which, apart from anything, is a risk when people are fight infections. One parent has effectively blocked an acute bed for over a week because the procedure they needed has been cancelled daily with a knock-on effect on all the others waiting and should have been avoidable.
Logistically, something is very wrong there. How did we get to the point where most of us would do anything to avoid elderly parents or, indeed ourselves, going to an ED? It’s not like we don’t spend on health.
Eurostat figures suggest that we spend an extraordinary amount on health, with only Luxembourg and Denmark spending more per person. Yet, the data seems universally depressing when you look at how our hospitals rank in Europe and globally.
In 2022, an average of €3 685 per inhabitant was spent on current healthcare expenditure in the EU. 🏥🩺
— EU_Eurostat (@EU_Eurostat) November 15, 2024
Highest in:
🇱🇺Luxembourg (€6 590 per inhabitant)
🇩🇰Denmark (€6 110)
Lowest in:
🇷🇴Romania (€858)
🇧🇬Bulgaria (€990)
Learn more ➡️https://t.co/ibJdtfhvFL pic.twitter.com/hQfKPp8UhF
The Euro Health Consumer Index 2024 comparing health systems across Europe includes wait times, and results show that we come in at 22 out of 35 countries, with France, Germany, the UK, Italy, Spain and Estonia, among many others, ahead of us.
The explanation for why we are here seems to be a complicated cocktail of factors: a shortage of beds and buildings, with the last public hospital built in the late 1990s in Tallaght; limited digital health records, a shortage of staff, with no accommodation for them; a shortage of community and long-term care facilities, medical graduates leaving the country when they qualify and bad management.
On the point of medical graduates, there’s something worthy of analysis here. We have the highest number of medical graduates per capita in Europe yet the highest rate of doctors from other countries. There are no precise figures on how much it costs the State to train a doctor, with figures ranging from between €140,000 to €300,000. Still, if the State provides training to doctors at great expense, then maybe we should oblige them to stick around for a prescribed period to contribute to Ireland’s health service before they head to the airport.
Waste with a capital W must also be part of the problem of how we spend public money on the health system. The estimated cost of the National Children’s Hospital (NCH) has risen to €2.2bn.
The contractor BAM has reportedly moved its completion date 14 times since early 2019. BAM, in turn, fingered the thousands of design changes ordered by the client. So, who ordered those ‘thousands’ of design changes on behalf of the client? Who is responsible?
Do we accept that the Irish health system is impenetrable to reform and that things will deteriorate further with a burgeoning and ageing population?
I understand the context is different but this month watching the beautiful re-opening ceremony of Notre Dame, I thought of the NCH. When Notre Dame was severely damaged in 2019, Macron promised to re-open the cathedral within five years, even though experts warned it could take decades to rebuild. Yet, he got the colossal reconstruction done in that time frame. What does that say? Where there’s a will, there’s a way. Is it a question of strong leadership?
On that note, before I sign off for 2024, Donal Ryan’s beautiful new book , which has just won Novel of the Year at the Irish Book Awards, conveys the situation in Irish hospitals.
“There was a yahoo here last week in a stripy tracksuit causing awful trouble for the nurses downstairs. ….The security guards were standing near him and one of them was saying, We told you Willy, you can’t be coming around here pissed and upsetting people…..He had the sliding door blocked and there was a man behind him wanting to get in and an old couple inside waiting to get out but Willy was having none of it. He was holding tough in the doorway, squaring up.”
With Ryan’s trademark compassion, he gets to the nub of the matter. To male readers of this column, I would say if you are one of those men who the AIB data shows, charge to the shops on 23 December to panic-buy a present, you will score brownie points if you produce this book, and you can let on that you came up with the idea yourself.
So, a happy and healthy Christmas to you all. Thank you for reading this column, and here’s hoping that you and your loved ones stay out of the ED this holiday season.