Sizing up Ireland’s emergency departments

Reports that the Trauma Steering Group are to propose removing emergency trauma services from nine hospitals across Ireland has been met with opposition but as recent figures highlight a shortfall in infrastructure to provide 24/7 cover across all 29 Emergency Departments, eolas looks at the arguments for and against a smaller emergency network in Ireland.

Fianna Fáil Health spokesperson Billy Kelleher has suggested the existence of “healthcare apartheid” during his criticism of emergency consultant cover across the country. The party claim that a reply to a submitted Parliamentary Question revealed that 10 hospitals across the country do not have “a named consultant in emergency medicine available and clinically accountable on a 24/7 basis”.

Kelleher said that it pointed towards worrying times for the future of some

EDs “on foot of recent rationalisation reports”. “This is not acceptable and cannot be best patient safety practice. These figures come on foot of recent rationalisation reports and will raise serious concerns about the future of certain emergency departments. There is already widespread anxiety about the viability of some EDs and these figures will do nothing to appease these fears,” he said.

“It is notable that with the exception of the Mercy University Hospital in Cork, none of the others are the largest urban centres – you might almost get a sense of healthcare apartheid based on geography. Dublin hospitals are relatively well staffed with internationally trained Consultants whilst the midlands, Kerry and more rural areas do not have Consultant led Emergency Care at all.”

However forceful those opposed to any closures or reduction of services in Ireland’s hospitals, the figures are a clear indication that the HSE struggles to maintain an equal level across all its premises. A number of factors can contribute to this including a low volume of patients presenting at EDs in certain areas, staff recruitment and retention issues and finances. The HSE has attempted to combat some of these ED shortfalls by establishing a bypass protocol, whereby ambulances will bring patients to a ED equipped to deliver treatment specific to their illness or injury, however, this information is not always easily available to the general public attending EDs by their own means.

That was acknowledged by the HSE back in 2011 when it proposed downgrading 10 emergency departments. To date there has been criticism of the move to minor injury units in the north-east, mid-west and Roscommon, while plans are advanced for a similar move in Navan and proposals have been put forward to reduce the emergency department at Portlaoise.

In July a report in the Sunday Business Post stated that the Trauma Steering Group, established under the last Government, is to put forward proposals to permanently close trauma care at nine EDs. The piece has fuelled fresh debate on the size of Ireland’s ED network. The report by the steering group, chaired by Professor Ellis McGovern, has not yet been published and Minister for Health Simon Harris has denied seeing any of the recommendations, however, the Post’s piece named the nine hospitals (right) it believes will be put forward.

One of those supporting a reduction in the number of Ireland’s emergency departments, the Irish Association of Emergency Medicine’s (IAEM) Fergal Hickey, said that politicians had failed to see the positive aspects of having centres of excellence.

“Many of these hospitals don’t have trauma services, it is illogical to bring patients there and then have to transfer,” Hickey told Newstalk Breakfast, while responding to the unconfirmed proposals.

“What we have is a legacy issue – so we have 29 emergency departments for a population of 4.7 million, which is far too many. Many of those departments really don’t meet the criteria for what would be described as an ED in 2016 and one of the difficulties some of them have is that they don’t have the staffing resource which is required.

“It’s not about rurality, it’s about the fact that these departments have not developed in the way that they should for 2016. We need to face up to the fact that we have too many emergency departments, so we need to reduce those numbers so they can be staffed at the appropriate level.”

The 10 hospitals with no named consultant in emergency medicine

• Mercy University Hospital Cork

• Kerry General Hospital

• Midland Regional, Mullingar

• Midland Regional, Portlaoise

• Our Lady’s Hospital, Navan

• Portiuncula Hospital

• South Tipperary General Hospital

• St Luke’s Hospital, Kilkenny

• Wexford General Hospital

• Mayo General