“Nurses are now expected to crisis manage a situation that isn’t of our making”.
This quote, from the Irish Nurses and Midwives Organisation, (INMO), perfectly encapsulates the feelings of frustration and despair amongst hospital staff in this country every winter.
The Health Service Executive (HSE) is Ireland’s healthcare system, responsible for over 40 public hospitals nationwide. During the first week in January, there were 931 patients across these hospitals without a bed, according to figures from INMO. This is the highest January figure since INMO began taking records in 2006. It is important to note that this article will be referencing figures collected by the INMO instead of the HSE’s own figures, which often differ greatly. The HSE does not take into account patients without beds in hospitals outside of emergency departments, such as patients waiting in corridors or on wards but without a suitable bed. However, whether you look at INMO’s figure of 931 patients, or the HSE’s figure of 772, Irish hospitals are clearly in crisis-mode.
The interim CEO of the HSE, Stephen Mulvany, who has been in charge of the health service since October 2022, warned that the hospital overcrowding crisis was likely to get worse before it got better as Ireland faces the peak of the flu season. However, stories of patients waiting on trollies or on the seats of emergency departments up and down the country are becoming something of a yearly tradition.
Despite the fact that the population of the Republic of Ireland has increased by over a million-and-a-half in the last thirty years, Irish hospitals actually have less beds than they did during the 1990s. This would be unacceptable even in a society that didn’t have an ageing population, as we do. Minister for Health Stephen Donnelly has said that “what we’re seeing this year doesn’t happen every year,” even though hospital overcrowding has been an issue for years, if not decades. Donnelly blamed the combination of the flu, RSV, and COVID cases, despite the fact that in 2018, when his party did not have a majority in government, he criticised the exact hospital overcrowding that he now claims does not exist every year. This was before the pandemic, leaving the Minister for Health’s current excuse difficult to swallow when it appears that he may not fully believe it himself.
The COVID-19 pandemic highlighted just how quickly our health services can become overrun, and this should have been a massive wake-up call not only for Donnelly, but for the whole government. It is not only patients who suffer when hospitals exceed capacity, doctors and nurses are also under intense pressure. In an effort to combat the high levels of overcrowding, the HSE has asked for extra staff to be rostered during the weekends in January to help with discharging patients. There has been a notable improvement as a result of this initiative, with the number of people without hospital beds halving from the first to third week of the month. However, this is an unsustainable solution. These extra demands on doctors and nurses are causing extreme stress and leaving many considering other options.
Irish hospitals are notorious for overcrowding, long hours, and poor pay, and Australia not only offers better pay and conditions, but the additional benefit of almost year-round sunshine
According to RTÉ, Ireland trains approximately 750 doctors every year, and in 2022 60% of that number moved to Australia in search of better working conditions. Irish hospitals are notorious for overcrowding, long hours, and poor pay, and Australia not only offers better pay and conditions, but the additional benefit of almost year-round sunshine. There has been a long tradition of youth emigration in Ireland, but after years and years of the HSE refusing to make substantial changes, we are at risk of an extreme shortage of doctors to tackle hospital overcrowding when it inevitably occurs — again.
Similarly, the INMO have highlighted the worsening of conditions for nurses and midwives across the country. During the first week of January, when trolley numbers were at their highest, INMO seriously considered industrial action over the horrendous conditions their nurses are forced to work under. They have shared many stories from their members of the reality of working in Irish emergency departments nowadays, including from a nurse named Sarah, who said that “it is soul destroying. We didn’t sign up to go into crisis management. We want to be there for our patients.”
These doctors and nurses, as well as every staff member that helps to keep our hospitals running, worked tirelessly throughout the pandemic to help those who needed it most. Unions have warned as early as July of 2022 that this winter would be especially difficult for staff and patients alike, and yet neither the government nor the HSE stepped in to ensure that another year of overcrowding wouldn’t happen.
The HSE will soon need to appoint a new permanent CEO, and a new era must begin.
If the Irish health service wants to keep its top-quality staff, if it wants a bed for every patient that needs one, then huge, sweeping changes are needed. In the 18 years since the HSE was established it has garnered a reputation for being a bureaucratic nightmare with incredibly long waiting lists. The COVID-19 pandemic should have alerted the government to the need for overarching changes in order to ensure the HSE’s future. The HSE will soon need to appoint a new permanent CEO, and a new era must begin. Assurances must be given to doctors and nurses that they will not be made to work for over two weeks on end without a day off, as has been reported to have happened to junior doctors this year as they move between hospitals. Assurances must be made that student nurses are given adequate pay and accommodation benefits. IT systems must be regularly updated, to avoid cyber attacks like the one experienced during the pandemic.
There is hardly an end to the number of ways that the HSE and the Department of Health can help in protecting their staff and their patients. Surely if any sector of society deserves the extra finance to improve it properly, our health service does. We should not have to reach a breaking point for action to be taken. After all, prevention is better than cure.