While the Association welcomes any move to address ED crowding caused by the practice of lodging admitted hospital inpatients in the ED, the HSE Winter Initiative launched to significant fanfare on 9th September 2016 is far too unambitious to have a significant positive effect.
Bizarrely, the “initiative” aims to achieve lower standards than those accepted by previous Ministers for Health. In 2006 the then Minister for Health, Mary Harney TD, espoused a Zero Tolerance Policy for trolleys on behalf of her government and, more recently, in June 2012, the then Minister, Dr James Reilly TD, accepted the target that 95% of all ED attenders would be either be discharged or admitted to hospital within 6 hours of registration and 100% within 9 hours. This latest “initiative” aims to achieve a 6 hour target of 75%, which quite frankly is an insult. Far from there being a zero tolerance approach in action, the plan accepts that as many as 236 patients can be legitimately waiting on trolleys before the number is regarded as unacceptable. The only acceptable number is zero and the HSE’s indefensible stance will inevitably result in harm and inferior medical outcomes for this unfortunate group of patients.
While the additional 55 acute beds are welcome (assuming staff can be recruited to open them), this is mere a drop in the ocean compared with the 1,600 beds lost from the acute system during the years of austerity. Furthermore, while a reduction in the number of delayed discharges in acute hospitals from the current approximately 640 to “no more than 500” sounds attractive, this is still far too high a number and represents the equivalent of a hospital the size of University Hospital, Limerick being effectively unavailable.
The risk to patients of ED crowding and prolonged trolley waits is well-established at this stage. The fact that any national Healthcare authority such as the HSE could decide to tolerate it to the extent that the HSE Winter Initiative tolerates it is a very sad indictment on the value placed on the lives and the long-term futures of those 93,000 patients warehoused in Ireland’s Emergency Departments in 2015 alone, just for the want of a hospital bed. Senior management in the HSE needs to show clear leadership and a determination to do the right thing for patients. This “Initiative” falls very far short of what is required.