December 2, 2023

Once again, the public is being told that the health service here is teetering on the brink of collapse.

t comes as Antrim Area Hospital struggled to cope with the number of people turning up at its emergency department on Tuesday.

Yet, at the same time, the public is being told that omicron is not as virulent as previous strains and there has been a significant drop in the number of critically-ill Covid patients.

The current threat posed by Covid was obviously enough to convince Stormont ministers to move safety measures from law to guidance last week – so why the latest crisis?

Coronavirus Data Graphs

First of all, take a look at the statistics. Figures released by the Department of Health on Wednesday show there were 390 Covid-occupied hospital beds – vastly fewer than the number of Covid inpatients during the wave at the beginning of 2021.

While the numbers have reduced, almost 400 inpatients with Covid is not an insignificant number, and is enough to fill an entire hospital.

This is going to put strain on a service that was already under severe pressure before the pandemic. For example, once a person has been confirmed as having the virus, their care instantly becomes more complex and time-consuming.

All the infection prevention control processes that are required when a patient has Covid, such as additional cleaning, fallow time, and isolating away from patients who don’t have the virus, slows everything down significantly.

So, even if a patient is admitted because they have broken their leg, the fact they happen to have Covid makes their time in hospital more of a challenge.

The number of beds across the system is essentially at the centre of the predicament. Dr Paul Kerr from the Royal College of Emergency Medicine said: “A growing bed problem was identified years ago due to the growing elderly population requiring hospital care.”

Beds require staff, yet staff shortages have been exacerbated by the ravages of working through a pandemic for two years, with exhausted employees on long-term sick leave or leaving their jobs altogether.

The situation is made even more difficult as Covid continues to circulate at such high rates in the community. While many workers may not be unwell, being infected means they can’t come into the hospital. This makes it difficult to operate a full and effective service.

So, beds are at a premium and there is a fine balance between trying to carry out elective surgery and making sure there are enough beds for emergency admissions.

Then there is the ongoing challenge in discharging patients to free up beds. A proportion of patients no longer need hospital treatment but aren’t well enough to be sent home without any support.

Staff shortages in hospitals are replicated in the community – there aren’t enough domiciliary packages or care home places to enable patients who require additional support to be discharged in a timely manner.

And so we see the logjam at what is essentially the front door of the hospital – the emergency department.

Attendances are returning to pre-Covid levels, so it isn’t that they are seeing more patients, but according to Dr Kerr, a significant proportion are unwell and require admission to a ward.

Northern Ireland’s hospital waiting list crisis and challenges in accessing treatments in the community has undoubtedly led to people becoming sicker and their conditions becoming a medical emergency.

Put simply, the majority of people turning up to A&E aren’t there because they have a minor injury, they need hospital treatment. However, the lack of beds in wards means there is nowhere for them to go.

With Covid case numbers remaining steady and no quick fix for the workforce issues, the health service is likely to remain on high alert for the foreseeable future.


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