The A&E CRISIS: Longer Wait Times Afflict Ireland’s Healthcare System

“HSE would say going to the A&E should be your last port of call, but for many people that’s just not an option,” reflects Siobhan de Paor, Head of Communications at Irish Nurses and Midwives Organisation.

Overcrowding in hospitals across the globe has significantly increased in the years after COVID-19. However, Ireland’s A&E departments have been grappling with this escalating crisis, characterised by longer wait times that are becoming a significant concern. Extended waiting periods have had serious implications for patient outcomes, with delays in treatment potentially leading to worsened health conditions or complications.

Two years ago, Florencia, a student from Mexico, sat down all alone in the hallway of Connolly Hospital from six in the evening to two in the morning in painful condition. “I googled ‘nearest public hospital’ because, with student health insurance, I had to go to a public hospital,” she said. A doctor attended her at 1:30 AM and “wasn’t familiar with her hormonal condition – insulin resistance.” After almost 7 hours of wait time, Florencia went home with antibiotics and an unidentified illness.

Florencia’s Medical Certificate. Source: Florencia.

In Budget 2024, €22.5 billion of the budget has been allocated to facilitate quality healthcare in Ireland. Of this, €500 million will be equipped to tackle the wait times crisis along with opening and staffing six new surgical hubs. Similarly, in 2023, €23 billion was allotted to healthcare in Ireland. However, these numbers look only so big compared to INMO’s trolley figures.

The investigation showed that 10,042 patients were admitted without a bed in the emergencies of Greater Dublin’s hospitals from January to April this year. HSE’s “self-imposed rules” like the current recruitment freeze and financial control issues have been attributed to the overcrowding in hospitals by INMO. Limited resources have put a strain on patient health. “Six hours or more on a trolley impacts on the health and illness of a patient,” adds Siobhan.

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Adding to that is the lack of doctors per capita in Ireland. “It is an issue. Most doctors work extended hours. However, the wait time crisis is not solved by hiring more doctors. You need ancillary staff, equipment, and hospital beds. The entire issue is broader than just the lack of doctors,” a specialist registrar at a public hospital said.

With Ireland’s population ageing and healthcare needs growing, the pressure on A&E departments has intensified, exacerbating the problem of longer wait times.

Suryapratim Roy, Assistant Professor at the School of Law, Trinity College, has been living in Ireland for five years. When his brother injured himself, they rushed to Tallaght University Hospital only to be told that they would have to wait “11 hours before doctors could see him.” “We chose to go to a private hospital as we had insurance. Waiting for 11 hours meant the injury could worsen,” he added. Many hospitals are struggling with understaffed A&E departments, leading to delays in care. “Busier hospitals lead to prolonged time to get care,” says Roy.

It was found that limited access to specialist care and community healthcare has led patients to seek treatment in A&E, contributing to overcrowding. Roy worries about inviting his parents to Ireland in this current situation. “Given Ireland’s high living costs, public healthcare is ideal, but I wouldn’t want my parents to wait that long for treatment,” he added.

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Rising patient numbers, particularly during peak seasons, have overwhelmed A&E departments, making it difficult to provide timely care to all patients. “Year on year, we have noticed that patient inflow increases in winter and decreases again in summer,” added Siobhan.

A patient waits an average of four to six hours before being triaged.

The longer wait times in Ireland’s A&E departments reveal significant challenges for patients and healthcare professionals. “Every 30 to 45 minutes, someone came to me to take a blood or urine sample. I was cold and in pain. They eventually gave me Paracetamol,” adds Florencia.

The root causes of the A&E crisis are complex and need a comprehensive approach. However, according to a specialist registrar, wait times vary based on clinical urgency. Emergencies are addressed promptly, showing effective triage. Yet, some patients still face delays, though with many large healthcare facilities in Dublin, the issue seems minor.

The INMO contends that Dublin’s capacity exceeds other areas, yet overcrowding remains. Staffing shortages and training deficiencies must be addressed. “Student nurses are exempt from the hiring freeze by HSE. However, it is also important to fill in positions of senior nurses who retire or relocate. That is currently not happening,” Siobhan commented.

With the current budget, solutions could involve investing in staffing, more beds, expanding primary care, and improving patient flow. This systemic drawback must be addressed for patient care and the sustainability of Ireland’s healthcare system.

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“Nurses face the brunt of, sometimes justifiable, anger. We want the employer to take away as many barriers to providing safe care. It feels like that is not happening,” reflected Siobhan. Without timely intervention and meaningful reforms, the strain on A&E departments is likely to worsen, further compromising the quality and accessibility of emergency care for all.

Irish healthcare consumers dread falling ill, whether needing an ambulance for emergencies or seeking care for injuries. They often cite the average 6-hour wait in public hospitals and steep bills at private ones as major concerns. “We are of the view that if people feel they need medical attention, then they should absolutely take it. And if that is in an emergency department, they should go,” concluded Siobhan.