Beds crisis behind trolley waits

Dot Kirby
BBC Northern Ireland health correspondent

Trolley waits in Northern Ireland's hospitals are running at record levels this winter.

How has the health service got into this position and why do those in charge appear powerless to solve the problem?

It is everyone's nightmare. You feel ill. You go to hospital. You wait to see a doctor. A decision is made that you need to be admitted, but there is no bed available.

So you lie on a trolley in the accident and emergency department. Waiting.

Often your trolley is in a corridor. You have no privacy. Nowhere to put even your toothbrush. In fact, no proper place to clean your teeth - or go to the bathroom.

It is not a good place to be - not for you and not for the staff who are doing their best to give you the care you need in inappropriate circumstances.

Why do trolley waits arise? The answer is overwhelmingly simple. There are not enough hospital beds.

Part of the reason for this is that in years gone by, there was a government push to cut the number of beds.

Among the reasons cited then were less invasive surgical techniques and better anaesthesia, meaning people could go home sooner, and that "care in the community" would mean fewer people would need to be in hospital.

So, for instance, 10 years ago the Eastern Health Board was ordered by the then health minister to cut its beds by 40%.

No quick fix

The Eastern - and the other boards - duly did "decommission" hundreds of hospital beds.

Simultaneously, there was a big reduction in the number of nurses being trained.

This meant that when the penny dropped that the number of people needing hospital care exceeded the number of beds available, there was no quick fix.

In many cases, the money could not be promised to get a hospital bed up and running - and even if the money was available, often the necessary medical or nursing staff was not.

Just recently, the Mater hospital in Belfast brought another 20 beds on stream - and by mid-year they are hoping to add another 20 to their stock.

In Craigavon, an extra 32 beds have alleviated their trolley waits. But, even with the extra beds, both hospitals have still been hit on occasion recently by severe trolley waits.

Extra beds have alleviated Craigavon Area Hospital's trolley waits

Part of the answer is undoubtedly even more hospital capacity. What we have had is too little, too late.

But part of the answer too is a more efficient use of health service resources.

Better organisation of hospital care components like radiology, pharmacology and laboratory tests.

And then there are the people called "delayed discharges".

As of Monday this week, there were more than 300 patients languishing in Northern Ireland hospitals who did not need to be there.

They were ready to be discharged but were waiting, often for a bed in a residential or nursing home, or for the money to pay for it.

Fewer of these delayed discharges would free up hospital beds for others.

Trolley waits in the last 12 months have got steadily worse. This has happened with no flu epidemic - or anything similar.

One commentator has said that if a "flu epidemic did hit, the prospect would be 'frightening'".