'Urgent efforts' needed as new report reveals unprecedented strain on Irish hospitals

A safety report on the Irish health system has revealed it is under "unprecedented strain" as the number of patients attending emergency departments (ED) continues to rise. 

The Health Information and Quality Authority (HIQA) today (December 14) published a report which revealed significantly worse overcrowding at Irish hospitals compared to years prior. 

Contributing factors include insufficient measures to enable patient flow, inadequate bed capacity, limited access to community services and short staffing.  

According to the report, six out of seven hospitals inspected were experiencing staffing shortfalls on the day of inspection, with five in seven EDs noted as over capacity. 

Throughout 2022, HIQA commenced a new monitoring programme of inspections in healthcare services against the National Standards for Safer Better Healthcare, with core assessment focused on key standards relating to governance, leadership and management, workforce, person-centred care and safe and effective care. 

According to HIQA’s Director of Healthcare, Sean Egan, the programme continues to highlight the compromised dignity and respect of patients at overcrowded emergency departments, as well as risks to health and safety. 

He said, "Improvements are needed to ensure that there is a balanced approach to the daily operational management of patient flow, capacity and appropriate staffing, which is clearly linked to patient safety and activity."

HIQA has identified four key areas for immediate and longer-term attention: 

These include: 

• The need to continue to urgently build additional capacity within the whole healthcare system, both acute and community
• A more effective approach to strategic workforce planning to better anticipate and manage shortages  
• More responsive leadership, governance and management arrangements at local, regional and national level which acts to address performance issues when identified 
• More effective identification, monitoring and management of patient safety risks associated with overcrowding in emergency departments 

Mr Egan continued: "The Irish healthcare system remains challenged by bed capacity and workforce shortages, and access and capacity issues in primary care. Emergency department overcrowding and insufficient access to acute and primary services will continue to occur unless a system-wide approach is taken to address major structural concerns and respond to, rather than continuing to tolerate or normalise, this problem.

"Delivering care in overcrowded and understaffed environments poses a significant risk to the provision of safe, quality, person-centred care. It is for this reason that urgent efforts to progress whole system change to our health service must be progressed."

The Irish Nurses and Midwives Organisation (INMO) has welcomed the publication of the report, with General Secretary, Phil Ní Sheaghdha, stating, "The report published by HIQA today compounds what the INMO has been consistently highlighting – our hospitals are under enormous pressure due to capacity issues and unsafe staffing.

"The report is particularly stark when it comes to safe staffing in our hospitals. According to HIQA, of the seven emergency departments they inspected, only one hospital was properly staffed. This is unacceptable. We know that many nurses are leaving emergency departments because of the conditions that they are faced with. This phenomenon cannot continue into 2023.

She continued: "Over 70% of the hospitals that HIQA inspected were over capacity. This is borne out in the INMO TrolleyWatch figures. Today alone over 638 patients were without a bed with many patients facing long waits before being admitted to a trolley. We know that excess time spent on a trolley or an inadequate bed has negative health implications for patients.

"We have sought an urgent meeting with the Minister for Health in the coming week to discuss how a more proactive approach can be taken to tackling the very serious challenges that exist in our emergency departments. Trade unions raised this issue as part of our engagements at the Labour Employer Economic Forum (LEEF).

"We are strongly of the view that emergency measures are now needed to prevent the unnecessary continuation of these inhumane and undignified conditions for patients and really unhealthy working conditions for nurses and midwives and other healthcare workers." 

University Hospital Limerick is the most overcrowded hospital nationwide today with 75 patients waiting for beds, followed by 68 people in Cork University Hospital and 51 in Letterkenny University Hospital. 

Four hundred and seventy five people were waiting in overcrowded emergency departments on December 14 last year, marking a jump of 163 people (or 34%).