IN January 2018, the son and daughter of a man who endured upsetting conditions at University Hospital Waterford’s Emergency Department prior to his death, wrote an open letter to Minister for Health Simon Harris outlining the “dire state of emergency services at the hospital”.
William Gallagher, a Professor of Cancer Biology at UCD School of Biomolecular and Biomedical Science and his sister Caitriona who trained at UHW but now works as a nurse in London said that they “witnessed not only our father but many vulnerable patients on trolleys, with lights on 24/7 in the corridor.”
“Our father, Michael was admitted on December 3 and spent three days on a hospital trolley waiting for an investigation to be made,” William told the Waterford News & Star. “Whilst on a trolley, at the end of a corridor, he didn’t get a wink of sleep and was left, like other patients that we saw there, without a shred of dignity or privacy.”
William said that his father often had to push a door release button, or staff had to lean over him to do so when the area was particularly busy – which it always seemed to be.
“The attention of the nursing and medical staff was impeccable despite these difficult circumstances,” William added. “However, to have vulnerable people on trollies in an open (unsafe) area for three nights is not acceptable.”
William received a response from the Patient Services Manager at UHW three months later, which attempted to answer the questions they asked in their original letter. The Waterford News & Star has received permission to reproduce those questions and answers.
Q.1. What has been the reduction in bed numbers at UHW in the last 5-10 years? It is reported that in the region of 70 beds have been lost. How can this be justified?
A.1. “In January 2007 there were 474 inpatient beds at UHW and 71 day beds/places. In January 2018 there were 406 inpatient beds, 125 day beds and 10 delivery beds”.
The manager said that the number of beds open in the hospital was dependent on nurse/health professional staffing. She said that at intervals it was necessary to close beds on a temporary basis due to vacancies/skills shortages, but they are reopened following successful recruitment.
Q.2. How often is the Emergency Department at UHW filled to capacity and what is the average wait time for a bona fide bed?
A.2. “Dr McCann, Clinical Lead in Emergency Department has confirmed the average wait time after decision to admit is nine hours. However this varies widely depending on the patient’s needs. UHW ED is one of the busiest in the country with 60,000 representations per annum. The ED has remained in Full Capacity protocol since mid-2016 with only short periods of relief.”
Q.3. In Waterford, we have an increased and aging population. Is this acknowledged when planning services and investment around resources, especially around the winter crisis? Particularly resources around provision for investigations, which would surely provide much more effective services in the longer term.
A.3. Dr McCann confirms there has been a 19% increase in patients aged over 65 years presenting to the ED between 2011 and 2016. In the past 12 months, it is often the case that close to 50% of UHW inpatients are 75 years or older. Each year, the UHW Executive Management Board submits a detailed estimate of service and staffing requirement for the year ahead. This is based on local specific resource requirements and demographic change. Individual service specific cases are submitted on going e.g. winter surge.
Q.4. What is being done to protect staff in the Emergency Department, whom are clearly doing their best with limited resources? What measures are being put in place to deliver safe and effective care to vulnerable people on trolleys and otherwise.
A.4. Additional nursing resources have been established arising from the INMO/ED task force, to reflect the needs of patients in the ED, especially those waiting for an inpatient bed. Nurse Management endeavour to provide additional resources (nurses and health care assistants) to the ED in times of increased demand. In January, 2018, security cover of the ED was also increased.
Staff working in this busy environment have access to a range of supports. The Occupational Health Department offers an Employee Assistance Programme and the usual occupational health services to all staff in UHW.
Speaking to the Waterford News & Star this week, William says that after this newspaper’s front page last week, it was clear that it situation “has not improved”.
“Looking from afar over the last 22 months since my father’s awful experience in the Emergency Department of UHW, it seems that the challenging situation there has hasn’t improved. Indeed, it would appear to have gotten worse,” William said. “Our family do not blame the hardworking medical professionals whom are working under these intolerable conditions; we rather blame the system in which they are forced to work within. We feel strongly that exposing vulnerable patients, particularly the elderly, to extreme sleep deprivation as a consequence of protracted delays on unsafe hospital trolleys over a period of days contravenes their human rights. Something has to give on this. People in Waterford are being treated as second class citizens in our state