Tuesday, October 25, 2011
Drogheda Hospital in crisis
In June this blog commented on the worsening state of the health service in the south. It made grim reading. The critique arose mainly as a result of several visits I had made to the Emergency Department of Our Lady of Lourdes Hospital in Drogheda. This blog witnessed many patients, some of them very elderly, lying on hospital trolleys, or sitting on chairs or the floor waiting to be treated by an overstretched and overworked medical staff.
This blog had also visited Louth County Hospital which was and is being slowly strangled by the withdrawal of key health services, including the closure of its emergency department.
And these two hospitals are the rule not the exception. Last Saturday I joined local Sinn Féin representative Paul Donnelly in Dublin West along with scores of local people who were protesting at the 20% cuts in funding for James Connolly hospital and the adverse impact this is having on services in that hospital.
But it was the news out of Drogheda that caused greatest concern. Last Friday it was revealed that a patient, who had been on a trolley in the Emergency Department for five days, had TB. Three other patients are now being screened for this dangerous disease and an undisclosed number of staff are also being checked.
The deterioration in the situation in Drogheda hospital was not unexpected. Three weeks ago this blog joined with party colleague Peadar Tóibín TD from Meath and Dr Ruairi Hanley from the Save Navan Hospital campaign, to write a letter to the Health Information and Quality Authority asking that it urgently and immediately “launch a full, public investigation of the Emergency Department in Our Lady of Lourdes, Drogheda and publish the findings.”
We did so because Our Lady of Lourdes in Drogheda was consistently ranking as the hospital with the worst waiting list in the state in its Emergency Department; a clear pattern which has been exacerbated since the closure of Louth County Hospital’s Emergency Department.
With Paul Donnelly in Dublin West protesting at cuts to Connolly Hospital
This level of overcrowding is not an anomaly. Nor is it simply a matter of inconvenience for patients. This is a matter of life and death. For months now the numbers of patients on trolleys in Drogheda has consistently exceeded 30. This has resulted in enormous pressure on the Emergency Department and represents a clear threat to patient safety and welfare.
Overcrowded EDs result in patients having their treatment delayed. Niall Hunter, who is the editor of Irish Health.com wrote recently that ‘experts now agree that hundreds of unnecessary deaths may occur in Irish hospitals each year that can be attributed to excessive Emergency Department pressure.’
The Irish Association of Emergency Medicine, representing consultants, said earlier this year - “It is now well-established that boarding hospital inpatients in emergency departments results in increased numbers of deaths among this group of ill patients, compared to similar patients who are admitted to a hospital ward in a timely fashion.”
The management in Lourdes responded to this crisis by putting into effect the ‘Full Capacity Protocol’. This essentially means that hospitals identify spaces on wards. Patients are put into those spaces even if the wards are not be appropriate for their health needs.
David Hughes, Deputy General Secretary of the Irish Nurses and Midwives Organisation explained: ‘When hospitals are operating in excess of 90% capacity (Irish hospitals with Emergency Department overcrowding are generally operating at 100% capacity) admitted patients are transferred to available beds which are not necessarily the appropriate beds.
Patients with heart problems should be cared for on a cardiac ward, while patients with lung disease should be admitted to a respiratory ward. This ensures that patients benefit from the experience of an appropriate specialist consultant and nurses with the right set of skills. The admitted patients and if additional trolleys are put up on wards, those additional patients will invariably be in the wrong ward. This leads to the movement of patients.
Patients may be moved two, three, or four times in the course of a week’s stay at a hospital. Excessive movement of patients increases the risk of transmission of infections and, although these practices are condemned in reports from Britain’s Healthcare Commission, they are now regular occurrences in Irish hospitals with Emergency Department difficulties.’
Moreover, hospitals across the state are daily breaking the target set by the HSE of a maximum of six hours from the time a patient presents at admission to the point at which they are admitted.
Regrettably, despite the clear evidence that Drogheda hospital is in serious trouble, HIQA declined to order an investigation. It said that it is ‘currently actively engaging’ with the HSE on the issue of quality and safety in the Louth Meath Hospital Group but didn’t specify what this meant.
The Health Act 2007 clearly states that HIQA has the power to carry out an investigation if it believes that there are reasonable grounds and that there is a serious risk to the health or welfare of a patient.
This blog believes that the safety, quality and standards in the Emergency Department of Our Lady of Lourdes Hospital, Drogheda are such that a statutory investigation is the only reasonable response.
If HIQA continues to refuse to implement this then the responsibility falls to the Minister for Health James Reilly. His party, Fine Gael, in its five point plan for the general election at the start of the year pledged to reform the health service and cut waiting lists.
Thus far they have perpetuated the mess created by their Fianna Fáil and Progressive Democrat predecessors.
Yesterday, Monday October 25th, there were 294 patients on trolleys in emergency departments across the state and Drogheda as ever was the worst in the state. This is a daily crisis confronting front line health staff and it exists even before the inevitable increase in demand that the onset of winter will bring.
Not only are waiting lists in Emergency Departments long but the waiting list for hospital treatment has increased by nearly 40% since the start of 2011. According to the most recent HSE statistics the number of patients waiting for over three months for operations and other hospital procedures at the end of August stood at 28,657. At the end of December last year the figure was 20,634.
In his first six months in office the Minister has had the distinction of increasing the waiting list by just over 8,000. That’s an increase of 39% of patients on the waiting list.
The Health service needs to be properly funded. That much is obvious to the health professionals and patients but not the government. It claims the money is not there. Not true! Next Wednesday November the 2nd the government will give €700 million of the people’s money to unguaranteed bondholders in Anglo-Irish bank.
€2 billion will be paid over by January next year. The government is under no legal or moral obligation to do this. And Anglo-Irish is a dead bank.
The government is making a political choice when it uses taxpayers money to pay off unguaranteed bondholders instead of fixing the health service.
These are short sighted and uneconomic policies which will make it more difficult to repair the damage done by the economic crisis. A public and popular campaign is needed on health issues to persuade the government to change its policy.
Visiting Our Lady of Lourdes with Cllr Imelda Munster