One of the country's leading emergency medicine consultants has warned that patients will continue to suffer waiting on trolleys for an acute bed unless the capacity issue in our hospitals is addressed.
Dr Alan Watts, an emergency doctor at University Hospital Limerick (UHL), which is consistently one of the busiest in the country, was speaking after an analysis of patient figures showed that overcrowding has been a persistent feature of our health service for decades now.
He said that he remains hopeful that increases in the bed capacity of our hospitals will make a difference, but unless it is resolved, it will continue to be a problem, and patients will continue to suffer as they wait on trolleys in emergency departments and on wards.
Permanent feature
Twenty years ago, the then minister for health, Mary Harney, declared the overcrowding crisis a national emergency and introduced a ten-point plan to eliminate it.
But the problem has persisted, becoming a permanent feature of our health service.
Dr Watts said: "Basically overcrowding is still a feature of our health service because of the capacity issue in our acute hospitals. It's important to distinguish between overcrowding and an ED which is busy.
"75% of patients are discharged after being seen by an emergency doctor ... and the 25% remaining have to be admitted, and it is this group who require inpatient care and do not have a bed to go to, that end up staying on a trolley in the ED, or on a ward."
The Irish Association for Emergency Medicine (IAEM) has been calling for an increase in capacity for many years. In UHL, they estimate there is a shortage of 300 beds.
Dr Watts said Ireland is behind its OECD colleagues when it comes to bed capacity. The average capacity in OECD countries is 4.3 beds per 1000 population, but in Ireland, it is 2.9, and in Limerick, it is just 2, or possibly less than that.
The IAEM welcomed the capacity review conducted last year by former Minister for Health Stephen Donnelly.
But Dr Watts urged the Government to prioritise those beds and that they be staffed adequately.
Danger to patients
In relation to the impact and danger caused to patients, multiple international studies have demonstrated how dangerous overcrowding can be.
A study in the Emergency Medicine Journal in 2022 showed there was an excess death for every 72 patients who waited eight to 12 hours. A further study in France showed that patients over 75 who stayed in the ED between midnight and 8am rather than an inpatient bed had greater mortality and morbidity.
He added that in 1980, we had approximately 4,500 more beds than we do at present, including the increase in the system highlighted by the HSE since 2020, so at the moment, we remain approximately 4,500 short.
He said the Government’s plans to increase bed capacity by up to 5,000 over their term will help, but attention must be given to the fact that even more beds will be required as time goes on because of the increase in our population and their older age profile.
Read More: How are overcrowding figures calculated and which hospitals are most affected?
Increase in ED attendances
The Health Service Executive said it is experiencing an increase in ED attendances in the year to date, with a significant increase in the number of patients aged 75 and over attending with complex care needs.
It said these patients often require admission to the acute hospital for treatment and in turn need supports on discharge.
On a daily basis, regardless of season, the HSE said health regions optimise capacity to meet demand from both scheduled and unscheduled care.
It added that factors that influence meeting demand and facilitating admissions to hospital beds include: increased ED demand, infection prevention and control, staffing, availability of community and stepdown beds and availability of surge capacity .
The HSE said there has been a massive, collective effort across its services throughout the winter period, with teams working tirelessly to ensure patients receive the best care possible.
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It added that in the latter half of 2024, it saw an increase in the presence of senior clinical decision-makers and support services in acute hospitals at weekends, and this helped reduce the build-up of numbers on trolleys at and immediately after weekends.
Meanwhile, figures from the Irish Nurses and Midwives Organisation showed there were 641 admitted patients waiting for a bed in hospitals around the country this morning.
The hospital worst affected was UHL with 89 patients waiting; there were 79 waiting at University Hospital Galway (UHG) and 56 at Sligo University Hospital.
There were 42 patients waiting for a bed at St Vincent's University Hospital and at Tallaght University Hospital in Dublin.
The Health Service Executive put the figure of patients waiting for a bed at 461.
Its figures showed there were 48 patients waiting at UHL, with 53 at UHG and 35 at Sligo University Hospital.
Additional reporting Fergal Bowers
