Seven-day working weeks, the return of retired GPs, the use of nursing home beds as well as more rehab and social care could all help alleviate the current trolley crisis
The flip side of the focus on trolleys in January is that the problem gets ignored for the rest of the year. Back in 2006 then minister for health Mary Harney said long waits on trolleys were “not acceptable”; Taoiseach Leo Varadkar said exactly the same this week. Little seems to have changed, and many of the solutions put forward this week have a familiar ring.
Considering over-65s, who now account for half of all bed-days in Irish hospitals, there has been a slight decline in provision relative to population, according to Walsh. “I don’t think it’s appropriate to have an emergency admission on a trolley in ED. The minute you do that one day, it doubles in number over days and days and days.”
“We staff as best we can. We use overtime, we do whatever it takes. If there’s no dialysis on tonight we pull the dialysis nurse over to ED. If paeds are less than [full] occupancy, we might pull a paeds nurse. We supplement nursing staff with healthcare assistants.” She was asked this week about people waiting in ambulances to get to bed. “That’s another misnomer: people don’t arrive in ambulances to go to bed. They arrive in ambulances to be seen in ED. You can only see people in order of clinical need.”Mr Donnelly responded to this week’s crisis by appealing to consultants to come in at nights and at weekends and the HSE later told hospitals to introduce seven-day working for this month.
“I wouldn’t get through a day here without the staff. We work really hard. We’re no different from any other place. But we manage things differently.” Retired GPs could be brought back into the workforce to provide telemedicine sessions and relieve the pressure on primary care, according to Tormey, who is editor of the Irish Journal of Medical Science and has just written a book on the Irish health service.
“If we had a little bit more time, we could look after the classic frail, elderly admissions such as COPD, heart failure or diabetes exacerbations, particularly if that could be supported by telemedicine from the department of gerontology in the local hospital. We have lots of nursing home beds, and we’re not using them as smartly as we could.”
He suggests doctors should be paid extra allowances to work in hospitals such as Sligo or Letterkenny, which traditionally struggle to attract staff. The simultaneous presence of flu, Covid and other respiratory ailments is the “new normal” that we have to adjust to, infectious diseases doctor Paddy Mallon said this week.
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