Overcrowding of Hospital Beds is a Symptom of bigger problem

[Speaking in the Seanad during Order of Business]

I have noticed substantial speculation in recent days which is a result of the welcome attention that has been placed on a very unwelcome problem, namely, the question of overcrowding in emergency rooms and the ultimate cause of the bottlenecks that prevent people in need transitioning through emergency rooms into more appropriate inpatient beds, if they are not suitable for discharge to community care. Much attention has been focused on one particular part of the problem, namely, a group of patients who have been designated now as delayed discharged. They are patients who no longer are felt to require acute hospital care of the kind for which our acute hospitals are set up and who are instead supposed to be discharged to intermediate or longer care facilities and, in many cases, nursing homes under one or other of the State-sponsored schemes such as fair deal.

It is being suggested seriously, and most of my fellow professionals were incredulous to hear this, that much of the delay is purely bureaucratic and that if there was a more rapid processing of applications and a more rapid accessing of moneys designated for long-term care, such beds that are blocked, and I use that word not in any sense disparagingly towards the people who have every right to be in them failing a more appropriate place for them to go to, would be freed up for the use of acute care patients.

Various discrete sums of money are being suggested as providing a fix for this problem, which is in many ways the poster child for all that is wrong in the health services and in many ways the shop front for that enterprise, which unfortunately is the mediocrity of care. Those who suggest that are wrong. The problem is much more profound than that. It is found in every bed, X-ray department, operating theatre and outpatients clinic. It is the lack of linkage of activity to resourcing and the problem of zero-based prospective global annual budgets. Trust me when I say that it will not work.

The only way to fix the bed crisis, which is not a primary problem but a symptom of a bigger problem, that is, the incentivised inefficiency in use of our hospital beds, is to fix the way we fund and manage the health service. That brings me back to the pre-election promise of Fine Gael before the 2011 general election, a promise which won me over to its cause and to advocate for its election, and one I still believe in, that the new health administration needs to be implemented if we are to fix this problem.

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