There is only one solution to the trolley crisis: more hospital beds

Superficially, nothing seems to have changed in our healthcare system. We start a new year facing an influenza epidemic, with hospital beds full of patients, and hundreds more patients on hospital trolleys. However, the recent concession by Minister for Health Simon Harris, that our acute hospital system needs thousands more beds is a game changer. At last there is recognition at a political level that the fundamental cause of waiting lists and trolley-based care in acute hospitals is an overwhelming shortage of hospital beds, equipment and staff.

Now there is an opportunity for the Government to address this key issue by investing in acute hospitals in the 10-year capital plan (2018-2028), which is to be announced in the next few weeks. What is needed now is a commitment from the Government to invest in people’s health by expanding acute hospital infrastructure. This means we must invest in more hospital beds and recruit more consultants and frontline staff.

Why are hospital consultants such as me so emphatic that the paucity of hospital beds and the shortage of hospital consultants are the fundamental causes of waiting lists and delayed care? OECD data confirms that our acute public hospitals operate at 95 per cent occupancy, which is way above the acceptable OECD average of 77 per cent needed to provide a safe, consistent and effective standard of patient care. In the past decade, our population expanded by 12 per cent, and the number of elderly patients increased by a third. In contrast, the number of inpatient acute public hospital beds contracted by more than 1,400. The result is that our hospitals are almost continuously full with patients.

As a direct result of the shortage of hospital beds, average hospital stay in Ireland at 6.2 days is much shorter than the OECD average of 8.2 days. So initiatives to improve efficiency, such as earlier hospital discharges are unlikely to have much effect. Even with such short hospital stays, and high bed occupancy, the shortage of hospital beds is such that Ireland annually hospitalises far fewer patients, at 139 per 1,000 of population, compared with an OECD average of 169. So patients have to wait for hospital admission.

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Not sustainable The shortage of hospital beds defines the nature of the care provided in our hospitals.

More than 80 per cent of acute hospital admissions are emergencies, as hospital admission is only feasible for patients with emergency medical and surgical conditions. Consequently, the volume of scheduled essential surgery performed in acute public hospitals has dramatically contracted over the past decade. Inevitably, waiting lists for such surgery are increasing. This system of care is clearly not sustainable.

How did this situation arise? Over the last decade, when acute hospital budgets were cut steeply, the number of patients treated increased by approximately 275,000, or 22 per cent. This dramatic increase in productivity, which nevertheless failed to keep pace with the growing need for medical care, is now no longer sustainable without increased capital investment in our crumbling hospital infrastructure. Indeed, no future plans for healthcare will succeed without basic staff and infrastructure.

Hospital consultants are also in short supply. Hospital consultants make up less than 2.5 per cent of the overall public health service workforce, which contrasts with 4 per cent in the NHS in England. In Scotland, which has a population just 13 per cent greater than Ireland’s, there are more than 5,000 hospital consultants compared with about 2,600 permanent consultants in post in Ireland. So there are significantly fewer hospital consultants in Ireland on a comparable population basis. Hence there are long waiting lists to see consultants.

The association is not alone in calling for an expansion of our acute hospital services. A recent ESRI study projected a 37 per cent increase in the need for inpatient and day-case capacity by 2030. To properly meet this demand there will need to be a dramatic and urgent change in healthcare policy. It is with this in mind that we welcome the recent acknowledgment by Harris that there is a shortage of hospital beds and consultants.

Critical care

Now we must act. If the new capital plan does not provide the essential funding to address the growing bed shortage, it will condemn the population to ever deteriorating acute hospital services for several decades to come. The only credible solution is for the Government to provide the necessary funding to expand the hospital bed capacity by more than 4,000 beds and, in tandem, increase theatre operating capacity and critical care, to reflect the increase in the population and the growing demand for acute hospital care.

This is not an impossible task for a country such as Ireland. In recent times, when we had a similar problem with infrastructure, with an antiquated road network that was not fit for purpose, the motorway network that was built transformed the country. Now we must likewise invest in health so as to transform healthcare and consistently provide safe and excellent care for patients.

Dr Tom Ryan is president of the Irish Hospital Consultants Association and consultant in anaesthesia and intensive care medicine, St James’s Hospital, Dublin