Health service facing ‘worst ever crisis’

This blog has had occasion to visit the Accident and Emergency unit in Our Lady of Lourdes Hospital in Drogheda. Each visit was as depressing as the previous.

Patients, many of them elderly, were lying on hospital trolleys, others were sitting on chairs, and in one instance a patient was lying on the floor. Most had been there for two days or more.

The staff were doing their best but were simply overwhelmed by the numbers of patients and the inadequate resources available to them.

The collapse and subsequent death of Peter Sherlock several weeks ago in Drogheda, and the failure of the ambulance service to respond promptly to emergency calls, is additional evidence of the cracks in local health provision and in the state health system.

And then there is the slow destruction of Louth County Hospital through the withdrawal of key health services, including the children’s ward, the maternity ward and then the gynaecological unit. And last year the HSE closed the A&E and Acute Medical Services.

A media report last week revealed that a confidential internal HSE submission, which looked at health services in Dublin and Louth, Meath and Monaghan, was warning that it might be necessary as a result of budget cuts to close down some hospitals as well as a large number of wards.

These could include Louth County Hospital and Monaghan hospital.

An additional grave difficulty to that posed by financial cuts, and poor management and bad planning by the government and the HSE, is the severe shortage of junior doctors within the health system.

It is estimated that there are currently just over 100 vacancies for junior doctors but this figure will jump to at least 400 in July when current contracts come to an end and new ones have to be agreed.

While 500 to 600 graduates are produced in this state each year many of these are leaving for Australia and elsewhere in the world.

The health service is therefore dependent on hiring in junior doctors from India and Pakistan but the numbers needed this year far exceed those available.

As one consultant described it there is a ‘drought of non-consultant doctors.’
So, there is a major crisis looming in health provision, particularly front line services, which will probably be the worst ever experienced by that state.

The Irish Association for Emergency Medicine (IAEM) which represents consultants who work in emergency medicine, warned on Monday that many emergency departments ‘face significant challenges in maintaining 24/7 cover.’

And the IAEM said that the ‘loss of medical staff both in emergency departments and front-line specialities, compounded by worsening ED overcrowding, will undoubtedly result in even more prolonged waiting for patients ... The IAEM fears that prolonged emergency department waiting times for patients will lead to delayed treatment and potential avoidable harm.’

The outworking of all of this is that some Accident and Emergency units are at risk of closing; some hospitals and hospital wards are also facing closure and the future of some essential services, including the maternity and infant scheme, are also under threat.

Having spoken to those working in the health service I believe that there are a number of hospitals which are especially at risk. These include, Drogheda, Cavan, Beaumont, Castelbar, Limerick, Letterkenny, the infirmary in Cork, Portiuncula, Tullamore, Roscommon, Portlaoise, Midwestern Regional Hospital in Limerick and Waterford.

I raised this matter during leaders questions in the Dáil yesterday morning and asked the Taoiseach ‘to take immediate action to assess what the impact on services will be on the 11 July.’

I also asked the Taoiseach to come back to make a statement to the House on what plans the Government will put in place to rectify this situation.
Regrettably, the Taoiseach did not answer my question. His response was vague and there is a clear absence of the kind of clarity and leadership that is urgently needed on this issue.

The Taoiseach tried to dismiss my concerns around the shortage of junior doctors as something that arises each summer. This is disingenuous. The reality is that this year’s short fall is significantly greater than ever before and the consequence of that for the Health Service will be profound.

Our public hospitals are completely dependent on Junior Doctors.

As I have noted earlier on July 11, following the changeover in job rotations, the number of vacant junior doctor posts will be at least 400.

This will be substantially worse situation than anything seen before and will have a devastating effect on the provision of services within the healthcare system.

I have been told that in the Louth and Meath area there are at least 50 junior doctors fewer than needed. The curtailment of emergency services and longer waiting lists will result.

Frontline services, including anaesthetics, emergency medicine and trauma paediatrics, are under so much pressure that they may not be able to maintain an emergency service.

One consultant described the scene in the Mater hospital in Dublin on Monday as like a ‘war zone’. This was because there were so many patients on trolleys and ambulances waiting to discard their patients into the A&E.

Failure by the government to get to grips with this crisis means that more and more of our hospitals are going to face similar scenes in the time ahead.