HSE challenges trolley figures

THE number of patients on trolleys at the Mid-Western Regional Hospital Ennis has doubled over the past year, it has been claimed.

Statistics compiled by the Irish Nurses’ and Midwives’ Organisation (INMO) show the number of Ennis patients on trolleys, awaiting an in-patient bed, jumped from 115 for the first three months in 2010 to 313 for the corresponding period this year.
However, the Mid-West Health Service Executive (HSE) has accused the nursing union of producing “inaccurate” figures for Ennis.
“The figure of 313 is inaccurate as it reflects nothing more than the cumulative figure by which we exceeded our bed compliment during the first quarter. It is a gross inaccuracy to assume that all these people were on trolleys. Ennis hospital utilise up to 12 overflow beds before we have anyone on a trolley,” said a HSE spokesman.
The latest details from the INMO’s Trolley Watch of all hospitals, has refocused attention on the controversial removal of 24-hour emergency services from Ennis in April 2009.
INMO Trolley Watch also reported the number of in-patients lying on trolleys at the Mid-Western Regional Hospital, Limerick jumped dramatically from 556 for the first quarter of 2009 to 1,079 a year later before falling slightly to 965 this year.
INMO Mid-West representative, Mary Fogarty said the overcrowding in Ennis and Limerick Regional Hospital was predicted by the union two years ago, following the publication of the Teamwork Report, which covered the ending of 24-hour emergency departments at Ennis and Nenagh.
Commenting on the HSE commissioned report, which led to the reconfiguration of services at acute hospitals, Ms Fogarty said it recommended that 135 extra beds should be provided at Limerick hospital, which never happened. Instead 25 beds were lost from St John’s Hospital, Limerick.
Ms Fogarty warned the current situation would get worse as the year goes on as a result of more bed closures, particularly in community hospitals such as Raheen in East Clare, which doesn’t have the necessary nursing staff in place to cope with its current bed complement.
She claimed efforts by the HSE to introduce an earlier discharge policy are being hampered by the lack of investment in community step-down beds, as there is no place to move in-patients from acute hospitals.
Although Ennis hospital only has official approval to provide 50 in-patient beds, 10 beds in its medical assessment unit and four HDU beds, Ms Fogarty claimed extra beds are being put in wards to cope with additional patients, which increase the risk of cross-infection.
She said Ennis hospital is operating at about 20% over capacity at the present, because of an increase in demand.
Asked about the methodology of compiling Trolley Watch figures, she explained nurses only counted the number of patients in hospitals who were admitted to hospital on a trolley and were waiting for an in-patient bed in a ward. She stressed nurses did not count the number of patients who were in overflow beds waiting to gain admission to a bed in a ward.
West Clare GP, Dr Tom Nolan, shares her concerns about the impact of changes in the hospital services in the Mid-West. He claimed the figures illustrate the current system of delivering emergency services in the Mid-West is not working.
Dr Nolan claimed the reconfiguration system was introduced by some people in the HSE “who had no experience in providing a new model for acute hospital services”, as a cost-saving exercise, ignoring proper levels of safe care.
Dr Nolan stated last January that Dr Fergal Hickey, president of Irish Emergency Medical Association, said overcrowding in Ireland caused 300 to 350 deaths.
He pointed out there are a number of medical reports and international data, which show that the longer a patient spent time on a trolley, their outcome was worse and there was an increased likelihood of death. He claimed the HSE had effectively decided to ignore this international data by allowing patients to spend an inordinate amount of time on trolleys.
Asked about the need for a better discharge policy, which the HSE has been trying to introduce in recent years, he noted that if there are difficulties with consultant contracts or consultants not being available to discharge patients at weekends, this is no solace to patients waiting on trolleys.
He claimed there are not enough doctors or beds in the system, which should have been provided before reconfiguration was even considered and noted this was also clearly stated in the Teamwork Report.
“Anyone waiting on a trolley will get sicker not better. All the medical studies have stated this. Reconfiguration as constituted is not capable of delivering adequate care to people because there aren’t enough beds or doctors.
“This situation is tolerated by the HSE and the Department of Health, which is the political master of the HSE. Regrettably, it is also contributed to by naive people to push a reconfiguration model that is unfair, undemocratic, and far removed from the international ethic of equity of care, and access to care,” Dr Nolan concluded.