Many doctors and health service administrators believe the long-term solution to the country’s trolley crisis is a major increase in hospital bed capacity, large-scale investment in primary care services and improved access to diagnostics for GPs.
However such measures will not come cheap and, even if the money was made available, the health service would have to overcome existing recruitment and retention problems to allow new facilities to come into operation.
Minster for Health Simon Harris told The Irish Times last week that thousands of additional beds in acute hospitals and in community facilities would be needed. A forthcoming bed-capacity review is expected to recommend specific numbers of beds.
The Department of Health told an Oireachtas committee in 2016 that the construction and capital cost of providing an additional hospital bed was about €325,000. And as a rule of thumb, the annual ongoing revenue costs of operating an additional hospital bed runs to €78,000 per year.
However even if magically several hundred additional acute hospital beds could be conjured up next week, the problem of securing sufficient staff to operate them would remain.
On Wednesday, the HSE said it had opened about 60 additional beds in Dublin and a similar number outside the capital in recent months in advance of the peak winter demand period. However, in the week before Christmas – the last period for which data was available – there were 83 hospital beds closed for a variety of reasons including for infection-control purposes and refurbishment/maintenance, it confirmed. And 34 of these beds were out of use because the hospitals concerned had insufficient staff to operate them.
Emergency departments
The HSE said that beds closed due to staff shortages included eight in St Columcille's, Loughlinstown; eight in South Infirmary, Cork; and four in St John's, Limerick. It said though that these hospitals did not have emergency departments.
However the closure of these beds means patients could not be transferred to these centres from hospitals with emergency departments which are facing an overcrowding crisis.
The issue of recruitment and retention difficulties in the Irish public health service is being examined by the Public Service Pay Commission with a report expected after Easter.
In its submission to the review, the Irish Nurses’ and Midwives’ Organisation (INMO) argued succinctly: “A shortage of registered nurses leads to the closure of beds.”
The INMO maintained in its submission that, despite Government plans to increase the number of nurses and midwives last year, the workforce actually decreased. It said at the end of September 2017, under an agreed workforce plan, there should have been a total of 25,798 whole-time equivalent staff nurses. However there were actually 24,541 whole-time equivalent staff nurses, it said.
Staff shortfall
It projected by Christmas there would be a shortfall of more than 1,250 nurses on the numbers the plan anticipated being in employment by that stage.
The INMO told the commission that Harris had accepted at a meeting in November that “all initiatives to recruit have so far failed”.
Health unions have argued that improved pay will be necessary for nurses and doctors if the recruitment and retention problems are to be tackled – a move which, if agreed, would likely threaten the Government’s overall public pay policy.
The reorientation of medical services towards primary care will also involve the agreement of a new contract with GPs. Such a development has been an ambition of the Department of Health going back to James Reilly’s time as minister. Last year talks finally got under way but little progress has been made.
