Home > Uncategorized > IRISH ELITE AND GOVERNMENT IMPLEMENT CRUEL LACK OF HEALTH CARE and Extra Unnecessary Deaths

IRISH ELITE AND GOVERNMENT IMPLEMENT CRUEL LACK OF HEALTH CARE and Extra Unnecessary Deaths

New Year Government  Present for the OLD?? –Homecare Charges for citizens but no Tax on Massive Wealth of Irish Super-Rich.  Existing recipients of Homecare to fund expansion of scheme

People receiving homecare services face charges under Government reforms

Minister of State for Older People Jim Daly suggested the co-payment would be based on the person’s income and not be linked to property assets.

Martin Wall , Irish Times, Tuesday, December 31, 2019,  https://wp.me/pKzXa-10V

People receiving homecare support in the future face having to pay some of the costs themselves, under proposed new reforms to the sector to be presented to the Cabinet in January.

Minister of State for Older People Jim Daly suggested the co-payment would be based on the person’s income and not be linked to property assets.

At present, home support services are provided free of charge, however residential care under the Fair Deal nursing home scheme involves individuals having to make a contribution to the cost.

The Department of Health had been looking at the idea of introducing some form of charging system for homecare. However, it has now been confirmed that a system of co-payments by individuals availing of such services will form part of major reforms to the sector to be recommended to the Cabinet by Mr Daly.

He said if the Government accepted his recommendations for future financing and regulation of home support services, the Department of Health would work on the precise funding model over the coming year.

He suggested as an example that if a co-payment of 10 per cent of the cost was put in place, it could fund an additional two million hours of home-help services across the country which would go a long way towards addressing unmet need.

The costs of homecare services can vary depending on the number of hours required, the needs of the person concerned and the number of staff involved.

 

——————————————————–Harris’s attack on hospital staff shows up his lack of leadership

Tony O’Brien, Former Head of HSE, Sunday Business Post,22nd December, 2019

The Minister for Health engaged in an ill-informed and ill-advised exercise in finger-pointing, instead of taking responsibility for his government‘s failure to solve the trolley crisis  https://wp.me/pKzXa-10V

“Lashing out at consultants in Limerick was an abdication from leadership. There has been an extremely hostile response from leading medical figures to these remarks and the minister’s general approach. For context, it is worth examining some key facts.

“First and perhaps most importantly, it is universally acknowledged that for the size of the population it serves, UHL has too few beds. It also has a lower ratio of beds to the population it serves than other major hospitals. A patient will remain on a trolley after being admitted as an in-patient for only one reason: there is not an available empty bed in which to accommodate them.

Trolley waits for admitted patients in Limerick are a function of too many patients needing one of too few beds”

Tony O’Brien, Former Head of HSE, Sunday Business Post,22nd December, 2019

Simon Harris, Minister for Health: how he handles the trolley crisis will have a big effect on Fine Gael’s re-election prospects. Picture: Rollingnews

Ministerial finger-pointing is no substitute for leadership. Simon Harris has been Minister for Health since May 2016. His three and a half years in the post have been both challenging and turbulent. In the twilight days of this government, he is also facing potentially the most testing winter the health service has ever experienced. How he handles it could have a big impact on Fine Gael’s fortunes in the next general election.

Like every health minister, Harris meant well and wanted to do great things when he was appointed. His appointment, as he himself has said, was a surprise. He was given health as his first senior ministry. His task was made all the more complicated by serving in a minority government.

His prior experience had not fully prepared him for the never-ending and relentless onslaught of interest group demands, serious levels of unmet need, emerging issues, and the ever-present obligation to make tough choices. A key asset was the confidence of then Taoiseach Enda Kenny, whose support he was sure of.

Health is a tough posting. It calls for considerable political skill and an ability to deal with both stress and frustration, which are never in short supply. A key test is how well a health minister understands their responsibility as a leader, especially when the going gets tough.

Sometimes people do and say things in haste just to get through a difficult meeting, navigate a hostile interview or survive a rough day. Such occasional liberties can be understood and are often forgiven. However, dumping on health professionals, the people who work tirelessly in extremely pressured environments, rarely works well.

Facing unfriendly fire over worsening trolley delays, which have resulted in even the very elderly enduring appallingly long waits, Harris struck out. He told an Oireachtas Committee that consultants in University Hospital Limerick (UHL) were treating an above average number of private patients, and he linked this to overcrowding and trolley delays in the hospital.

He said he had “no confidence in some of the work practices of consultants, none, absolutely none”. These remarks generated a particularly scathing lead in a national daily newspaper: “Consultants were too busy treating their private patients when a woman in her 90s endured an ordeal on a trolley.” This angle was also widely reported by broadcast media.

Lashing out at consultants in Limerick was an abdication from leadership. There has been an extremely hostile response from leading medical figures to these remarks and the minister’s general approach. For context, it is worth examining some key facts.

First and perhaps most importantly, it is universally acknowledged that for the size of the population it serves, UHL has too few beds. It also has a lower ratio of beds to the population it serves than other major hospitals. A patient will remain on a trolley after being admitted as an in-patient for only one reason: there is not an available empty bed in which to accommodate them.

Trolley waits for admitted patients in Limerick are a function of too many patients needing one of too few beds. Bed occupancy at UHL is running at an average of 120 per cent. In the NHS, anything above 85 per cent is considered a crisis. UHL is in permanent bed supply crisis.

In his remarks, Harris appeared to have forgotten that inconvenient truth. It is inconvenient since it is not the doctors or other staff who control the total number of beds; that responsibility lies at his own feet.

While the minister cannot magic up beds, at least not outside the confines of a press release, he does have political responsibility for long-term policy in this area. Acknowledging that, however, would have made it harder to kick the poor devils at the coalface.

The following figures are important. Official HSE data shows that 70 per cent of all patient care episodes in Limerick are through the emergency department. Some 30 per cent of all those who attend the emergency department in Limerick are deemed to require admission and are admitted. A total of 68 per cent of all the private practice taking place at UHL is in the emergency department.

Consultants cannot influence the mix of insured and non-insured patients who present at emergency departments. In general, this is just a reflection of the level of insurance penetration in the population.

The last government introduced legislation – the Health Insurance Amendment Act, 2013 – specifically designed to ensure that anyone with private insurance is treated as a private patient.

There used to be a limited number of ‘private beds’ in hospitals. Since 2014, any bed can be private if the patient in it has private insurance. At times, patients and insurers have been vocal about patients being virtually press-ganged into using their insurance.

The motive behind this was to gain income from private insurers for each hospital, allowing the government to fund less. This has driven rates of private practice up. Just blaming doctors for that is simplistic at best and a calculated cheap shot at worst.

In the aftermath of Harris’s Oireachtas Committee appearance, UHL’s medical director took to Twitter to point out that the average number of in-patient discharges per acute hospital consultant at UHL is far in excess of that at other hospitals. For example, there were 216 discharges in Limerick compared to 134 in Cork University Hospital or 94 at Beaumont in Dublin.

No Irish hospital is without an opportunity to improve itself, nor is there one completely staffed by saintly consultants. However, the minister’s verbal assault on UHL staff looks ill-informed as well as ill-judged.

His remarks about consultants refusing to move between group hospitals look questionable. They are also hotly contested. But whatever their merit, they have been drowned out by Harris’s rhetoric.

A hospital operating under the constraints and pressures of UHL is dependent on the dedication of its key staff. This is true throughout the health service, but especially so in Ireland’s most congested hospital at the busiest time of any year and in the teeth of one of the most concerning flu seasons in recent times.

Little wonder then that in the immediate aftermath of Harris’s morale-shredding remarks, senior national HSE figures were on the ground in Limerick trying to repair the harm. They were doing the right thing in response to the minister succumbing to his frustrations and losing sight of the leadership task at hand.

While this drama played out, the Irish Medical Organisation’s ballot on industrial action on the issue of pay equality was ongoing. The doctors’ group called the vote following continued frustration with oft-repeated but unfulfilled promises of meaningful engagement. Both the IMO and the Irish Hospital Consultants Association appear to have lost all faith in Harris.

A day after a strike vote and after years of dithering and missed datelines, the government finally made a move. It has offered a new increased rate of pay for consultants who only do public work. It mirrors an offer made in 2008, but reneged on by successive governments. Making a clear proposal and getting discussions going is an overdue and welcome step.

It remains to be seen how meaningful this proposal is and how it fits in with Sláintecare and the De Butleir report. There are concerns that it will fuel the growth of the private sector and lead to a brain drain from public hospitals on the one hand, while on the other prompting insured patients to declare themselves as ‘public” in order to be treated in the often superior setting of a large public teaching hospital, thus letting the insurers off the hook and forcing increased government funding.

Let us hope the government has modelled this fully and now has a coherent overall plan. Time will tell.

Sadly, for the second year in a row, loose words from senior government figures are undercutting the morale of key personnel just when the country needs the best possible level of performance from them.

We can only hope that in the atmosphere of an overcrowded emergency department such as Limerick’s, stressed patients will not use Harris’s words to justify venting unfounded frustrations on hard-pressed staff.

With an election looming, Harris may have just a few months left to make a long-term, positive mark on our health system and its staff. We all want our health service, and the person responsible for it, to succeed. It would be genuinely unfortunate if Harris left his post to sighs of relief, and a terrible shame if he was remembered as the minister who served only to demoralise our key workers.

Tony O’Brien is a former director general of the HSE

 

——————————————————-Varadkar Government Allowing 350 to 400 Additional Unnecessary Deaths each year due to failure to adequately Fund Irish Health Service-Medical Consultants.  “Obscene”- Nurses Union https://wp.me/pKzXa-10V

Act Now! Ask your Local Fine Gael and  Independent Alliance Councillor  To Publicly Oppose Varadkar Government Deaths Policy


 

Minister trying to blame doctors for trolley crisis, say University Hospital Limerick consultants https://wp.me/pKzXa-10V

“The failure on behalf of the Department of Health to follow through on promises made at the outset of reconfiguration in the midwest for the past 10 years has led to the well-foreseen worsening conditions suffered by patients and staff on the Limerick campus.”-Consultants

 Paul Cullen, Irish Times, Tuesday, December 17, 2019, 02:15

Medical consultants at University Hospital Limerick have accused Minister for Health Simon Harris and Cabinet colleagues of trying to deflect responsibility for the trolley crisis onto doctors.

In an angry response to remarks by Mr Harris last week about the level of private practice at the hospital, seven of its consultants have accused the Minister of “breathtaking political cowardice” for criticising doctors working in underfunded conditions.

Mr Harris enraged many doctors last week when he accused consultants at UHL of being too busy to treat a 95-year-old patient in the emergency department because they were doing private work upstairs.

The level of private work in the hospital is above that found in an average hospital, he told the Oireachtas health committee. Most consultants were not “getting into their cars” and going to smaller hospitals in the region to treat patients.

‘Confidence’ The following day, Mr Harris sought to clarify his remarks, saying he had “every confidence in our brilliant doctors, who work extremely hard”. However, “we cannot be confident that some of the work practices we see as part of private practice in public hospitals are serving patients well,” he told the Dáil.

In a letter to The Irish Times published on Tuesday, the consultants say Government ministers have “ accused clinicians of failing to travel between UHL and the peripheral hospitals in order to treat patients”.

“We refute this in the strongest possible terms,” they write.

Overcrowding in UHL is the result of a botched reconfiguration of hospital services in the midwest, they say.

“The failure on behalf of the Department of Health to follow through on promises made at the outset of reconfiguration in the midwest for the past 10 years has led to the well-foreseen worsening conditions suffered by patients and staff on the Limerick campus.”

“Attacking clinicians, who have steadfastly struggled to maintain the highest standards of care under the most severe underfunded conditions, displays a level of political cowardice that is simply breathtaking.

“We will of course continue to strive for the best care for our patients, and abhor the conditions that many of them are forced to bear, but it is important for the general public to know exactly where the blame for this fiasco truly lies.”

The letter is signed by professors Calvin Coffey, Patrick Dillon, Eamon Kavanagh and Austin Stack; Dr James Shannon; Colin Pierce and Tony Moloney.

© 2019 irishtimes.com

 

————————————————————Limerick hospital sets new record as 85 patients wait on trolleys for a bed—–Hospital Unsafe for Patients https://wp.me/pKzXa-10V

Nursing Union Calls For:

More home care packages to move patients out of the hospital -An immediate end to the recruitment ban for nurses and midwives-Emergency funding for extra agency staff NOW until above demands are met

Eilish O’Regan: Irish Independent:Nov 25
A new record for the number of hospital patients on trolleys in a single hospital was set today as 85 waited for beds in University Hospital Limerick this morning.The previous record was 82, set in October 2019, also in Limerick.

 

The previous record was 82, set in October 2019, also in Limerick.

The Irish Nurses and Midwives Organisation (INMO) said patients without beds are typically on chairs and trolleys, often in corridors.

In Limerick today, there are 55 patients in the emergency department and 30 in wards elsewhere in the hospital.

The INMO called for a direct, immediate intervention in the hospital from senior HSE management, including:

  • Cancellation of non-essential elective work
  • More home care packages to move patients out of the hospital
  • Emergency funding for extra agency staff
  • An immediate end to the recruitment ban for nurses and midwives
  • Extra support for GPs and Public Health Nurses to allow more home/community treatment

There are 631 patients without beds across the country today – 22 of them are children. The worst-hit hospitals include:

  • Cork University Hospital – 52
  • Letterkenny University Hospital – 47
  • Tallaght University Hospital – 36
  • University Hospital Galway – 33

INMO Assistant Director of Industrial Relations for the region, Mary Fogarty said: “Despite the best efforts of local staff, the situation in Limerick continues to escalate. The hospital is breaking records in the worst possible way.

“Promises of future improvement will not suffice. Real action is needed today.

“We simply do not have sufficient capacity. Without an increase in beds and the professionals to staff them, this problem will continue to escalate.

“Our members are on the front line providing the best care they can – but the situation is intolerable for them and unsafe for patients.”

——————————————————————As Consultants Claim  400 unnecessary Deaths of Patients per year, Deep Cynicism of Government Response to Health Crisis is Condemned by Former Head of HSE in Sunday Business Post

“If Ministers are So Frustrated By Trolley Crisis, Then Government Should Fix it-To Do Otherwise is to Turn Overcrowding into a Government Policy covered up by shifting all responsibility to the front line

The government’s response to the problems in emergency departments is well-rehearsed and utterly ineffective. The steps needed to ease the pressure are obvious.The old staple government responses include: Minister is discussing the matter with the head of the HSE, having a teleconference with the hospital group chief executives, releasing a few home care packages, talking about the number of beds closed by previous Fianna Fáil administrations, expressing ‘beyond frustration’ with a suitably furrowed brow, and, above all, deflecting all responsibility to the frontline health service.-Tony O’Brien

By Tony O’Brien,  Nov 10, 2019  https://wp.me/pKzXa-10V

Over time, our national tolerance level has increased so that there are now higher and higher thresholds for the numbers of patients affected to constitute a ‘crisis’.

Sadly, there is also almost a palpable sense of relief when the Irish Nurses and Midwives Organisation (INMO) releases its inevitable ‘worst day of the year’ or ‘worst day in history’ media statement.

Media interest peaks, the media management plan is unleashed, the opposition huffs and puffs, and then there is a sense that the worst is over in political terms, at least, although not necessarily in terms of trolley numbers.

When these psychological thresholds are breached, as they have been this week, all sorts of cosmetic efforts are made to show that the Minister for Health is responding.

The old staples include: discussing the matter with the head of the HSE, having a teleconference with the hospital group chief executives, releasing a few home care packages, talking about the number of beds closed by previous Fianna Fáil administrations, expressing ‘beyond frustration’ with a suitably furrowed brow, and, above all, deflecting all responsibility to the frontline health service.

These are shallow, tokenistic and cynical responses, but they are also tried-and-tested manoeuvres from the political spin playbook. They are shallow and cynical because none of this is really about solving the problem. As the headline numbers are marginally reduced to the previous crisis threshold, attention wanes and then it’s business as usual.

Reducing the headline total by a few dozen or fewer may well solve the political problem of the day, but it is cold comfort to a patient stuck on a trolley in an emergency department (ED) corridor for 24 hours – which is not an unusual experience.

The causes of ED overcrowding are not mysterious and the measures necessary to resolve them are not exceptionally complicated, but the situation is not improving – it’s getting steadily worse. Politicians show no signs of being sufficiently motivated to fix the causes of the problem.

In fact, political trolley fatigue syndrome has set in. Its symptoms include periods of policy inaction, evidence denial, resource misdirection, ministerial hand-wringing and blame deflection. Sufferers tend to cling to irrational beliefs – for example, that an increasing and ageing population can have its needs met by a system that independent reports, commissioned by ministers, have demonstrated is just too small in terms of bed numbers to meet the country’s needs.

Add to this syndrome the fact that hospitals must accept and somehow accommodate all patients through a perennially open entrance door and keep many of them inside, even if there is no clinical reason to do so.

Each hospital has a fixed number of beds; once they are full, as they typically are, only when a patient leaves can a new one be accommodated. Of all those who present to EDs, between 20 and 30 per cent will need a bed. The excess of patients who need admission over the number of available beds is what produces the daily trolley count.

This annual official ‘trolley crisis’ – there is an unofficial one most days now – is entirely predictable.

The numbers presenting to EDs are rising steadily, as are the numbers who need beds. But all too frequently, the services patients need to facilitate their discharge from hospital are in short supply, which closes off their exit route and thus ‘blocks’ a bed. They may need home adaptation, home help, intensive home care, long-term home or residential care, or rehabilitation.

The budgets for most of these care programmes are limited, the supply is rationed, and the result is avoidable hospital congestion, as patients are forced to use our most expensive healthcare asset, an acute hospital bed, for want of a much cheaper and more appropriate alternative service.

If the government is sincere in its stated concerns about ED overcrowding, then it should be taking action to make the alternatives to hospital admission, and the exit route following an emergency admission, demand-driven, just like the ED front door. There should be no artificial limit on access to any clinically or socially necessary form of supported discharge. Anything less than this is just not good enough – in fact, anything less means that ED overcrowding is actually government policy.

The government also knows that to bring an end to persistent hospital overcrowding, it needs to reform the way hospitals are configured and function. Major urban centres need to have differentiated hospitals for planned versus emergency care patients to end the damaging competition for beds.

The large number of EDs in Dublin needs to be reduced to allow resources to be concentrated and 24/7 senior consultant in-person cover to become the standard.

It is a widely held belief that having senior clinical decision-makers on site would improve quality of care and minimise avoidable admissions.

Smaller regional hospitals with EDs are featuring prominently in daily trolley counts and the conditions for some patients in such locations, for example South Tipperary General, can be particularly poor. Hospitals like this are often also the worst hit by the crisis in consultant recruitment. The stubborn refusal of the government to sort out pay inequality among consultants, despite numerous empty promises to do so, is exacerbating the recruitment and retention woes of the system in general and does not help hospitals like South Tipperary.

Consultant shortages lengthen inpatient and outpatient waiting lists. Patients end up sicker before they are seen and then go to understaffed EDs. There, they are seen by less experienced doctors who tend to admit more patients than experienced consultants, resulting in patients enduring hours and maybe days on a trolley where they are at greater risk of an adverse outcome.

What we need are fewer broken promises, less furrowed-brow sympathy and a bit more action. Patients need, expect and deserve no less.

Tony O’Brien is a former director general of the HSE

 

DEEP Cynicism By Government in Response to Health Services-Former Head of HSE in Sunday Business Post

“The old staples include: discussing the matter with the head of the HSE, having a teleconference with the hospital group chief executives, releasing a few home care packages, talking about the number of beds closed by previous Fianna Fáil administrations, expressing ‘beyond frustration’ with a suitably furrowed brow, and, above all, deflecting all responsibility to the frontline health service.

These are shallow, tokenistic and cynical responses, but they are also tried-and-tested manoeuvres from the political spin playbook. They are shallow and cynical because none of this is really about solving the problem. As the headline numbers are marginally reduced to the previous crisis threshold, attention wanes and then it’s business as usual.”

https://www.businesspost.ie/opinion/ministers-frustrated-trolley-crisis-fix-456627

 

 

————————————————————-Irish Association of Emergency Medicine (Eminent Consultant Officers below):    “350 to 400 excess deaths are occurring each year because of the state of the emergency departments, the overcrowding and the long delays in treatment in those departments.”

The Irish Nurses and Midwives Organisation, INMO, yesterday described the situation in the Health Service as “obscene” and said, “Winter has not even started, and Irish hospitals are overwhelmed”. It went on to say that nurses are faced with an inhumane working environment, while patients are put at ever-increasing risk.

Officers of Irish Association of Emergency Medicine

Chair: Dr Emily O’Conor, FCEM
Consultant in Emergency Medicine

 Connolly Hospital Blanchardstown Abbotstown  Dublin 15

Secretary: Mr (Surgeon) M. Ashraf Butt FRCSI, Dip IMC (RCSEd), FRCSEd (A&E), MScDM, FFSEM
Honorary Senior Clinical lecturer, Royal College of Surgeons in Ireland
Consultant in Emergency Medicine

Cavan General Hospital Lisdarn  Co. Cavan.

Treasurer;Dr Sinead O’Gorman MMedSci, DCH, FRCSI, FACEM, FRCEM
Consultant in Emergency Medicine

 Letterkenny University Hospital,Letterkenny,  Co. Donegal.

Seamus Healy TD: Dáil Nov 5

I have to say that I am shocked at the lack of urgency that the Taoiseach displays, almost indifference, almost as if this situation is normal. The trolley figures are absolutely obscene. We have people suffering on trolleys in our hospitals and people are dying on trolleys in our hospitals. The Taoiseach is the leader of this country and I have to say that he has a responsibility for this obscenity, he has a responsibility for the suffering and a responsibly for the deaths of these people on trolleys in our hospitals over recent years, a position that continues to this day. The Taoiseach can solve this problem.

Micheál Martin, Fianna Fáil  Dáil Nov 6

Critically, the Irish Association for Emergency Medicine has said that this is costing lives as people are dying as a result of the overcrowding. It says that 350 to 400 excess deaths are occurring each year because of the state of the emergency departments, the overcrowding and the long delays in treatment in those departments. This was confirmed to me by experienced medical authorities in Cork University Hospital, who reluctantly said that they had to admit and confirm that some people who attend the hospital will die as a result of the overcrowding and delayed treatment. In addition, there is a chronic shortage of consultants and a lack of rehabilitation beds, step-down facilities and home care packages.

When will the moratorium on the recruitment of staff be lifted? There are approximately 1,000 posts on the front line unfilled currently.

Officers of Irish Association of Emergency Medicine

Chair: Dr Emily O’Conor

FCEM
Consultant in Emergency Medicine

Connolly Hospital Blanchardstown Abbotstown  Dublin 15

 

Secretary: Mr (Surgeon) M. Ashraf Butt

FRCSI, Dip IMC (RCSEd), FRCSEd (A&E), MScDM, FFSEM
Honorary Senior Clinical lecturer, Royal College of Surgeons in Ireland
Consultant in Emergency Medicine

Cavan General Hospital Lisdarn  Co. Cavan.

Treasurer;Dr Sinead O’Gorman

MMedSci, DCH, FRCSI, FACEM, FRCEM
Consultant in Emergency Medicine

Letterkenny University Hospital,Letterkenny,  Co. Donegal.

——————————————————————

As Numbers on  HOSPITAL TROLLEYs reach second Highest Figure Ever- Seamus Healy TD called on Taoiseach in the Dáil  to  Reopen the Accident and Emergency departments at Nenagh General Hospital and Ennis General Hospital, reopen Our Lady’s Hospital Cashel and lift the GOVERNMENT BAN on both extra  staffing and home help hours.-BUT TAOISEACH REFUSED

https://wp.me/pKzXa-10V

“One of the areas which has suffered the brunt of the policy that I am speaking is the mid-west, including Limerick, Clare and north Tipperary, which is part of my constituency. There are knock-on effects at South Tipperary General Hospital in addition. University Hospital Limerick and South Tipperary General Hospital consistently among the highest trolley figures in the country. Today’s trolley figures are absolutely obscene. Patients are suffering and patients are dying on trolleys in our emergency departments, something the Irish Association for Emergency Medicine has warned us about for the past number of years. Today’s figures are the second highest ever recorded.”-Seamus Healy TD

Question by Seamus Healy TD  Nov 5, 2019: From 2002 on, successive Governments have espoused and implemented the downgrading of hospitals and the transfer of acute hospital services to so-called centres of excellence. We all know that that policy has created chaos. It was wrong then and it is wrong now, and it should never have happened.

We in South Tipperary were lucky, that people power, that 15,000 people on the streets stopped the transfer of our services to other areas, but other areas were not as lucky. It is now time to recognise that failure of policy and reverse that policy failure.

The trolley figures are a clear example of the chaos. Those figures, and we are talking about human beings on trolleys in accident and emergency departments, on corridors and in wards are a clear example of the chaos, are a clear example of the failure and a clear example of the indignity suffered by thousands upon thousands of patients over the past ten years. The figures for October, 11,452, are absolutely outrageous. The figures are climbing year on year, and of course we haven’t really entered Winter at all yet.

One of the areas which has suffered the brunt of the policy that I am speaking is the mid-west, including Limerick, Clare and north Tipperary, which is part of my constituency. There are knock-on effects at South Tipperary General Hospital in addition. University Hospital Limerick and South Tipperary General Hospital consistently among the highest trolley figures in the country. Today’s trolley figures are absolutely obscene. Patients are suffering and patients are dying on trolleys in our emergency departments, something the Irish Association for Emergency Medicine has warned us about for the past number of years. Today’s figures are the second highest ever recorded.

Mary Harney, the former Minister for Health, declared an emergency when there were 602 patients on trolleys. Today there are 679 patients on trolleys. The particular problems at University Hospital Limerick and in Clare and north Tipperary started with the closure of the accident and emergency departments at Nenagh General Hospital and at Ennis General Hospital. There is now a campaign locally and there have been a number of very successful meetings to demand the reopening of the Accident and Emergency departments both at Nenagh General Hospital and at Ennis General Hospital

The chaos resulting from the policy I have described has been compounded by two moratoriums. Everybody in this Chamber, including the Taoiseach, knows they are real.

We have a moratorium on the recruitment of staff. There are currently 432 vacant posts for staff nurses, public health nurses and staff midwives. There are more than 500 nurse vacancies in mental health services. I know three nursing posts have been vacant for the past six months in South Tipperary mental health services, in the child and adolescent mental health services and a Clinical Nurse Specialist for mental health services in the accident and emergency department in Clonmel.

Is it now time to accept that the policy of downgrading hospitals has failed and that the policy should be reversed? Isn’t it now time to agree to the reopening of the accident and emergency department in Ennis and Nenagh? And isn’t it now time finally to recognise what we all know that there is a moratorium on both staffing and home help hours and that that moratorium should be lifted immediately.

I have to say that I am shocked at the lack of urgency that the Taoiseach displays, almost indifference, almost as if this situation is normal. The trolley figures are absolutely obscene. We have people suffering on trolleys in our hospitals and people are dying on trolleys in our hospitals. The Taoiseach is the leader of this country and I have to say that he has a responsibility for this obscenity, he has a responsibility for the suffering and a responsibly for the deaths of these people on trolleys in our hospitals over recent years, a position that continues to this day. The Taoiseach can solve this problem.
He absolutely can solve this problem. I ask him to introduce immediately a supplementary budget to tax the 1%, the very wealthy people, the billionaires who own 27.3% of all the wealth in this country. They are not paying their fair share now, nor have they ever done so. I want the Taoiseach to reopen the accident and emergency departments at Nenagh General Hospital and Ennis General Hospital and to reopen Our Lady’s Hospital Cashel, a state-of-the-art hospital which has been vacant for the past ten years. The Taoiseach has the responsibility to solve this problem. He can do it. The question is whether he has the political will to do it.

—————————————————————————————————————————–Full Exchanges with Taoiseach: Seamus Healy TD Questions Taoiseach on Crisis in Health Service   05/11/2019

As trolley figures published today reach the highest figure this year and the Second Highest Figure in History, Will the Taoiseach tax the Irish billionaires to fund our health services?-Healy  https://wp.me/pKzXa-10V

That will not be necessary. Everything is already being done by government -Varadkar

Deputy Seamus Healy

One of the areas which has suffered the brunt of the policy about which I am speaking is the mid-west, including Limerick, Clare and north Tipperary, which is part of my constituency. There are knock-on effects on South Tipperary General Hospital. University Hospital Limerick and South Tipperary General Hospital consistently have the highest trolley figures in the country. Today’s trolley figures are obscene. Patients are suffering and dying on trolleys in our emergency departments, something the Irish Association for Emergency Medicine has warned us about for the past number of years. Today’s figures are the second highest ever recorded.

From 2002 on, successive Governments have espoused and implemented the downgrading of hospitals and the transfer of acute hospital services to so-called centres of excellence. We all know that that policy has created chaos. It was wrong then and it is wrong now, and it should never have happened. We in south Tipperary were lucky that 15,000 people on the streets stopped the transfer of our services to other areas, but other areas were not as lucky. It is now time to recognise and reverse that policy failure.

The trolley figures are a clear example of the chaos. The human beings on trolleys in accident and emergency departments, on corridors and in wards are a clear example of the chaos, failure and indignity suffered by thousands of patients over the past ten years. The total figure for October is 11,452, which is outrageous. The figures are climbing year on year, and we have not yet entered winter.

One of the areas which has suffered the brunt of the policy about which I am speaking is the mid-west, including Limerick, Clare and north Tipperary, which is part of my constituency. There are knock-on effects on South Tipperary General Hospital. University Hospital Limerick and South Tipperary General Hospital consistently have the highest trolley figures in the country. Today’s trolley figures are obscene. Patients are suffering and dying on trolleys in our emergency departments, something the Irish Association for Emergency Medicine has warned us about for the past number of years. Today’s figures are the second highest ever recorded.

Mary Harney, the former Minister for Health, declared an emergency when 602 patients were on trolleys. Today, the figure is 679. The particular problems at University Hospital Limerick and in Clare and north Tipperary started with the closure of the accident and emergency departments in Nenagh and Ennis general hospitals. A local campaign held a number of very successful meetings to demand the reopening of the accident and emergency departments in those hospitals.

The chaos resulting from the policy I have described has been compounded by two moratoriums. Everybody in this Chamber, including the Taoiseach, knows they are

We have a moratorium on the recruitment of staff. There are 432 vacant posts for staff nurses, public health nurses and staff midwives. There are more than 500 nurse vacancies in mental health services. I know three nursing posts have been vacant for the past six months in south Tipperary mental health services, child and adolescent mental health services—–

—–and mental health services in the accident and emergency department in Clonmel. Is it now time to accept that the policy of downgrading hospitals has failed and that the policy should be reversed? Is it not time to agree to the reopening of the accident and emergency department in Ennis and Nenagh?

Reply by Taoiseach

Regarding Clonmel hospital, which I know is very severely overcrowded at the moment, a new bed block is under construction there and we will get it open as soon as we possibly can once construction is finished.

Deputy Mattie McGrath

 

Where will we get the staff?

 

The Taoiseach

 

As for Limerick, as Deputies will be aware, a new emergency department, perhaps the most modern in the country, is open and functioning; a new block, the Leben block, opened two or three years ago; a further block of 60 beds is under construction and should open next year; and another block of 96 beds is planned to be built after that. Deputy Healy, I think, called for the reopening of the emergency departments in Nenagh and Ennis and perhaps other parts of the country. He also quoted the Irish Association for Emergency Medicine. They are the doctors who work in emergency departments, they are the experts when it comes to emergency departments and they say we should not reopen—–

Deputy Seamus Healy

 

They say 350 patients are dying on trolleys.

 

The Taoiseach

 

—–any emergency departments. In fact, they say we should further consolidate them because modern emergency care can only be provided properly in a relatively small number of large centres rather than a large number of small centres. The latter might have worked in the past, when medicine was different, but it will not work in the future.

The mid-west and the north east tell different stories. In the mid-west, it is absolutely the case that Limerick experiences very severe overcrowding. I know that people there link it to changes made to the role of Ennis and Nenagh. In the north east, however, the story is very different. Monaghan and Dundalk emergency departments were closed quite some time ago – again, long before my party was in government. However, we see in the hospitals that took over from them, namely Cavan and Drogheda, the lowest levels of overcrowding in a very long time. There are record low levels of overcrowding in some of those hospitals. Therefore it is not as simple as saying reconfiguring causes overcrowding because one sees such a totally different story in the north east than in the mid-west.

 

Deputy Seamus Healy

 

I am shocked at the lack of urgency, almost indifference, the Taoiseach displays, almost as if this situation is normal. The trolley figures are absolutely obscene. We have people suffering and dying on trolleys in our hospitals. The Taoiseach is the leader of this country and has a responsibility for this obscenity, the suffering and the deaths of these people on trolleys in our hospitals over recent years, a position that continues to this day. He absolutely can solve this problem. I ask him to introduce immediately a supplementary budget to tax the 1%, the very wealthy people, the billionaires who own 27.3% of all the wealth in this country. They are not paying their fair share now, nor have they ever done so. I want the Taoiseach to reopen the accident and emergency departments at Nenagh hospital—–

An Ceann Comhairle

 

I thank the Deputy. He is way over time again.

Deputy Seamus Healy

 

—–and Ennis hospital and to reopen Our Lady’s Hospital Cashel, a state-of-the-art hospital which has been vacant for the past ten years.

An Ceann Comhairle

 

The Deputy’s time is up.

Deputy Seamus Healy

 

The Taoiseach has the responsibility to solve this problem. He can do it. The question is whether he has the political will to do it.

An Ceann Comhairle

 

I thank the Deputy and call the Taoiseach to conclude on this matter.

The Taoiseach

 

I assure the Deputy there is absolutely no need for a supplementary budget. The HSE will get an extra €1 billion next year.

Deputy Seamus Healy

 

This situation is normal, is it?

The Taoiseach

 

This will be the biggest budget the HSE has ever had and a very high one relative to other countries per capita—–

Deputy Seamus Healy

 

The Government will not tax the rich then.

The Taoiseach

 

—–so that will not be necessary. The Deputy thinks the solution to hospital overcrowding is higher taxes; it is not.

Deputy Seamus Healy

 

I referred to higher taxes on billionaires, who own 27.3% of all the wealth in this country. They are the 1%.

An Ceann Comhairle

 

Please, Deputy.

The Taoiseach

 

The solution is more beds, more funding for fair deal, more home care packages and investment in primary care and public health, all of which is being done.

 

————————————————————–Lack of staff, beds to trigger ‘worst winter trolley crisis’-Hospital Consultants Association

https://wp.me/pKzXa-10V

Some 500 consultant posts – accounting for one in five specialists – remain vacant or filled on a temporary basis, the president of HCA added

 

Eilish O,Regan, Irish Idependent, September 3 2019

Hospital overcrowding is in danger of reaching record levels this winter as more patients endure long delays on trolleys before being moved to a ward, senior doctors warned yesterday.

Dr Donal O’Hanlon, president of the Irish Hospital Consultants Association (IHCA), warned: “Our acute hospital system is at breaking point due to a severe shortage of consultants and a lack of beds and other facilities.

“The quality and safety of patient care is deteriorating further due to persistent underinvestment.”

He was speaking at the launch of IHCA’s pre-Budget submission, calling on the Government to prioritise investment in medical staff and public hospital capacity deficits.

Some 500 consultant posts – accounting for one in five specialists – remain vacant or filled on a temporary basis, he added.

Talks are expected to begin this month on filling the gap which leaves new consultant recruits earning around €50,000 less than their long-serving colleagues.

However, the doctors’ body looks set to resist any move to make increased productivity measures part of any new deal, saying they are already seeing more patients than colleagues in other countries.

Secretary general Martin Varley also rejected any plan to make all new recruits work only for public patients with no private practice. He said it was tried on two occasions, including 2011, and it failed.

Commenting on yesterday’s capital plan, the IHCA said it only provides for 480 beds, or 100 fewer beds over each of the three years compared to National Development Plan promises.

————————————————————LONGER THAN 1 YEAR AND 3 MONTHS WAITING For IN-Patient Treatment

HSE:Analysis of waiting lists by the NTPF, as of February 2017, identified that 38,991 patients will be waiting for in-patient or day case treatment greater than 15 months at the end of October 2017.

——————————————————————–

LIMERICK AND CLONMEL- Hospitals Serving Co Tipperary Top THE TROLLY  COUNT  https://wp.me/pKzXa-10V

But Minister Harris tells people who are feeling sick to check a website to see how sick they are

 January 15, 2019 11:50 James Brennan Irish News

The former trainee journalist turned Minister for Health has decided to give advice to the public on minding their health.

University Hospital Limerick once again tops the shameful list, with 59 patients suffering while waiting for a bed, followed by South Tipperary Hospital with 50, and Cork University Hospital with 48.

As 600 people languished on trolleys around the country yesterday, according to figures just released by the Irish Nurses and Midwives Organisation (INMO), Minister for Health Simon Harris had a very simple Simon answer, check a website!

Speaking on VirginMedia News yesterday, Harris advised people who are feeling sick to check a website called “undertheweather.ie” to see just how sick they really are!

This is the highest figure recorded since March of last year.

University Hospital Limerick once again tops the shameful list, with 59 patients suffering while waiting for a bed, followed by South Tipperary Hospital with 50, and Cork University Hospital with 48.

It appears you’re not been advised by the actual Minister for Health himself to go to a website rather than A&E.

—————————————————-EMERGENCY: PROTECT CHILDREN FROM DEADLY BACTERIAL MENINGITIS THAT CAN KILL IN HOURS NOW MINISTER HARRIS!Shocking Cynicism by Health Minister

Support Petition 

https://my.uplift.ie/petitions/catch-up-meningitis-b-vaccine-for-all-children?source=facebook-share-button&time=1547126605&fbclid=IwAR1Y4kW48PmORO3q_j-AG_mKYde2ybNJXka4y0v6L15-M5aTpURMF4YsBrM

VACCINATION MUST BE PROVIDED FREE! Vulnerable Children with Medical Cards including those with Downs Syndrome and Diabetes born before October 2016 must pay 300 Euro for two Jabs. Children under 3 years must pay!

HSE ADVISES THAT VULNERABLE CHILDREN MUST BE VACCINATED IMMEDIATELY As A PRIORITY

MINISTER MUST ACT TODAY TO SAVE LIVES!!!

When Minister Harris Brought in Free Vaccinations in OCTOBER 2016, Children born even one day before that, still under 3 years of ageto-day were not covered

When a parent seeks free vaccination on behalf of a child covered by medical card, but born before October 2016, the HSE replies that it cannot supply the vaccine free as this is not provided for in law. The request for the vaccine, even for a disabled child over 2 years and 3 months, is “elective”  not “mandatory”

 

—————————————————————————————

Mr Harris is looking to employ market research consultants to ask the general public, health workers, and others what they consider to be the key health issues and priorities and then devise a communications strategy based on their answers.
Minister badly afflicted by a case of out-of-touchitis
Irish Examiner, Friday, January 11, 2019 By Caroline O’Doherty
Flu and the winter vomiting bug may be the afflictions of the season, but out-of-touch-itis is the one that’s taken hold of Simon Harris.Emergency departments are overflowing, GPs are swamped, waiting lists are out of control, mental health services are in crisis, staff are in exodus, and nurses are about to strike — the list of ailments affecting the health service is long, serious, and, one would think, obvious.
Unless, it seems, you’re the minister for health.
Mr Harris is looking to employ consultants — of the market-research kind (we can’t afford the medical kind) — to ask the general public, health workers, and others what they consider to be the key health issues and priorities and then devise a communications strategy based on their answers.

VACCINATION MUST BE PROVIDED FREE! Vulnerable Children with Medical Cards including those with Downs Syndrome and Diabetes born before October 2016 must pay 300 Euro for two Jabs. Children under 3 years must pay

HSE ADVISES THAT VULNERABLE CHILDREN MUST BE VACCINATED IMMEDIATELY As A PRIORITY

But when CHILDREN with MEDICAL CARD seek vaccination, parents are told that HSE is not required by Law to provide it free as it is “elective” for those born before October 2016!!!  Official Savagery!!!

MINISTER MUST ACT TODAY TO SAVE LIVES!!!

When Minister Harris Brought in Free Vaccinations in OCTOBER 2016, Children born before that, still under 3 years to-day were nor

—————————————————————————————

Irish Mirror 17 April, 2018 PLEASE SHARE

Student Nurse , Tara Nic Chormaic, pens powerful social media message to Health Minister Simon Harris after walking miles through snow to work during Storm Emma

Full Letter  https://wp.me/pKzXa-10V

Tara penned a furious open letter to Simon Harris voicing her fears for the future of the health service that is already at breaking point.

 

(Fourth-year Student Nurse, Tara Nic Chormaic, 28, says the hell of hospitals has left the Class of 2018 burnt out and disillusioned.Student nurses have as little as €6 a week left to buy food on their pathetic pay.The trainee from Tallaght, Dublin, will soon qualify as a Children’s and General Nurse.But crisis conditions are sparking a brain drain, she claims.)

 

The letter went as follows:

Dear Mr Harris,

I don’t know of any other undergraduate courses in Ireland, outside health-sciences, where one day your bringing life into the world, and the next holding the hands of someone leaving this world, comforting families who have been totally broken apart.

 

 

Nurses are glue. We hold teams, families, friends and patients together.

We try and stop people from taking their own lives, instil hope.

Many of us can’t do it for ourselves.

Why are student nurses going home crying at the end of a week of 39hours unpaid placements and a further 36 hours of their normal jobs to keep a roof over their heads, because student grants are just a drop in the ocean to helping with student debt?

Student nurses although officially “not counted in the numbers” are being counted in the numbers on wards – to the point without students the wards would collapse at times.

You keep talking about retaining nurses. If we don’t get treated well in training why would we think it’ll be any better when we qualify.

We see the stress qualified nurses are under to feed their families and keep a roof over their head as it is. Nurses sleeping in their cars.

New graduates not able to afford their rent and mortgages or even dream of ever getting a mortgage without moving away.

Despite this we go in day after day and care for everyone else when we can’t care for ourselves.

This week I had €6.49 to spend on food, more than normal, to keep me going for a week.

 

Not sure if you know, but nursing is a physically and mentally demanding job. You need energy. Energy comes from food and sleep. Two basics that I just don’t get, because I chose in the face of adversity to better myself. To do what I’ve always wanted to do and become a nurse. To help others.

I’m a Children’s and General Nursing student. Everyone tells me I’m incredibly lucky to be in such a prestigious course and how it’ll stand to me and be worth it in the end. €28,768 a year as a staff nurse. €2791 I earn extra a year for having dual qualification.

Four and a half years of studying and doing the same workloads as General Nursing students at the same time as covering the extra work, study, assignments, exams, placements and stress of doing the Children’s Nursing aspect for €2791 extra a year when I qualify.

That doesn’t even cover one years student contribution fee. That doesn’t touch the student loans I’ve had to take out because of the cost of living (and it’s far from a fancy life I live).

Student and Staff Nurses are burnt out.

The conditions and pay we are working under are beyond shocking.

The job we do is worth so much more. We are worth so much more. When will you see that?

Tara

——————————————————————————-WAITING LISTS

Martin Wall, Irish Times,: Friday, January 12, 2018, 18:23

There are now more than 500,000 people waiting for an out-patient appointment to see a hospital consultant, new figures show.

The National Treatment Purchase Fund (NTPF) on Friday published figures showing that overall the number of patients on hospital waiting lists is continuing to rise.

There were 81,468 people on waiting lists for hospital in-patient or day case procedures at the end of December, up from 80,595 at the end of November.

The number of patients waiting for an out-patient appointment in December was 500,800, up from 497,721 in November.

Minister for Health Simon Harris said the out-patient waiting list remained “a big challenge that needs to be addressed”. He said the budget for the NTPF and to deal with waiting lists had dramatically increased .

He said he expected “ to see good progress in driving down waiting lists as we come into the spring”.

However, Fianna Fáil’s health spokesman Billy Kelleher said it was “absolutely appalling” that more than half a million people were now waiting for an outpatient appointment.

He argued that Mr Harris had “clearly taken his eye off the ball as he attempts, and fails, to grapple with emergency department trolley crisis”

“A total of 138,584 of these patients spent all of 2017 waiting unsuccessfully for an outpatient consultation. And half of these have actually being waiting since the middle of 2016,” he said.

“We should remember too that Leo Varadkar promised that no-one would be waiting more than 18 months by the middle of 2015. Delivery on that commitment seems further away than ever.”

Mr Harris said it was worth highlighting that the number of patients waiting more than 12 months was lower in December than at any point last year and there were marked decreases in those waiting for treatment for a number of specialities including cataracts; ear, nose and throat; urology and scopes.

“At present over 57 per cent of patients on the in-patient list wait less than six months, and over 84 per cent wait less than 12 months for their procedure. This is despite the additional demands on our hospitals,” he said.

“The out-patient waiting list remains a big challenge that needs to be addressed. It is worth noting that last year almost half a million (479,000) outpatients did not attend their appointment. This is something that must be tackled.”

Mr Kelleher said it was “ bitterly disappointing” that after four months of modest improvements, the numbers waiting on the inpatient day case list have edged upwards again.”

“Sadly the chaos we have seen in our emergency departments so far in 2018 means that we are likely to see a further increase in January,” he said. “It is critical that the Minister for Health publishes the bed capacity review as soon as possible and bring forward a costed plan for its swift implementation.”

———————————-

RTE:Almost 679,000 patients waiting for hospital care, new figures show

Updated / Friday, 6 Oct 2017 22:55

Over 101,460 were waiting for inpatient or day case treatment, down slightly on the August figure

Over 678,800 patients are now waiting for hospital care, according to the latest figures from the National Treatment Purchase Fund.

The figures released this evening are up to the end of September.

While the overall figures represent an increase of about 19,000 on the previous month, some lists have seen reductions.

Of the 678,800 total, over 101,460 were waiting for inpatient or day case treatment, down slightly on the August figure.

19,100 were waiting for a gastrointestinal endoscopy check.

Over 495,300 were waiting to be seen by a consultant at an outpatient clinic, down slightly on the August figures.

A further 62,800 people were scheduled for follow-up care soon having had initial treatment already.

In August, the National Treatment Purchase Fund changed the way the waiting list figures are presented.

The figures now detail patients who have a date set to be seen, patients waiting for a date, and suspended patients – those who are temporarily unfit or unable to attend due to clinical or personal reasons.

The total number in the suspended list is 10,317.

Included in the suspended list are patients whose treatment is being outsourced to another hospital, possibly a private hospital.

The NTPF also publishes a list of what are called ‘planned procedures’ – a list of patients who have had an initial episode of care and who are waiting for further treatment.

Minister for Health Simon Harris has said he welcomes that there has been a reduction in the total number of patients waiting for both procedures and outpatient appointments.

In a statement, Mr Harris said: “This is evidence that the measures being taken to reduce waiting lists are beginning to work. We are seeing a downward trend and we expect that to continue. This is the second month in a row that we have seen a reduction in the number of patients waiting for Inpatient or Day Case procedures.

Mr Harris said that “good progress” was being made, before noting the long waiting list times faced by patients, saying: “I acknowledge that waiting times are too long and I am keenly aware of the burden that long waiting times for treatment places on patient and their families.

“That is why we now need to do more and that is why funding for the NTPT is to rise in 2018, so that more procedures can be carried out and more people can be treated.”

He added that the reduction of waiting times for patients and improving access to health services is one of his key priorities.

Mother waiting over two years for procedure

Serena Guilfoyle from Portlaoise is 34 years old and is the mother of four young children.

She was recently treated for breast cancer and has ongoing problems with her stomach and had part of her bowel removed.

Ms Guilfoyle is awaiting news on a possible diagnosis of coeliac disease.

 

She is on the waiting list at the Midland Regional Hospital Tullamore for a stomach biopsy – with an appointment date over two years away.

She told RTÉ Newsshe is terrified of the wait.

The Midland Regional Hospital in Tullamore said it cannot comment on individual patient care.

The hospital said it is actively working with the HSE to ensure no patient is waiting more than 18 months and to meet targets set for those waiting less than 15 months.

It said it is committed to ensuring that those with the greatest clinical need are prioritised for treatment.

The Private Hospitals Association has called on the Minister for Health Simon Harris to convene a crisis summit over hospital waiting lists.

The Association said radical solutions are now required to drive down waiting lists and to keep them down for good.

Its Chief Executive, Simon Nugent, said it was like a chronic ‘Groundhog Day’ for hundreds of thousands of patients and their families who every month are being told that their wait must go on.

 

—————————————————

Current hospital crisis will seem like picnic if more beds not provided in future – HSE

Martin Wall, Irish times,Wednesday, January 10, 2018, 11:07

The current level of hospital overcrowding will “look like a picnic” compared to what will happen in the future unless capacity is increased, the head of the HSE has said.

Tony O’Brien said the population was growing and ageing and people would need more access to healthcare. He said this meant the healthcare system would have to be “differently shaped and differently sized”.

He said he was pleased that there was now a political consensus about the issue.

Speaking on RTÉ’s News at One, Mr O’Brien said if additional bed capacity was not provided, the healthcare system would face “an existential crisis” in the years ahead.

“We cannot go through the next five years without addressing this issue, because what we’re seeing today will look like a picnic if we don’t,” he said.

“If we continue with the healthcare system in the shape that it is, with only the number of beds that it has, with the population changing and increasing, the level of demand for emergency care will continue to grow with a static bed stock.”

Mr O’Brien made his comments after new figures compiled by nurses revealed there were 551 patients on trolleys in emergency departments or on wards awaiting admission to a hospital bed.

Mr O’Brien said he acknowledged that the experience for many patients in hospitals at present was not good.

He said the trolley figures for Wednesday were much too high but they were also clearly evident of the tremendous work being carried out by staff and the fact that some of the planning put in place over the last year had been effective in part.

Mr O’Brien said the Irish public health system was structured for a different time, as was its level of capacity.

He said bed occupancy in many of the country’s major hospital was running at well over 100 per cent.

“Last week in the UK, because it exceeded 85 per cent (bed occupancy levels) we saw the prime minister apologising for the cancellation of all elective treatment. If we followed that we would not be doing elective treatment at all.”

He said he was pleased that with the forthcoming report of the Government’s bed capacity review and the Slaintecare reforms “we are on the brink of changes which will mean in the future we will not see what we are seeing now”.

Not competitive

The Irish Times reported on Saturday that the review will call for the provision of an additional 2,000 – 2,500 acute hospital beds if planned healthcare reforms were implemented and up to 9,000 additional beds if the changes were not put in place.

Mr O’Brien warned, however, that increasing capacity in hospitals did not involve “going down to Bargaintown and buying a few beds”.

He said providing infrastructure in hospitals was a complex, long and expensive business.

He said additional staff would also have to be found and he acknowledged that Ireland was not internationally competitive in recruiting healthcare personnel.

New figures released by the Irish Nurses and Midwives Organisation (INMO) said there were 43 patients at LetterkennyGeneral Hospital and 42 patients at Galway University Hospital waiting for a bed after being deemed by doctors to require admission .

The INMO figures suggest that the number of people on trolleys is down from the 575 recorded on Tuesday and the record levels of 677 reached last week.

The INMO figures show that in Dublin the largest number of people waiting for a bed was at Tallaght Hospital while 29 people were on trolleys or on wards awaiting admission to a bed.

Capacity

Meanwhile the Irish Medical Organisation (IMO) urged the Government to acknowledge that the health service was experiencing a system-wide problem of lack of capacity and not just an emergency department or trolley crisis.

“ What we are seeing in our emergency departments is only the manifestation of the wider problems – and we are now seeing the same problems in other parts of our services as they struggle to cope with capacity and patient demand.”

“It is not sustainable to have solutions that:

*cancel elective procedures. In many of these cases the patient will simply present back in the emergency department and in all cases will add to the already unmanageable waiting lists.

*transfer patients from hospitals to private facilities. Continuing a policy of investing much needed resources into the private system with no corresponding investment in our public system will simply maintain the status quo – it is the same number of patients requiring treatment but we are putting taxpayers’ monies into a private profit based system.”

The IMO said all the problems being experienced centred around capacity:

“capacity with regards to the number of beds in both acute hospitals and the community setting; capacity with respect to the number of medical staff. We need to attract more consultants and capacity in general practice – we must deliver a wider range of services at GP surgeries .

“The unfortunate truth that Government seems to be avoiding, is that all this requires a seismic shift in the way we deliver and fund our health services and that costs money. It would be truly revolutionary to hear the Government saying not only have they decided on the priorities but they are actually going to fund them. As a society we cannot continue to simply give out about our health services, we need to agree on the solutions and agree that these will have to be paid for.”

Meanwhile the trade union Siptu called on health service watchdog HIQA to investigate the overcrowding being experienced in hospital emergency departments.

HIQA said it did not have the power to regulate acute general hospital services and had no enforcement powers.

————————-

Population projections spell trouble for struggling hospitals

Peter Murtagh, Irish Times, Saturday, January 6, 2018,

Capacity problems currently facing hospitals, and evidently defying effective measures to resolve them, can only get far worse, if recent population and life expectancy projections come to pass.

Based on data from the 2016 Census, an Economic and Social Research Institute report, Projections of Demand for Healthcare in Ireland, 2015-2030, published last October postulated a population growth of up to 23 per cent, or 640,000-1.1 million extra people.

All of those people will, by definition, place additional demands on maternity and childcare services, with a proportion of them needing ongoing care. But it is the ageing nature of the population that will place a disproportionately greater burden on services.

The number of people aged 65 and over is expected to grow from its present one in eight to one in six. The number of people aged over 85 will almost double.

Older people’s dependency on support services and greater proneness to illness will probably translate into greater demands for elective operations, such as hip and knee replacements, and on care prompted by other ailments related to age such as oncology care, dementia and respiratory care, circulatory problems related to heart disease and strokes and, ultimately, home help and residential nursing home care.

The ESRI projected that demand for home help and for residential and intermediate care places in nursing homes and other settings would increase by up to 54 per cent.

Demand for public hospital services is projected to increase by up to 37 per cent for inpatient bed days and up to 30 per cent for inpatient cases; and demand for GP visits is projected to increase by up to 27 per cent.

The report’s authors suggested additional demand projected for the years to 2030 will give rise to demand for additional expenditure, capital investment and expanded staffing and will have major implications for capacity planning, workforce planning and training.

In public hospitals, they suggested demand for inpatient bed days would increase by 32-37 per cent by 2030, from 3.27 million in 2015. Demand for inpatient cases is projected to increase by between 24-30 per cent by 2030, from 510,000 in 2015.

Demand for day-patient cases is projected to increase by 23-29 per cent by 2030, from 1.01 million in 2015.

Private trends

Regarding private hospitals, which are often colocated with public hospitals and share staff, demand for inpatient bed days is projected to increase by 28-32 per cent by 2030 from 610,000 in 2015.

Demand for private hospital inpatient cases is projected to increase by 20-25 per cent by 2030, from 130,000 in 2015; and demand for private hospital day-patient cases is projected to increase by 24-28 per cent by 2030 from 460,000 in 2015.

The report projected that demand for GP visits would increase by 20-27 per cent by 2030, from 17.55 million in 2015; and demand for practice nurse visits is projected to increase by 26-32 per cent by 2030, from 5.94 million in 2015.

Demand for long-term and intermediate care places in nursing homes and other settings is projected to increase by 40-54 per cent by 2030, from 29,000 in 2015.

Demand for home help hours is projected to increase by 38-54 per cent by 2030 from 14.3 million in 2015.

Up to 9,000 additional hospital beds needed, review finds

Martin Wall, Sarah Bardon
Last Updated: Saturday, January 6, 2018, 03:00

Between 7,000 and 9,000 additional hospital beds will be required over the next decade or so if the existing model of healthcare continues, the Government’s long-awaited review of capacity requirements has found.

The review has concluded, however, that the number of additional beds needed could be reduced to 2,000-2,500 in the years up to 2030 if Sláintecare reform proposals, such as investing heavily in healthcare services in the community, are implemented.

In addition, the review recommends that a number of hospitals should be established to deal exclusively with elective or non-urgent cases. It argues this would assist in reducing waiting lists and emergency department overcrowding in acute hospitals.

Health service sources said this could involve a reconfiguration of existing services in some parts of the country including potentially closing some emergency departments.

Existing reform plans along these lines in Portlaoise have prompted strong criticism from local politicians and campaign groups in the midlands.

The bed capacity review also calls for dramatic increases in long-term residential places. This would assist in reducing the number of delayed discharge patients in hospitals; those whose acute phase of treatment has concluded, but cannot be sent home or transferred to other healthcare facilities.

The Minister for Health Simon Harris has repeatedly pointed to the forthcoming bed capacity review as the way to deal with the overcrowding and trolley crisis in public hospitals.

Trolley count

Nurses on Friday maintained that more than 2,400 patients had to spend time on trolleys in hospitals in the first few days of 2018 while waiting on a bed.

The number of people deemed to require admission to hospital by a doctor and waiting for a bed fell to 483 on Friday, from record levels of 677 experienced early this week. However doctors and health service administrators forecast that the numbers could rise again in the next week or so as the peak of the flu season hits.

The HSE said on Friday it expected non-urgent elective procedures would not take place in hospitals next week but maintained this would be considered on a hospital-by-hospital basis.

However, the HSE stressed hospital groups and individual hospitals were ensuring that cancer and other urgent elective procedures were continuing to be carried out.

“Other non-urgent elective work will be reviewed on a site by site on a clinically prioritised basis during the course of the next week. We expect that non-urgent elective procedures will not proceed but stress that this will be considered on a site by site prioritised basis.”

Community facilities

The bed capacity review is expected to be published within the next three weeks and will feed into the Government’s overall 10-year capital plan.

The provision of additional hospital beds along the lines of the recommendations in the forthcoming capacity review would cost hundreds of millions of euro.

The Department of Health told the Oireachtas committee on the future of healthcare last year that the construction and capital cost of providing an additional hospital bed was about €325,000.

On this basis it would cost in excess of €800 million to provide the 2,500 additional beds proposed by the capacity review as part of a reformed health service.

Mr Harris told The Irish Times in an interview prior to Christmas that thousands of additional beds in acute hospitals and community facilities would be required in the future and that the forthcoming review would set out specific numbers.

He said on Thursday that significant additional funding would have to be provided by Government to meet the cost of opening additional hospital beds.

Almost 680,000 on public hospital waiting lists, latest figures show

Mark Hilliard

Irish Times Friday, October 6, 2017, 20:55

Almost 680,000 people remain on public hospital waiting lists for various procedures, according to the latest published figures.

By the end of September, outpatients, the largest group of those awaiting treatment, has approached half a million, now at 495,318, figures from the National Treatment Purchase fund show. That compares to 497,300 at the end of August.

There were just over 83,000 existing or active inpatients awaiting treatment while a further 18,423 who had been given first appointment dates are also now among those listed.

Just over 10,000 patients had procedures suspended which can happen for a variety of reasons, whether through voluntary postponement of a previous appointment or because an individual is not well enough to undergo a procedure.

A further 62,874 people are awaiting follow-up appointments having completed initial treatment.

Simon Nugent, chief executive of the Private Hospitals Association, noted a welcome slight reduction of 909 inpatients awaiting treatment.

“Endoscopy waiting lists are up by 682 which is similar to the number of patients to be treated by [the Health] Minister’s endoscopy NTPF initiative announced in the last couple of weeks,” he said in a statement. “It looks like this will just address this one month’s increase. This is worrying.”

Specialist appointments

He also noted that while the out-patient total had dropped by 2,000, the number of those waiting for a specialist appointment for longer than 18 months has gone up by almost 1,500.

“We still need dramatic new thinking to stop tinkering with the numbers at the margin and to see real reductions,” he said. “That’s why the Minister for Health Simon Harris needs to convene an emergency summit bringing all players together to see what approaches could be most effective.”

In its own analysis, the Health Service Executive (HSE) said the number of patients waiting more than five months has fallen by 1,333 from 10,791 in August to 9,458 in September.

The total number of patients on the in-patient and day case list has reduced by 900 in the same month.

 

Fintan O’Toole: The A&E crisis is perfectly acceptable

Fintan O’Toole Saturday, January 13, 2018,

Exactly seven years ago this weekend, The Irish Times reported: “Waiting times for patients attending emergency departments in many hospitals earlier this month were unacceptable, Minister of Health Mary Harney told the Dáil. She said she had discussed plans with the HSE for ensuring that this situation did not recur.”

This week, the Minister for Health Simon Harris used that same word, declaring the current crisis in hospital emergency departments “unacceptable”.

It is a word that returns again and again in almost every discussion of the inadequacies of Ireland’s public hospital system. “Unacceptable” or its variants was used five times, for example, in the 2002 Acute Hospital Bed Capacity report.

In the foreword, the then minister for health, Micheál Martin, wrote of “cancellation of elective admissions, long delays in accident and emergency departments, waiting lists for elective procedures and unacceptably high bed occupancy levels in the major hospitals”.

It is time we admitted that “unacceptable” is a big lie. By definition, if a situation is unacceptable, it does not become an annual event, a kind of grotesque winter festival of suffering that is now as much a part of the calendar as Christmas and New Year.

National emergency

Each year, it is greeted with the same language: unacceptable, intolerable, “bloody awful” (Leo Varadkar, 2015) or even, as Harney declared it in 2006, a “national emergency”. (“People who need to be admitted will have beds, not trolleys, and the basics for human dignity. This will be put in place in the coming months. Anything less than this is not acceptable to the public, not acceptable to me and not acceptable to the HSE.”)

It took an outsider to tell the truth. Tracy Cooper, who came in from Britain to establish the Health Information & Quality Authority, spoke in May 2012, after a patient had died on a trolley, of the “persistent, and generally accepted, tolerance of patients lying on trolleys in corridors for long periods of time”.

‘Generally accepted’ is the honest description of the misery inflicted every winter on vulnerable, sick people. ‘Unacceptable’ is a self-serving pretence

“Generally accepted” is the honest description of the misery inflicted every winter on vulnerable, sick people, most of them elderly. “Unacceptable” is a self-serving pretence.

It sounds good. It suggests that there is a collective public and political shock at the realisation that something “bloody awful” is being done to real people. And it suggests that this will end simply because it must, that all stops are being pulled out, that loins are being girded, that this is the very last time. None of this has ever been true.

Because “unacceptable” is a lie, everything that follows it has to be regarded with extreme scepticism. What follows, invariably, is the firm purpose of amendment – the capacity review, the task force, the promise that this time it’s different.

Harris this week declared that 2018 would be the “year of reform”. Like, presumably, the year of reform that has been announced by every one of his predecessors since the late 1990s.

Acceptable cruelty

The UK home secretary Reginald Maudling got into trouble in 1971 when he spoke of “an acceptable level of violence” in Northern Ireland. But we have to confront the fact that there is an acceptable level of cruelty in the Irish healthcare system. Not acceptable to the patients or their families or the medical staff who are doing their considerable best to alleviate the suffering – but collectively tolerable nonetheless.

It is the price that must be paid if we are to maintain a refusal to create a rational national health service that allocates resources efficiently, effectively and above all fairly.

The underlying problem is not money. Ireland spends about €20 billion a year on healthcare, €8 billion of it on hospitals. This is relatively high, especially if we take into account that we have a young (and thus healthy) population. Per capita, it is about the same as Austria, Sweden, the Netherlands or Germany – all countries that seem to be able to avoid the scale of inbuilt cruelties that Ireland routinely inflicts on patients.

We spend enough on a current annual basis to have a decent healthcare system. (There is an obvious need, of course, for major capital investments.) So why don’t we have one?

There are many reasons, but the core problem is not the money itself. It is the way we raise it and spend it. The headline figures for health expenditure mask something that is quite distinctive about Ireland: the weird mix of public and private spending.

Our fragmented, illogical and inefficient health system is full of perverse incentives for hospitals and consultants to chase private money at the expense of public patients

Only 70 per cent of Irish health spending comes from Government revenues – a figure that has declined drastically since 2000 when it was nearly 80 per cent. The rest comes from private insurance and from out-of-pocket payments to GPs and pharmacists. This creates a fragmented, illogical and inefficient system, full of perverse incentives for hospitals and consultants to chase the private money at the expense of public patients. The private 30 per cent distorts the purposes of the public 70 per cent.

Why do we have this system? The answer is quite bizarre and it goes right back to the 1950s. This was the postwar era in which most European countries were creating national health services. But the Catholic Church and much of the medical establishment was ideologically opposed to the creation of a single, unified NHS in Ireland.

Irish compromise

An Irish compromise was reached – 85 per cent of people would be entitled to free care in public hospitals but the top 15 per cent of earners would buy private insurance, thus guaranteeing the consultants they could still have extra, “private” income and guaranteeing Catholic “voluntary” hospitals that they would not become State entities.

Weirdly, however, this “private” care would be provided in public hospitals. The two-tier system was born. And it got weirder over time: entitlement to public hospital care became universal in the 1990s but at the same time the number of people buying private health insurance rose from the initial 15 per cent to almost 50 per cent.

Nobody thinks this system makes any sense. It has many people paying twice for the same service and many other people being displaced because they can’t afford private insurance. It allocates resources chaotically and in ways that are hard to track, never mind justify.

On the one hand, highly efficient parts of the system, such as local general practice, are starved of resources, pushing patients into the emergency-department nightmare. On the other, highly skilled professionals are incentivised to treat people on the basis of money, not of need.

The absurdities multiply to the point where public hospitals are now putting pressure on patients who have private insurance to declare that they are “private patients” and thus cash cows.

But do we really want to change this system? Do we really want a coherent national health service that spends money where there is greatest need? Do we really want a system that starts by ruling out the “unacceptable” – a regular, predictable and “bloody awful” ritual of suffering – and works back from there?

Doing this would limit the incentives for professionals to chase private patients while drawing public salaries. It would also limit the ability of those private patients to skip ahead of the long queues for elective procedures. It would take away the sense of healthcare as a private commodity and make it a public good.

The annual A&E crisis reveals one brutal truth behind all the rhetorical reassurances: you can’t buy your way off a chair or a trolley and into a public bed. The public emergency departments are the arenas in which all are equal – and equally miserable. This truth waits for us all. The question is whether we want to change it before we have to experience it.

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